T he Ohio State
The Ohio State Medical Journal
Vol. 46
January, 1950
No. 1
Published monthly by The Chio State Medical
per yeaj^tQ-'
i?t§
frbi?-members ; Single ^Gc
Ubjjpr,
Entered as second class matter July 5, 1905, the Postoffici^T Columbus, '^
Acceptance for mailing at special rate of postage provided for^^Sfcl^on 1103,
The Journal does not assume responsibility for" opinions ,^c^r-'ssed by tl
standards and regulations established by tjie American MlHlcal Association.
street, Columbus 15, Ohio. Subscription, $3.09
cents.
under act of Congress of March 3, 1879 ;
t of Oct. 3, 1917. Authority July 10, 1918.
essayists. Advertisers must conform to
°OL OF
LOV
Summary of Conttens
Current Trends in the Treatment of Hernia. Frank Glenn, M. D., New York, New York - 25
Medical Follow-Up of Vagotomy Plus Gastro-Enterostomy or Pyloroplasty for Peptic Ulcer. E. N.
Collins, M. D., George Crile, Jr., M. D., and W. S. Dempsey, M. D., Cleveland 33
Keeping Up With Medicine. Jonathan Forman, M. D., Columbus 35
The Treatment of Sterility: Report of 100 Consecutive Cases. Moses Garber, M. D., Cleveland 36
Electro-Mechanical Aids in Resuscitation and Anesthesia. Mr. Kenneth Wolfe and Mr. H. J. Rand,
III, Cleveland , 39
Sight Restoration Program of the Cleveland Society for the Blind. Charles I. Thomas, M. D.,
Cleveland jl j ... „• 41
A Case of Proven Systemic Histoplasmosis with Apparent Recovery. Valerie Friedman, M. D.,
Los Alamos, New Mexico, J. E. Brown, Jr., M. D., and E. V. Turner, M. D., Columbus 44
The Story Behind the Word. Harry Wain, M. D., Mansfield .. 46
Pneumococcic Meningitis: A Case Report — Complications, Treatment and Recovery. Robert E.
Slemmer, M. D. Cincinnati 47
The Historian’s Notebook. The Proceedings of the General Medical Society of Ohio in 1829.
Robert G. Paterson, Ph. D., Columbus 51
The General Practitioner and the Hospital Staff. Edward J. McCormick, M. D., Toledo 53
The Physician’s Bookshelf 8
Tuberculosis Abstracts 50
Veterans Administration 56
Time To Make Hotel Reservations 57
Second Call for Entries in Scientific and
Educational Exhibit 58
Problem of Malpractice 60
High Spots of A. M. A. Session 65
Prescribing Barbiturates 67
Fees and Public Relations 68
Federal Grants Will Advance Cancer Re-
search in Ohio 69
On the Firing Line 70
Licensed Through Endorsement by State
Medical Board 72
New Members of O. S. M. A 72
In Our Opinion:
Few Have Been Able To Escape the Tax
Collector 74
An Investment Which Is Sound and
Warranted 74
Inspection of Hospitals for Casualty
Hazards 74
Editors Only Print the News; They
Don’t Make It 76
Offers for Help in Campaign Need
Careful Screening 76
Medical Coverage for the Individual 76
Who Says D’s Not a Political Issue? 78
Physicians Can Make or Break the Blue
Cross Plans 78
Tax and Tax and Give Orders! 78
Mayors of Other Cities Please Note!.... 78
Buckeye News Notes L. 81
Do You Know? 82
Rural Doctor Shortage 84
In Memoriam 86
V. A. Can Pay But One Fee Unless Sepa-
rate Service Is Rendered 88
Activities of County Societies 90
Woman’s Auxiliary 97
A. M. A. Council Warns Against Unwise
Use of Cold Tablets 102
Coming Meetings 102
Index to Advertisers 102
Classified Advertisements 103
Annual Meeting, Ohio State Medical Association, Cleveland, May 16-18, 1950
Digitalis
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Standardized
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is equivalent to oneOJ.S.P. Digitalis Uni
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Clinical samples $Jfit to physicians on request
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Boston 18, Massachusetts
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D 22
for January, 1950
7
^Jlte PUifiioLank BaoJz'lltell
By JONATHAN FORMAN, M.D.
The Psyche Is the Thing Today
IT was to be expected that with the load
which we of this generation have been called
upon to carry in our time, we should worry
about our minds and wonder how they work.
People of my generation have had to adjust
their lives to the automobile, the airplane, Sun-
day comics, a World War with gas as a new
weapon, installment-payment purchases, radio,
mechanical refrigerators, another global war
with its atomic bombs and long-distance planes
and a threatened biological warfare, sulpha drugs
and the antibiotics, television in black and white
and now in colors.
As a result, in the World War II and the sub-
sequent years, great advances were made in
knowledge of the causes of mental illness, in im-
provement in methods of treatment, and in the
development of more effective organization for
prevention.
The Commonwealth Fund has made available
an excellent book, Mental Health in Modern So-
ciety, by Thomas A. C. Rennie, M.D., and Luther
E. Woodward, Ph.D. ($4.00. The Commonwealth
Fund, New York City), presenting the contem-
porary thoughts in the field of mental hygiene.
Your reviewer is deeply impressed that our
experts on mental illness spend much time re-
cording the vagaries of a mind that is not work-
ing right in an attempt to find the precipitating
cause of. the functional failure but not a minute
in an attempt to get at the primary cause.
It has been my contention (see Soil, Food and
Health, $4.50. Friends of the Land, Columbus,
Ohio, August, 1949, issue O.S.M.J.) that back
of all these brain malfunctions is a bad state of
nutrition, both in the patient and in his parents.
Ralph Borsodi, one of the greatest modern phil-
osophers, has written a clear explanation of the
impact of modern living on the human mind.
(Living and Education, by Ralph Borsodi, $10.00.
Four Volumes. Devin- Adair Company, New
York City.) He insists that our failure to ad-
just ourselves to this world of gadgets is based
upon a system of miseducation. “What we should
have been asking at all steps,” Borsodi says, “is,
‘Is this within the “biological norm” for Man?’ ”
He supplies us the criterion for determining
whether it is or is not.
A number of “success” books have cashed in
on this modern trend in reading. Several have
been best sellers for several months now. A
third edition of Character Analysis by Wilhelm
Reich, translated by Theodore Wolfe ($6.00.
Or gone Institute Press, New York City), has
appeared with a jargon all of its own. It is very
confusing to the average reader and I am sure
no busy physician will find time to acquaint
himself with its ideas. On the other hand,
Successful Living, by W. Beran Wolfe, M.D.
($1.00. Blue Ribbon Books, Garden City, Neu)
York), is a reprint of a book designed to give
practical advice in the conduct of this problem of
everyday life. It is a practical approach in that
it asks the reader “to address himself to the
artistic problems of fulfilling his destiny as the
master of his own soul and the captain of his
life.” This means that he will do something
decisive about the problem, if he can. If he
recognizes that the problem is too big for him
then he reasons that such problems are in the
hands of destiny and he develops an attitude of
trust towards his Maker.
It seems certain that the real peril to our
Western civilization lies not in the atomic bomb
or in Russian aggression, but in the way our
people have succumbed to a feeling of insecurity
and confusion. William G. Niederland, M.D.
(Man-Made Plague — a Primer on Neurosis, $3.50.
Renbayle House, Publishers, New York City),
has pointed out the astounding amount of preju-
dice, hatred, superstition, fear, and bad logic
the average individual harbors in his mind.
While all of this is well known today, it makes
no impact upon the average mind. In our mod-
ern system of miseducation, as Borsodi has said
so many times, our students complete eight years
of so-called higher education in law, medicine,
sociology, education, and engineering without
ever becoming aware of the significance of these
facts. Here is one authority who recognizes the
close connection between physical and mental
health.
Whether mental hygiene has a place in the
work of the public health officer is very debatable,
but that it has a place in the work of the teacher
and the physician there can be no doubt. That
mental hygiene has a place in preventive medi-
cine, there can be no doubt, and in all consid-
erations of the health of the public. Funda-
mentally, it is a personal problem and a personal
responsibility since it is not communicable. So
while I can quarrel with the title, I can also
warmly recommend Dr. Paul V. Lemkau’s new
book (Mental Hygiene in Public Health, $4.50.
8
The Ohio State Medical Journal
McGraw-Hill Book Company, New York City)
to teachers and physicians. My quarrel is that
teaching should be done in our schools by per-
sons who are trained teachers — else there is no
excuse for our college of education.
Speaking of what was learned about mental
disease and mental hygiene during the last war,
William C. Menninger has attempted to revise
the evolution of psychiatric practice in the Army,
where as you know, to the disgrace of our civi-
lization, it was necessary to promote it to first
place. (Psychiatry in a Troubled World by
William C. Menninger, M.D., $6.00. The Mac-
millan Company, New York City.) The second
part of this book has been written to help any
person get along with other people. It repre-
sents the author’s idea of the possible contribu-
tion psychiatry can make to social experiences of
all kinds.
In spite of the abundance of literature con-
cerning the diagnosis, pathology, and therapy of
compulsion neurosis, we still are confused by the
divergence of opinion in this field. While a large
group of authorities of the old school consider
obsessional desires as organic brain disturbances
and compulsion neurosis as a form of insanity or
degeneration, some writers, even as far back as
the Nineteenth Century, were able to recognize
compulsion neurosis as a disease sui generis and
generally differentiated it from psychosis. A
translation of Wilhelm Stekel’s Zwang und
Zweifel has been made by Emil Gutheil, M.D.
(Compulsion and Doubt, $7.50. Two Volumes.
Liveright Publishing Corp., New York City),
in the effort to show more light upon the problem
of obsession-compulsion disorders.
He insists that obsessions are obtrusive ideas
which the patient considers “ego-foreign” and
which he vainly attempts to renounce.
Compulsions included various acts executed as
a result of irresistible impulses. The patient
himself may consider these acts nonsensical or
alogical, yet he is forced to comply with his im-
pulses because of his fear of an impending dis-
aster. The therapy — analysis, of course.
The collector and the student of psychiatry
who wishes to get a historical prospective will
enjoy Robert Fliess’ book (The Psychoanalytic
Reader, $7.50. International Universities Press,
Inc., New York City) which is an anthology of
essential papers with critical introductions.
It is now fifty-six years since Freud began
the publishing of his work which started a new
method of treating illness. To bring us up to
date and to evaluate what has happened in these
six decades, Sandor Lorand, M.D., has called
upon some thirty well-known Freudians to help
him. (Psychoanalysis Today, $6.00. Interna-
tional Universities Press, Inc., New York City.)
Modern man, aware of this lack of conscious-
ness of the complicated arrangements upon which
science has to rely in order to gain valid data,
has relinquished the exercise of his function of
judgment in scientific questions to a small num-
ber of highly specialized experts. He would,
consequently, not think of challenging the valid-
ity of a chemical formula, the existence of a
physiological process, or the aptness of hypo-
thetical concepts in physics on the grounds that
they failed to appeal to his imagination or in-
terfered with his personal preconceptions. To
put it briefly, in an age when neither imaginability
nor compliance with general prejudice are any
longer criteria for the validity of a scientific
conclusion, the “naive” observer has become ob-
solete and the “trained” observer has taken his
place. This is the defense of the Freudians and
the Christian Scientists, as well, both of whom
refuse to allow me to call my soul my own. So,,
a “naive” observer like your reviewer welcomes
this anthology and all the more this last book
and its attempt to evaluate what the Freudian
school has accomplished.
Then, there is the writer, E. Pickworth Far-
row (Psychoanalyze Yourself, $3.25. Second re-
vised edition. International Universities Press,
Inc., New York City), who attempts to show us
how to remove unreasonable fears and depres-
sions from our minds. Of him, Freud has writ-
ten, He “is known to me as a man of strong and
independent intelligence who, probably on ac-
count of a certain willfulness of character, could
not get on well with the two analysts with whom
he experimented. He then had recourse to a con-
sistent application of the process of self-analysis
which I had once used myself in order to analyze
my own dreams. His results deserve notice,
especially because of his special individuality and
his technique.”
In an attempt to show what the physician can
do for his patients, Dr. Ludwig Eidelberg has
written a popular book. (Take Off Your Mask,
$3.25. International Universities Press, Inc.,
New York City.) The Doctor has done this be-
cause “in the last few years, more people want
to know more about the mysterious instincts
which cause us to love and hate. They want to
understand those parts of the personality that *
control and direct these instincts.” With new
names “id,” “ego,” and “super ego,” we have a
scientific (?) description done much in the spirit
of the old class-leader in the Orthodox Methodist
Episcopal Country Church which I attended in
my youth. But instead of the testimonial tech-
nique of confessing his sins and testifying for
Jesus and glory on account of his simple soul
and “the still small voice,” the modern intro-
duce the “couch and confidence” technique. Dr.
Eidelberg explains the new advancement in
hypnotic technique. He tells what happens to
the analyst back on his chair and to the patient
on his analytical couch when he begins to tell
jor January, 1950
9
what is going through his mind. But the author
urges you not to try it on yourself — it is dan-
gerous, he says.
To keep his followers up to date, Sandor
Lorand, M.D., together with an equally distin-
guished editorial board, produces each year
The Yearbook of Psychoanalysis ($7.50. Volume
Four. International Universities Press, Inc.,
New York City.) It contains this year some 23
essays on various phases of the practice.
The day has passed when psychiatry suffered
from inattention. It now occupies the center of
the stage. Melvin W. Thorner, M.D., assistant
professor of neurology in the graduate school
of the University of Pennsylvania, is much dis-
turbed because so many of us physicians look
upon psychiatry as a strong cult built upon a
vain attempt to diagnose on the basis of multiple
records of the vagaries of a sick brain and no or-
ganic pathology. He is as much embarrassed as
we are discouraged by the strange point of view
and elaborate jargon — both foreign to the rest of
the medical profession — which has grown up
around the subject.
To an astonishing degree the author of this
book has overcome the language barrier. He
has presented the subject in a way that is both
interesting and understandable. (Psychiatry in
General Practice. $8.00. W. B. Saunders Com-
pany, Philadelphia.)
He recognizes that psychiatry is still a spe-
cialty in the making, only now accumulating
data that have a basis in scientific determina-
tion. Only now, descriptive diagnosis of mental
diseases are being replaced by established disease
entities. In other words, it lags a hundred and
fifty years behind other fields. But this book,
because it makes complicated things simple,
gives us in general medicine a good deal of help
in lieu of actual experience with patients.
To help us in general medicine, the Staff at
Columbia-Presbyterian Medical Center has at-
tempted to bring psychiatry seventy-five years
nearer by following the plan introduced in
1890 by William Osier. Synopsis of Psychoso-
matic Diagnosis and Treatment, by Flanders
Dunbar and Staff ($6.50. C. V. Mosby Company,
St. Louis, Missouri), is a fine addition to the
physician’s library because it goes over each sys-
tem by system.
It is just six years ago that Weiss and Eng-
ish brought out the first edition of their larger
volume of Psychosomatic Medicine. Now they
come with a second edition ($9.50. W. B. Saun-
ders Company, Philadelphia.) In the meantime,
the concept behind this book has gained wide ac-
ceptance. It contains much new material on
diagnosis, on social work, and many new illus-
trative cases.
Our own Joseph L. Fetterman gave a series
of lectures to student officers of the school of
military neuropsychiatry during 1943 and 1944,
and a series of seminars in Cleveland in 1945
and 1946. This material he has also assembled
into a book (Practical Lessons in Psychiatry,
$5.75. C. C. Thomas, Springfield, Illinois), in
the hopes that it will help towards a better un-
derstanding of the common conditions.
There is, it is said, one or more incipient cases
of mental disturbance in every family circle as
well as one more advanced case. These lighter
cases are often overlooked both by the family
and their physician. To recognize these and thus
take an immense load off the backs of the medi-
cal profession and to empty as many as 25 per
cent of our hospital beds, Benzion Liber, M. D.,
has written a popular book, Psychiatry for the
Millions. ($2.95. Frederick Fell, Inc, New York
City.) Such efforts should stimulate more medi-
cal men to recognize incipient psychoses and see
the connection between mental and physical ills.
To explain The Re-Creating of the Individual,
Dr. Beatrice M. Hinkle has reissued her book by
that title. ($5.00. Dodd, Mead and Company,
New York City.) Wherever we touch upon the
current of American thought these days, we find
the same impelling force: Flight from personal-
ity responsibility; an avoidance of risk and ro-
mance of endeavor; a mad urge for submergence
into the group where, it is believed, the certainty
and regularity of existence will be achieved. It
is this promise of relief from this obligation,
this escape from personal responsibility that is
the real lure of socialized medicine.
Dr. Hinkle’s book is an attempt to get away
from this infantile wish and to help us develop
intellectual maturity. “The gaining of a true
meaning in life and the need of the individual to
become conscious of his personal responsibility
for himself and to fix his own direction, is an
imperative necessity for many persons today.”
The work is truly inspirational and points the
direction to the greatest happiness that man
can experience — to develop his own human dig-
nity to the point where he will have regard
for the human dignity of all others.
One of the most helpful books which I have
read in this field is Everyday Psychiatry, by John
D. Campbell, M.D. ($6.00. J. B. Lippincott Com-
pany, Philadelphia) , now in its second edition
with several new chapters as well as such re-
visions as time and constructive criticism could
offer.
It is a practical book which gives the phy-
sician not specializing in this field, a compre-
hensive outline that leads to understanding.
A book that is almost a best seller is Con-
ditioned Reflex Therapy by Andrew Salter
($3.75. Creative Age Press, New York City).
This book makes a direct approach to the re-
construction of a personality by following virtu-
ally in the path of Pavlov and other great neuro-
10
The Ohio State Medical Journal
physiologists. “All the highest neurosis activity,
as it manifests itself in the conditioned reflex,
consists of a continual change of . three funda-
mental processes — excitation, inhibition, and dis-
inhibition.” This approach makes sense to a
biologist. The appearance of this book marks
the beginning of sense in psychiatry rather than
the classification of the vagaries of sick brains.
Most physicians have not tried to interest
themselves in an attempt to understand the psy-
chological disorders or their relationship to bodily
upsets. Yet unfavorable psychological factors
are a component of the unfavorable forces that
break down the resistance of our total person-
ality. This breakdown is definitive of DIS-ease.
We physicians have not even tried to listen
to the jargon of the psychiatrists. As practical
men we have noted all too often that the special-
ist was himself a maladjusted individual who
was trying to escape from himself by projecting
himself to his patients. In other words, all too
frequently, it is self-evident that this psychiatrist
is a misfit who enjoys sticking his nose into
other people’s business because he cannot man-
age his own.
The general trend of the books covered in this
review, however, points to a new day when the
biology of the psyche will dominate. The crying
shame for the sick and the near-sick is that
effective psychotherapy has been neglected.
A large part of this form of treatment is
neither mysterious nor difficult. By following
certain simple principles, any physician can
better the state of mind of a high proportion of
his patients. For, after all, there are but three
things that a person can do about things which
are upsetting him emotionally. He can calm
down and with the help of his pastor and his
physician can recognize the nature and magni-
tude of his problem. He can then go ahead in a
matter-of-fact sort-of-way and solve it. Or, he
may recognize his problem is not his responsi-
bility and he is not going to be able to solve it.
Then he can secure the help of his God to bear
his cross and be all the greater and kinder a
personality for it. Or, lastly, he can do what
more than half of the people are doing in this
country today, viz., wring his hands and keep
saying “What shall I do? What shall I do?”
If the factor is removable, like the fear of a
grave disease, this can be solved easily by the
forceful physician. Or as we specialists are
prone to do, the mistake may be made of fixing
the patient’s mind on some special organ and so
hysteria is often developed. The whole subject
of psychotherapy may be defined as maintain-
ing the reassuring attitude of sympathetic un-
derstanding. It has a wide application in medi-
cine.
The essential basis of this psychotherapy for
the hysteria is to put the burden of recovery on
the patient himself. In doing so, the attitude
adopted must be unsympathetic, whereas in the
patient who is only emotionally upset, this atti-
tude must be sympathetic and understanding.
All of this the old family doctor knows and
practices.
Hematology, by Willis M. Fowler, M. D. ($8.50.
Second Revised Edition. Paul B. Hoeber, Inc.,
New York City), presents the problems in its
field in a form that will meet the needs of the
medical student and his elders in medicine.
How To Become a Doctor, by George R. Moon,
M. A., ($2.00. Blakiston Company, Philadelphia,
Pennsylvania) , is a book of advice to those young
persons who think that they want to practice
applied biologic science in the healing fields —
physician, dentist, veterinarian, pharmacist,
chiropodist, occupational therapist, hospital ad-
ministrator, medical illustrator and biological
scientist. It is the most complete discussion of
the problems of finances, housing, outside employ-
ment, internships, and residencies. The advice
is based upon twenty years as a registrar and a
member of an admission committee of a medical
faculty.
Atlas of Obstetric Technic, by Paul Titus, M. D.,
($7.50. Second edition. C. V. Mosby Company,
St. Louis, Missouri) , is an excellent example of
visual educational material. The material has
been rearranged in some instances into a better
working sequence and modernized throughout.
The illustrations are by Shackleford of Pittsburg.
A Baby Is Born — The Story of How Life Be-
gins, by Milton I. Levine, M. D., and Jean H.
Seligmann ($1.50. Simon and Schuster, Inc.,
New York), looks like most of the other story-
books for youngsters and so could be laid out for
the time when curiosity has been aroused enough
to ask or look in it. It is a sound text with clever
illustrations by Eloise Wilkin.
The 1949 Year Book of Medicine, edited by
Beeson, Amberson, Minot, Castle, Harrison and
Eusterman ($4.50. The Year Book Publishers,
Chicago, Illinois), maintains the high standards
that have characterized this work for years. It
makes one of the handiest places to review the
happenings of the past twelve months rapidly.
Your reviewer would not think of being without
it.
A Study of Institutional Children with Parti-
cular Reference to the Caloric Value As Well
As Other Factors of the Dietary, by P. B. Mack
and Charles Urbach (Monographs of the Society
for Research in Child Development, Serial No.
U6, Volume XIII, No. 1. National Research, Wash-
ington 25, D. C.), recites the improvements in 234
children as their diets were improved over a
period of two years.
for January, 1950
11
ill WM
THE McMILLEN SANITARIUM
COLUMBUS, OHIO
LICENSED BY DIVISION OF MENTAL DISEASES, DEPARTMENT OF PUBLIC WELFARE, OHIO
Member National Association of Private Psychiatric Hospitals. Doctors Are Members American Pyschiatric Association
A Private Neuropsychiatric Hospital With 50 Years Continuous Operation.
All Modern Equipment and Conveniences.
Nervous and Mental Diseases, Alcohol Habit and Drug Addiction treated.
SHOCK THERAPY
ROBERT A. KIDD, JR., M.D. NICHOLAS MICHAEL, M.D. \
840 N. Nelson Road, Columbus, Ohio LAWRENCE TURTON, M.D. > Consultants
Telephone: FA. 1315 HERBERT L. PARISER, M.D. f
THE CINCINNATI SANITARIUM
Established 1873
A PRIVATE HOSPITAL for NERVOUS and MENTAL DISORDERS
D. A. JOHNSTON, M.D., Medical Director W. N. WRIGHT, M.D., Resident Psychiatrist
EMERSON A. NORTH, M.D., and CHARLES KIELY, M.D., Visiting Consultants
HENRY GRUENER, M.D., Resident Physician ELLIOTT OTTE, Business Manager
FOR TERMS APPLY TO THE CINCINNATI SANITARIUM, couege mu. CINCINNATI 24. oh.o
Licensed by State of
Ohio.
Approved by Amer*
ican College of
Surgeons.
Member —
American Hospital
Association.
Ohio Hospital
Association.
Central Psychiatric
Hosp. Assoc.
TELEPHONE
KIRBY 0135
KIRBY 0106
12
The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association, a scientific society, non-profit corporation, with a definite
membership, for scientific and educational purposes.
Vol. 46 January, 1950 No. 1
Jonathan Forman, M. D., Editor
Charles S. Nelson,
Managing Editor — Bus. Mgr.
R. Gordon Moore,
Asst. Managing Editor
Current Trends in the Treatment of Hernia
FRANK GLENN, M. D.
THE incidence of hernia in our population
apparently remains constant. It is com-
monly held that in each 125 male births
there will be one with a congenital hernia.1
Though many of these hernias spontaneously
recede, they may recur during the period of
robust activity in early adult life. Therefore, it
follows that the repair of a hernia remains one
of the most frequent operations performed. On
the surgical service of The New York Hospital
— Cornell Medical Center, for example, almost
4,000 hernia operations have been performed over
a period of sixteen years, from 1932 to 1948.
This is an average of about 230 a year. In
other words, an operation for hernia is done on
almost every operating day during the year,
and I believe that in many hospitals hernia
repair constitutes an even greater proportion
of the total number of operations performed.
In general, it may be said that the results
of hernia repair have been highly satisfactory
over the past fifty years. This has been par-
ticularly true for the congenital indirect inguinal
hernia in the young adult. However, the direct
hernia found particularly in the older age group,
and the recurrent hernia have always been, and
continue to remain, problems that require the
best of surgical effort. Although the inguinal
type is found most frequently, there are other
types of equal importance which often constitute
problems of greater magnitude. In our own ex-
perience they range as follows:
Presented before the Section on Surgery at the Annual
Meeting of the Ohio State Medical Association, Columbus,
April 19-22, 1949.
The Author
• Dr. Glenn, New York City, N. Y., is a gradu-
ate of Washington University School of Medi-
cine, 1927; member, American Surgical Associa-
tion, Society of University Surgeons, and Society
of Clinical Surgery; surgeon-in-chief, New York
Hospital; and professor of surgery, Cornell
University Medical College.
HERNIA REPAIR
New York Hospital 1932-1948
Year
Inguinal
Ventral
Femoral
Epigastrijc
Umbilical
bt
es
h
JS
a
a
Q
Misc.
Total
1932 (a)
154
23
7
5
4
1
1
195
1933 (a)
209
25
10
5
10
5
7
271
1934 (b)
29
19
3
1
4
17
73 (b)
1935
140
24
6
4
11
6
191
1936
73
17
12
1
9
_
7
119
1937
104
15
11
4
_
15
149
1938
155
14
14
2
12
16
214
1939
155
36
16
9
2
19
237
1940
184
33
19
11
1
22
270 •
1941
180
28
20
1
7
1
18
255
1942
223
24
25
4
10
1
287
1943
240
22
24
2
17
1
10
316
1944
201
21
12
1
18
1
254
1945
179
17
8
22
2
9
237
1946
198
15
16
23
2
11
265
1947
218
20
37
21
5
301
1948
219
32
20
8
16
2
....
297
TOTAL :
2,861
354
268
58
208
19
163
3,931
(a) Sept. 1 to Aug. 31
(b) Four months only: Sept. 1 to Dec. 31
Thereafter calendar year is used.
This table gives the over-all numerical incidence
as to type, but does not indicate the group of
patients that require special attention. Such
a group includes the long-standing and neglected
25
hernia, the recurrent hernia, the large ventral
hernia that contains many of the abdominal
viscera, and the acute hernia that is often as-
sociated with intestinal obstruction. Then there
is the diaphragmatic hernia which frequently
causes severe symptoms in the older patients
or debilitated individuals. These variations are
brought to your attention because many questions
remain unanswered in treating these groups.
In reviewing the reported experience of various
clinics throughout the country, it is evident that
continual progress is being made in the manage-
ment of the patient with a hernia. Through
prolonged follow-up studies, past inadequacies
of treatment have been brought to light and new
measures devised to correct them. One can say
that over the past thirty years several trends
in treatment have developed that account for a
lower morbidity of complications and a decreas-
ing incidence of recurrence. These trends are
the result of more meticulous handling of all
structures at the time of operation, the use of
finer suture material, more accurate approxi-
mation of structures without tension, better
preoperative preparation, more selective anes-
thesia, closer attention to metabolic require-
ments following operation, earlier postoperative
mobilization, and, in certain instances, chemo-
therapy.
TRENDS AS TO WHICH PATIENTS SHOULD
BE OPERATED UPON
There is a tendency now to operate on children
at an earlier age than previously. This has
been reported from the Boston Children’s Hos-
pital2 and by other clinics. Infants with a
congenital hernia that allows entrance of viscera
into the sac, are now being treated by two
methods.
By the first, using local anesthesia, the sac
is dissected free from the cord and ligated at
its neck. No attempt at repair of the abdominal
wall is made other than to replace the structures
in their proper anatomical relationship. This
procedure when done with meticulous care has
resulted in a very low incidence of testicle
atrophy, one of the chief objections to the oper-
ations voiced by the textbooks on surgery. Fol-
lowing this repair, these children are kept in the
hospital only a very short time and are then
brought back to have their sutures removed
after the usual interval.
The second method is the revival of an old
procedure that was used in many of the European
clinics around the turn of the century. This
consists of exposing the neck of the sac under
local anesthesia, dissecting the cord from the
sac, and then ligating the sac with a simple
ligature. This procedure has been recently re-
ported as an ambulatory treatment with satis-
factory results, but follow-up statistics are not
yet available for critical evaluation of this
method.
At the other end of the life scale, in the
older age group, there has been an increase in
the operative attack on hernia. Several factors
account for this. First of all, the number and
proportion of individuals over sixty years of age
has increased sharply over the past thirty years.
In this group hernias are associated with de-
bilitation and those changes that may produce
increased intra-abdominal pressure. There are
also those who have tolerated a hernia over a
number of years, but with increased age lose
muscular tone which permits small hernial
defects to become enlarged and allows addi-
tional abdominal viscera to escape into the sac,
with symptoms that may be anything from
annoying to intolerable.
There are thus more older people with hernia,
but improvements in the administration of
anesthesia and the management of geriatrical
problems in general have rendered few of
these patients inoperable. This holds true for
all types of hernia, including the diaphragmatic
and large postoperative ventral.
Between these two extremes of life are the
hernias that appear among the more active
members of our population. In recent years
there has been a tendency to bring a greater
number of these individuals to operation as
soon as a hernia is discovered. Such practice
has been materially fostered by the compen-
sation panels and industrial insurance groups.
SHOULD THE PATIENT WITH A LARGE OR
PROMINENT EXTERNAL RING BE SUBJECTED
TO OPERATION?
The compensation and insurance groups, how-
ever, are partly responsible for another trend
that is open to question. A physician who
examines patients for an industrial organiza-
tion looks for “potential” hernias as well as
actual. Should he discover a hernia, it is to
the advantage of the company as well as the
patient that it be repaired before the em-
ployee is put on the payroll. Of this there is
no question. However, when the same physician
finds an external ring that is larger than usual,
more often than not he recommends repair of
the “potential” hernia. The patient often has
had no symptoms of hernia, careful examination
shows that he has none of the classical find-
ings of hernia, and at operation no hernia is
found, but following the operation the patient
is eligible for employment. Certainly it is
questionable whether he has benefited by the
operation, and indeed, he may develop a “recur-
rent” hernia later that might not occur if the
first operation had not been done.
An external ring may be larger than average,
and if so an impulse on coughing may be felt.
But this may also be the case in the average
26
The Ohio State Medical Journal
or normal ring and does not demonstrate a
hernia. A sac or a projection of the peritoneal
cavity must exist if a hernia is present. Some-
times a patient may have a history of symptoms
and manifestations of hernia and yet on examin-
nation, a sac cannot be demonstrated, even though
an enlargement of the structural mass of the
cord that does not continue down the extent
of the cord in many cases can be palpated just
distal to the external ring.
It is therefore our contention that patients
with no demonstrable hernia and without a history
suggesting hernia should not be operated upon.
Far too many “potential” hernias are subjected
to operation, and the process of seeking to de-
monstrate a hernia at operation may result in so
distorting and weakening the structures in this
region that a recurrence is likely to occur sub-
sequently.
TRENDS IN ANESTHESIA
Great strides have been made in anesthesia
over the last two decades, and the range of
anesthetic agents open to selection for hernial
repair has greatly increased. The administration
of anesthesia has become much more efficient,
with the result that the incidence of postoperative
complications with hernia has been markedly
reduced.
In our own experience over a five-year period
from 1940 to 1944, 3 in a group of 1,385 con-
secutive cases on whom 1,545 hernias were re-
paired, there were 13 instances of atelectasis,
five of pneumonia, and eight of pulmonary in-
farction. These we group under postoperative
pulmonary infections incurred principally as a
result of anesthesia. Coronary occlusion oc-
curred twice and was fatal in one instance. It
is our opinion that early mobilization is also
contributing to the decrease in pulmonary com-
plications commonly ascribed to anesthesia.
Even twenty years ago there was a distinct
trend toward local anesthesia, which is parti-
cularly suitable for the majority of hernias.
On the other hand, many still insist on spinal
anesthesia because it produces more complete
relaxation and hence consider it more satisfac-
tory when handling the deeper structures. In
general there can be little to argue with the
adequacy of this type of anesthesia, but there
are occasional untoward reactions following
its use. Some patients require a general anes-
thesia and for these ether, nitrous oxide and
oxygen, cyclopropane, and other inhalation anes-
thetic agents are highly satisfactory. In our
clinic we have found that a local anesthesia sup-
plemented with pentothal drip has recently gained
in popularity both with the staff and the pa-
tients. For the repair of subdiaphragmatic
hernias, closed system inhalation provides an
anesthesia for the intrathoracic approach that
has much to recommend it.
Hernia repair in children in our experience has
not been satisfactorily handled under local anes-
thesia, and so we have come to use general
anesthesia in some form. Of course this opera-
tion does not require profound muscular re-
laxation and thus light stages of surgical anes-
thesia are sufficient. It is our feeling that the
open drop ether technique for infants is by far
the safest in most hands. During the ad-
ministration of open drop ether a large flow
of oxygen is run beneath the mask so that the
oxygen saturation will be within normal limits
and the carbon dioxide saturation is reduced to
a sufficiently low point to prevent hyperventila-
tion, a complication of anesthesia administra-
tion. Preoperative medication consists of a
dose of atropine suitable for the age and weight
of the child, together with an appropriate dose
of phenobarbital or morphine.
Dr. Digby Leigh,4 one of the outstanding
pediatric anesthesiologists, of Vancouver, Canada,
feels that children should have a suitable dose
of morphine medication combined with atropine
or scopolamine. He believes that these children
under anesthesia have an exhaustingly rapid
respiratory rate and tachycardia. Since some
of the large hernias in infants may take a con-
siderable amount of time to repair, the exhaust-
ing respiratory and cardiac rate tends to be
fatiguing. Morphine premedication counteracts
these effects and helps maintain a more normal
respiration and cardiac rate. Premedication
should always be given subcutaneously an hour
to an hour and a half before anesthesia is
started. We also recommend a cut-down with
appropriate fluid therapy if it is anticipated
that the procedure will last over an hour and
a half.
When we reported the repair of 1,545 hernias
in 1947, 3 we listed the types of anesthesia used
as follows:
Local 1,090
General 397
Local and general 37
Spinal 21
Since then there has been an increase in the use
of local anesthesia supplemented with pentothal
and a decrease in the use of general anesthesia
alone. This is particularly true for inguinal
hernia operations.
METHODS OF REPAIR
For the simple, uncomplicated, indirect inguinal
hernia, the regular anatomical hernial repair is
adequate. This provides for removal of the
sac with high ligation, and reconstruction of the
normal anatomical relationships of the abdominal
wall structures.
For the older patient, or for the individual
with a large indirect inguinal hernia, transplan-
for January, 1950
27
tation of the cord external to the internal
oblique and beneath the external oblique, as
described by Bassini,5 is an adequate repair.
But these patients and those with a direct in-
quinal hernia are probably better protected from
recurrence by the Halsted method.6 This pro-
vides for transplantation of the cord to the sub-
cutaneous tissue, thus avoiding a critical angle
near the pubic spine, through which recurrences
commonly take place.
In addition to these three methods, which are
the ones most commonly employed today,
numerous modifications have been developed that
have become popular during the past ten years.
One of the most recent of these is the utiliza-
tion of Cooper’s ligament as advocated by Mc-
Vay.7 He has reported his experience with
100 inguinal and femoral hernioplasties without
a recurrence in a one-to-nine year follow-up.
Figure I
(2) For the larger hernia, with a weakened
wall, Cooper’s ligament is used to bring the
fascia over and secure it up to the iliac vein.
To facilitate this, a relaxing (Rienhoff) incision
is used.
(3) The external oblique is replaced, per-
mitting the cord to exit through the external
ring, which leaves the structure in a more normal
position.
M. rectus o bd.
Tuber
pubicum
Figure 3
Fig. 3. — The reconstruction is complete. The previously
incised transversus stratum has been sutured to Cooper’s
ligament from pubic tubercle to femoral vein (2) and then
to the anterior femoral sheath (3). The cord has been pulled
laterally (4) to demonstrate the closure of the abdominal
inguinal ring. The relaxing incision is now a triangular
defect, and the lateral margin has been sutured to the un-
derlying tendon of the rectus abdominal muscle. The sper-
matic cord is dropped in against the new posterior inguinal
wall and the external oblique aponeurosis closed over it
with the subcutaneous inguinal ring in the normal position.
A.iliaca ext.
V.iliaca ext.
Peritoneum.
^''pubicum
superius
Zakina
femoralis
\ M.pectmeus(fasc^)
'Annulus femoralis
Funiculus v irL^v
Figure 2
^ ^ ' Lip', in.puin.ale
spermaticus
His illustrations are distinctive and might be
copied. They emphasize three points:
(1) In the small, simple, indirect hernia, the
sac is excised and the slightly dilated abdominal
ring is closed snugly medial to the cord, using
the aponeurosis of the transversalis fascia.
Nothing additional is done.
Illustrations reprinted with permission from an article by
Chester B. McVay, M.D., Surgery, Gynecology and Obstet-
rics, April, 1949.
The author’s contribution lies in his recon-
struction of the posterior inguinal wall in large
indirect, direct, and femoral hernias.
In a more recent article, McVay8 has presented
in detail a single operative procedure for the
repair of large indirect, direct, and femoral
hernias. This operation consists essentially of
restoring the inguinofemoral anatomy to its
normal status. Repair is similar for all three
types because the three represent defects in
the same layer at different points.
Since there is no anatomic defect in the in-
guinofemoral region in the uncomplicated small
indirect inguinal hernia other than the presence
of a congenital hernial sac and a slight dilatation
of the abdominal inguinal ring, it is recommended
that this type of hernia be repaired by removal
of the sac by accepted methods and by subsequent
tightening of the abdominal inguinal ring.
Harkins and Schug9 reports 294 patients with
367 operations for inguinal hernia. Their policy
is to employ Cooper’s ligament instead of Pou-
part’s, and to secure the structures to it. They
follow the recommendations of McVay and Anson
and employ silk sutures throughout. It is their
general policy to keep the patient in bed at rest
28
The Ohio State Medical Journal
for about twelve days for a simple unilateral
hernia, fifteen days for bilateral, and nineteen
days for recurrent. During the past two years,
however, all patients have been gotten out of
bed within twenty-four hours after operation.
The recurrence rate has been 2.3 per cent for
cases followed over two years.
As to the repair itself, Harkins and his group
have used the transversalis fascia when it ap-
peared strong enough, but if inadequate, the
internal oblique aponeurosis has been included
as well. Fixation of these structures to Cooper's
ligament instead of Poupart’s is, in their opinion,
the procedure of choice for the repair of in-
guinal hernia.
Zimmerman,10 in a recent editorial in Surgery,
Gynecology and Obstetrics, offers the following
objections to the McVay procedure for inguinal
hernia. First, the inguinal ligament is not a
fixed structure since it is suspended between
two points, being attached to the fascial lata
of the thigh. Secondly, the operation is not an
easy one and there is a greater likelihood of
thrombosis of the femoral vein. He concludes
that this new procedure will not replace the
old in which the inguinal ligament is used be-
cause of the greater difficulties in its accomplish-
ment.
A slight variation of the McVay procedure has
been reported by Clark and Hashimoto11 of Salt
Lake City. They report a series of 162 con-
secutive hernia cases in which the various
structures in the region of the pubic spine have
been used. These include Henle’s ligament, the
iliopubic tract, the aponeurosis transversus ab-
dominis, and Cooper’s ligament. It is doubtful
if all of these structures are often required to
secure a satisfactory repair, but it is well to keep
in mind their relationship to the common site
of recurrence. Also, since these structures vary
as do all those that are customarily used in
hernial repair, it would seem unwise to ad-
vocate this or any other method as a fixed
routine.
Recently there has been considerable emphasis
in the surgical literature on the premise that
the surgeon has his best opportunity to cure
a patient of a malignancy by complete removal
of the tumor at the primary operation. This
is sound teaching, and one that lends itself
equally well to the treatment of hernia. At the
primary operation the inguinal hernia, both di-
rect and indirect, can be repaired with a very
low incidence of recurrence. To be successful,
hernia repair requires good surgical judgment
and skill. It is not a minor operation and
should not become the victim of any standard
routine. To the careful surgical eye, no two
hernias are alike. Simple obliteration of the
hernial sac has long since been discarded as
the only step in the surgical treatment of hernia
in the adult. Meticulous reconstruction of the
abdominal wall to approach anatomical perfec-
tion is equally important. True, simple high
ligation of the sac for the congenital type of
hernia found in young adults may result in
cure for a high percentage of patients, but
anatomical restoration of the structural rela-
tionships in the inguinal canal will give these
patients some insurance against the development
of an inguinal hernia later in life. For the
acquired hernia, more common in later life,
and often the result of the individual’s occupa-
tion, reconstruction of the abdominal wall is
of even greater importance. If the hernia is
large and the structures are weak, good surgi-
cal judgment will dictate that maximum strength
to the abdominal wall may be obtained by com-
plete closure of the lowest portion and trans-
plantation of the cord to the subcutaneous
tissues.
When repairing a hernia, a few basic prin-
ciples should be kept in mind:
(1) Careful dissection to identify all struc-
tures.
(2) Evaluation of the operative findings
before embarking on the repair, so as
to select the operation best suited to
that particular hernia.
(3) Obliteration of the sac at its neck, so
that a stump does not remain.
(4) Meticulous hemostasis and gentle hand-
ling of tissues.
(5) Proper selection and use of suture mate-
rial.
OPERATIVE TREATMENT OF INGUINAL HERNIA
IN INFANTS AND CHILDREN
Coles12 of New York City has expressed the
opinion that because congenital hernia is in
no way associated with weakness of the ab-
dominal wall, hernia repair in infants can be
accomplished by simple ligation of the sac and
nothing more. Specifically, he makes a small
incision to expose the cord and sac, dissects the
sac free of the cord at the internal ring and
transects it. The distal portion of the sac
is allowed to remain. This is a very old pro-
cedure and may very well have merit. He re-
ports a series of 186 patients as of May, 1944,
of which 78 were examined from six months
to six years following operation with one recur-
rence noted. But what is of greater significance
is that testicular atrophy, the reason most com-
monly given for not repairing hernia in the
infant age group, was not found in a single
instance.
TRENDS IN CHOICE OF SUTURE MATERIAL
One cannot discuss the subject of methods
of hernia repair without commenting on the type
of suture material to be employed. At the
New York Hospital, we employ silk suture
for January , 1950
29
material except for those patients with an acute
hernia associated with infection. For this group
we employ catgut suture material. A few years
ago, we began to use fine steel wire after the
method described by Babcock, but found that
our repairs were no better and that our patients
occasionally complained of pain around the su-
ture material, necessitating its removal. At
the present time we use silk for all uncomplicated
cases and have used cotton with equally satisfac-
tory results.
Zollinger and Flynn13 have reviewed a series
of over 200 inguinal repairs in which cotton
and catgut have been compared. They found
that patients with cotton sutures have a lower
daily postoperative temperature, require less
narcotics, and return more quickly to normal
than those in which catgut is used. These find-
ings parallel the work done recently by Pareira14
in his comparison of silk and catgut for hernial
repair.
It would appear that at the present time, silk
and cotton are the suture materials of choice,
but it should be pointed out that using very
fine catgut should overcome many of the objec-
tions raised against its use in the past. Ori-
ginally, only No. 1 and No. 2 chromic catgut
were used for repairs, which introduced con-
siderable foreign body reaction into the wound
and traumatized the structures involved as they
were being placed.
The use of fascial sutures and grafts have
had limited popularity, chiefly because it has
been demonstrated that a careful dissection which
permits accurate approximation of the structures
in the immediate vicinity of the hernial defect,
using silk or cotton suture material, produces
better results. Harkins maintains that repair
with fascial sutures or grafts is distinctly in-
ferior to the method to which was just referred.
Garner,15 in a report of 2,040 hernia patients
from the Veterans Administration Hospital in
Dayton, Ohio, has expressed the opinion that
the McArthur fascial suture hernioplasty has
been less effective than herniorrhaphy with silk
sutures, and is decidedly inferior to the Gallie
fascial suture hernioplasty. He states that they
reserve the Wangensteen pedicle fascial graft
operation for those patients with large defects
in the fascia of the abdominal wall. He also
recommends the use of silk suture material for
approximating the transversalis fascia to
Cooper’s ligament.
There are other substances that have been
lately introduced for repairing hernial defects.
Scola16 of Buffalo, New York, has reintroduced
the use of a buried dermal graft. This consists
of cutting an almost full thickness graft and
then removing a very thin portion of the epi-
dermis. The skin is used in the place of the
structures that are more commonly employed
in the repair of hernias. We have had no first-
hand experience with this procedure, but we feel
it might offer a real solution to the difficult re-
current cases, and that it might be as effective
as fascia transplants.
Still another method has been introduced by
Koontz,17 who has used tantalum mesh in the
repair of large ventral hernias in five obese
patients. There has been no apparent untoward
reaction of the tissue to this foreign body, but
his report gives only one follow-up of eleven
months, and in this patient there was some
fragmentation of the mesh. The mesh is secured
to the tissue with tantalum sutures.
Perhaps the most recent contribution is that
proposed by Dr. John E. Sutton18 of New York.
For difficult hernial repairs, he advocates a
pedicle graft of the sartorius muscle with its
anterior fascia lata placed in the defect of the
posterior wall of the inguinal canal. This is
accomplished without tension and is sutured
with interrupted sutures that are tied snugly
but do not produce tension or strangulation of
the tissues. By using this method, the defect
in the wall of the inguinal canal is “patched”
by living fascia and muscle with its nerve and
blood supply intact.
The conventional exposure of the hernial sac
is carried out, and the sartorius muscle ex-
posed through a long thigh incision. Then the
sartorius muscle and fascia lata are divided
by transverse incision in the middle third of the
muscle. The fascia lata is then incised both
laterally and medially to the sartorius muscle;
the muscle is freed from its bed and drawn up-
ward, leaving its blood and nerve supply intact.
The muscle and fascia flap are now transferred
into the defect in the posterior wall of the
inguinal canal, exercising care not to injure
the blood and nerve supply or to disturb the
origin of the muscle at the anterior superior
iliac spine. The fascia lata is first sutured to
the rectus sheath, conjoined tendon, internal
oblique and Poupart’s ligament with interrupted
sutures. The sartorius muscle is then sutured
to the same structures anterior to the fascia
graft with interrupted sutures. All sutures are
tied without tension.
TRENDS IN POSTOPERATIVE CARE
Less than ten years ago, in our zeal to prevent
recurrence, we maintained a policy at the New
York Hospital of complete immobilization of
hernia patients during the first week following
operation. This immobilization included not
turning in bed and being kept as quiet as pos-
sible, often supplementing instructions with seda-
tives. All patients were kept in bed for a period
of fourteen days. At the end of that time,
the patient’s activity was limited for several
days until he could regain his strength suf-
30
The Ohio State Medical Journal
ficiently to get about. Since 1945, however, we
have changed our policy to one of early mobiliza-
tion. The patient stands to void on the day of
operation, walks about on the day following
operation, and thereafter continues his activity.
Dietrich19 and his co-workers have demon-
strated in their metabolic studies on patients
mobilized and immobilized that a favorable
nitrogen balance is maintained in the patient
wTho is allowed to move about. This prevents
the development of invalidism and furthermore,
tends to maintain the proper nutritional balance
in the body, which is, of course, reflected in
tissue healing. It has been our experience thus
far that the incidence of recurrence has been
diminished rather than increased by this practice
and w*e therefore now consider it an established
postoperative routine to mobilize patients as soon
as practicable after operation.
The use of antibiotics in patients with a com-
plicated hernia associated with infection needs
no elaboration here, but we have not found
necessary, nor do we advocate the prophylactic
use of penicillin or other antibiotics following
operation. Proper management of fluids and
nutritional needs are reduced to a minimum by
early mobilization and we believe that postopera-
tive care directed at early mobilization will further
reduce all postoperative complications. Our experi-
ence with 1,385 consecutive cases shows this to be
true. A careful analysis of our last series reveals
95 patients that developed postoperative com-
plications of varying significance, six of which
ended in death, a mortality rate of 0.4 per cent.
Three of these six deaths, however, were due
to peritonitis associated with acute hernia,
and were, in fact, examples of patients upon
whom the treatment for hernia had been too
long postponed.
The problem as to when an individual may
resume his normal occupation following a hernia
operation depends on several factors: the age of
the patient, the type of hernia, the method of
repair used, and the nature of his occupation.
The compensation courts, for the most part,
consider that an individual should be allowed eight
weeks to recuperate from his operation before
returning to work. For the person doing manual
labor this is probably the safest policy to fol-
low. However, if healing is complete at the
end of two weeks, and the patient has been up
and about, he can probably return to work
much sooner. This is particularly true of an
office worker or any individual who is not likely
to be subjected to unusual muscular effort.
TRENDS IN RESULTS
We now come to our observations on the trend
in results from the surgical treatment of hernia.
McVay8 has recently reported a series of 100
hernial repairs without a known recurrence in a
follow-up of five to eight years for his first
group of 35, and 10 to 28 months for the second
group of 65 cases. Of the 100, 56 are classified
as difficult repairs, including twelve recurrent
cases.
In our experience at the New York Hospital
we have found that our results have improved
over the years. In 193620 we reported 500
hernial operations, as follows:
RESULTS IN 500 HERNIA OPERATIONS
The New York Hospital 1932-1935
•5
*2
u
s-i w
o c
©
® 3
O g
+> s
u .5
u 5
v tt
*-» 4)
flj t,
C tt
x at
- fi u
tt *4
o u
c
c hi
s a
£.2
so
£ 3
3 a)
W 3
U V
4> 4)
ZO
Cntf
Indirect inguinal
303
253
6
2.4
Direct inguinal
38
32
2
6.3
Recurrent inguinal
26
' 20
6
30.0
Femoral
33
26
3
11.5
Umbilical
34
28
Epigastric
18
14
2
14.3
Postop. ventral
48
41
-
—
500
414
19
These results, as
far as
i the
recurrence rate
goes, appear better
than
those
reported
in our
later series3 of 1,545 hernia operations done
between 1940 and 1944:
RESULTS IN 1545 HERNIA OPERATIONS
The New York Hospital 1940-1944
Follow-Up Results
a
tt
EC
©
tt
a
>>
H
Number of
Patients
Number of
Operations
Number of
Patients
Followed
Number of
Repairs
Examined
Number of
Recurrences
Per Cent of
Recurrence
Indirect inguinal
770
840
659
616
19
3.1
Direct inguinal
205
279
144
220
18
8.2
Recurrent inguinal
95
103
86
95
14
14.7
Femoral
110
114
94
94
8
8.5
Umbilical
57
57
43
43
5
11.6
Epigastric
12
12
11
11
1
9.(1
Postop. ventral
136
140
100
100
12
12.0
1,385
1,545
1,037
1,179
77
This larger group, however, contains more dif-
ficult problems in hernial repair and represents
an older age group which was followed for a.
longer period of time than the earlier group. The
later group also includes many patients that
would not have been considered suitable for oper-
ation in the earlier period.
These figures parallel reports from many
other clinics in that they suggest that every
attempt should be made to do whatever operative
repair is indicated for inguinal hernia at the
time of the primary operation. Each patient
should be carefully evaluated and no single pro-
cedure should be expected to apply to all pa-
tients. Individuals with weak structures should
be subjected to the type of repair that will give
for January, 1950
31
them the greatest insurance against recurrence.
For example, a patient with an indirect inguinal
hernia who has a poor transversalis fascia and
possibly a weakened Poupart’s ligament should
have a McVay type of hernioplasty or a Halsted
repair with transplantation of the cord to the
subcutaneous tissue, rather than removal of the
hernial sac and restoration of normal anatomical
relationship of structures in the inguinal region.
If the latter is done, such a patient is likely to
develop a direct hernia type of recurrence at
the site of his weakest structure in the inguinal
region.
Our results may be further improved by operat-
ing on all hernias as soon as they are diagnosed,
advocating in so doing that a truss not be worn
for mere convenience. The patient who is advised
to wear a truss as a matter of convenience or
as a temporary measure, too often accepts this
advice as being the proper treatment for his
particular case. Such a practice only leads to
the necessity for a more difficult procedure when
the repair is made later on, and is also ac-
companied by the hazard of complications such
as incarceration, strangulation, and intestinal
obstruction.
These principles should also be followed in the
treatment of postoperative ventral hernia. When
a hernial defect is demonstrated in the abdom-
inal wall wound, that defect should be repaired
as soon as the induration and reaction from
wound healing has subsided. A hazard to the
patient exists if any defect is permitted to re-
main, and of course the smaller defect is much
easier to repair than the larger one. The risk
to the patient from his operative burden is also
much less if it is not necessary to return a
large portion of the viscera to the abdominal
cavity.
Acute hernia as a problem will continue to
account for a large proportion of the mortality
associated with hernia repair, but the mortality
rate can bo reduced if the best possible surgical
judgment is used. Acute hernia in a late stage
of intestinal obstruction often exhibits a pic-
ture of profound shock and must be handled as
carefully as shock from any other cause. With
our better understanding of fluid and electro-
lite balance, the various methods of decompress-
ing the intestinal tract, and chemotherapy, many
of these patients can be salvaged. There is
perhaps no other group of patients in surgery
with whom we should proceed more cautiously,
and we should keep in mind that to do too much
too quickly may prove fatal.
CONCLUSION
The surgical repair of hernia as done in most
general hospitals throughout the country, is a
frequently performed and highly successful pro-
cedure. Each succeeding decade sees further
improvement in the end results of these opera-
tions. Improved surgical technique is but one
of the several factors accounting for this favor-
able trend. Other factors include earlier diag-
nosis and operation, better preoperative prepara-
tion, more selective anesthesia, adaptation of
the type of repair to correct more perfectly the
structural defect, employment of finer suture
material, better postoperative management in-
cluding early postoperative mobilization, and
chemotherapy in those instances of “acute” hernia
complicated by infection.
BIBLIOGRAPHY
1. Dale, John H., Jr.: Personal Communication.
2. Gross, Robert E. : Personal Communication.
3. Glenn, Frank : The Surgical Treatment of 1545
Herniae. Ann. Surg., 125:72-79, January, 1947.
4. Leigh, Digby : Premedication in Infants and Children.
Anesthesiology, 7 :611, November, 1946.
5. Bassini, Eduard : Ueber die Behandlung des Leisten-
bruches. Arch. f. klin. Chir., 40:429-476, 1890.
6. Halsted, W. S. : The Radical Cure of Inguinal Hernia
in the Male. J. H. H. Bull., 4 :17, 1893.
7. McVay, Chester B. : Inguinal and Femoral Hemi-
oplasty: Anatomic Repair. Arch. Surg., 57:524-530, Octo-
ber, 1948.
8. McVay, Chester B., and Anson, Barry J. : Inguinal
and Femoral Hernioplasty. S. G. & O., 88 :473-485, April,
1949.
9. Harkins, Henry N., and Schug, Richard H. : Hernial
Repair Using Cooper’s Ligament. Arch. Surg., 55 :689-709,
December, 1947.
10. Zimmermann, Leo M. : A Critique of the McVay
Operation for Inguinal Hernia. Editorial in S. G. & O.,
87 :621, November, 1948.
11. Clark, John H., and Hashimoto, Edward I. : Utiliza-
tion of Henle’s Ligament, Iliopubic Tract, Aponeurosis
Transversus Abdominis and Cooper’s Liagment in Inguinal
Herniorrhaphy: A Report of 162 Consecutive Cases.
S. G. & O., 82 :480-484, April, 1946.
12. Coles, Jerome S. : Operative Cure of Inguinal Hernia
in Infancy and Childhood. Am. J. Surg., 69 :366-371, Sep-
tember, 1945.
13. Zollinger, Richard W., and Flynn, William J. : The
Effect of Cotton and Catgut in Hernial Repair on Post-
operative Temperature and Pain. S. G. & O., 81 :201-205,
August, 1945.
14. Pareira, Morton D. : Reaction in Surgical Wounds
to Surgical Gut, Silk and Cotton Sutures. Arch. Surg.,
58:308-311, March, 1949.
15. Garner, Amos D. : A Study of 2,040 Hernia Patients
at the U. S. Veterans Administration Hospital, Dayton,
Ohio. Am. J. Surg., 74:14-23, July, 1947.
16. Scola, James V.: Improved Technic for Preparing a
Buried Dermal Graft in Hernial Repair. Am. J. Surg.,
66 :249-251, November, 1944.
17. Koontz, Amos R. : Preliminary Report on the Use
of Tantalum Mesh in the Repair of Ventral Herniae. Ann.
Surg., 127:1079-1085, May, 1948.
18. Sutton, John E., Jr. : Personal Communication.
19. Deitrick, John E., Whedon, G. Donald, and Shorr,
Ephraim : Effects of Immobilization Upon Various Meta-
bolic and Physiologic Functions of Normal Men. Am.
J. Med., 4 :3-36, January, 1948.
2-0. Glenn, Frank, and McBride, A. F. : The Surgical
Treatment of Five Hundred Herniae. Ann. Surg., 104:1024-
1029, December, 1936.
Allergy in General Practice
One of the few advances in clinical allergy
has been the realization that many cases of
intractable asthma and vasomotor rhinitis be-
ginning after the age of 40 are not due to the
usual environmental allergens. Bacterial allergy,
“depletion,” psychosomatic factors, emphysema,
tumors, and foreign bodies are the more impor-
tant etiologic factors in these patients. — Milton
S. Clark, M. D., Goldsboro; North Carolina Medi-
cal Journal, Vol. 10, No. 11, November, 1949.
32
The Ohio State Medical Journal
Medical Follow-up of Vagotomy Plus Gastro-Enterostomy
Or Pyloroplasty For Peptic Ulcer*
E. N. COLLINS, M. D., GEORGE CRILE, Jr., M. D., and W. S. DEMPSEY, M. D.
DURING the past three years and three
months 360 patients have been subjected
to bilateral vagotomy for complicated
peptic ulcer at Cleveland Clinic Hospital. Two
annual reports of our experience have been
published.1’ 2 The transabdominal approach plus
gastro-enterostomy or pyloroplasty was adopted
as the procedure of choice.
The present report concerns the first 100 con-
secutive patients having this combined procedure
for complicated duodenal ulcer.
Bilateral vagotomy plus gastro-enterostomy
73 patients
Bilateral vagotomy plus pyloroplasty
27 patients
(Operations performed by Drs. T. E. Jones
and George Crile, Jr.)
Gastric ulcer is not included in this report
because we believe gastric resection is the surgi-
cal treatment of choice for this disorder. Neither
are jejunal or marginal ulcers considered, even
though we have found, and it is generally ac-
cepted, that bilateral vagotomy is an effective
method of treatment.
Members of our group are conservative in
advising surgical procedures for duodenal ulcer.
At least 85 per cent of our patients make satis-
factory progress on medical management. There-
fore, the only patients operated on had com-
plicated problems. In most instances the pa-
tients were incapacitated and unable to follow
their usual occupations.
Complications prior to operation:
Pyloric obstruction 24
Massive hemorrhage 21
multiple 9
Acute perforations 10
multiple 2
Twenty of the 24 patients having pyloric ob-
struction had 50 to 100 per cent gastric retention
in six hours by roentgen examination. More
than half of the patients in this series had in-
tractable pain, including night pain, and medical
management was not effective.
The sex and age distribution and the duration
of symptoms are as follow:
100 consecutive patients having complicated
duodenal ulcer.
♦From the Cleveland Clinic and the Frank E. Bunts
Educational Institute.
Presented before the Section on Medicine at the Annual
Meeting of the Ohio State Medical Association, Columbus,
April 21, 1949.
The Authors
• Dr. Collins, Cleveland, Ohio, is a graduate
of Rush Medical College, University of Chi-
cago, 1923; diplomate, American Board of
Internal Medicine; fellow, American College
of Physicians; member, American Gastro-
enterological Association; in charge of medical
section on gastro-enterology, Cleveland Clinic.
• Dr. Crile, Cleveland, Ohio, is a graduate of
Harvard Medical School, 1933; fellow, Amer-
ican College of Surgeons; diplomate, American
Board of Surgery; member, American Goiter
Society; and on surgical staff, Cleveland Clinic
Hospital.
• Dr. Dempsey, Cleveland, Ohio, is a graduate
of University of Vermont College of Medicine,
1941; diplomate, National Board of Medical
Examiners; formerly fellow in surgery, Cleve-
land Clinic; and now, exchange fellow in sur-
gery, Bellevue Hospital, New York City.
Sex 85 men 15 women
Age Average 47 years
Duration of ulcer symptoms — average 12.6
years
RESULTS OF FOLLOW-UP STUDIES
Results to date are known in 97 of the 100
consecutive patients. One patient died while in
the hospital and one patient died six months
after operation of an unrelated disease. We
were unable to trace two patients. Another pa-
tient had obtained an excellent result at the
end of nine months but we have not seen him
recently.
This follow-up study, therefore, concerns 95
patients who have been followed twelve to
twenty-nine months. The average duration of fol-
low-up studies has been twenty months.
Insulin tolerance tests and drainage studies,
unless positive, have not proved reliable in
determining the completeness of the vagotomy
in this investigation, because of regurgitation of
duodenal contents. Therefore, this appraisal is
based on a survey of clinical results.
QUESTIONNAIRE
A questionnaire was filled out by the patient
at the time of progress examinations or has
been received by mail within the past month.
for January, 1950
33
1. Have you had any recurrence of your
ulcer-like pain?
(Pain in the upper abdomen occurring
two or three hours after meals and
relieved by food.)
Yes 3 patients
No 92 patients
One of the three patients who answered
“yes” developed a jejunal ulcer nine months
after operation, demonstrated by roentgen exami-
nation. At the second operation, in addition
to the jejunal ulcer, three additional intact
vagus fibers were found. He has had two sub-
sequent operations and prior to each operation
he had had highly positive insulin tolerance
tests. It is now known that complete vagotomy
is not possible in approximately 5 per cent
of patients, due to anatomical variations in the
distribution of the vagus nerves.
The other two patients who answered “yes”
have had progress roentgen examinations. There
was no evidence of an ulcer crater, the stoma
functioned normally, and motility studies were
normal.
2. Have you had any abdominal pain of
any type? If so, describe:
Yes 33 patients
No 62 patients
Three of the 33 patients who answered “yes”
were those who answered “yes” in question one,
four have a mild “dump syndrome,” and the
remainder have gaseous dyspepsia characteristic
of an irritable colon syndrome or incisional pain.
3. Have you vomited? If so, how often?
Yes 15 patients
2 repeated, 3 transitory, 10 mild (1 to 6
times a year)
No 80 patients
One of the 15 patients who answered “yes”
was the one who developed a jejunal ulcer. The
other patient who has had repeated vomiting has
been classified as a failure, despite negative
roentgen findings.
Progress roentgen examinations in the re-
mainder of the group answering “yes” to this
question have revealed normal findings, including
normal motility.
4. Have you had diarrhea? If so, how
many stools per twenty-four hours ?
Yes 35 patients
transitory 7
occasional 20
mild 6
severe 2
No 60 patients
The patients in the “transitory” and “oc-
casional” groups were not concerned about their
diarrhea. Those having recurrent mild diarrhea
34
have less than four stools daily while the pa-
tients classified as having recurrent severe
diarrhea have four to six stools daily. In no
case has the diarrhea been disabling. Food
allergy seemed to be an important factor in a
number of these patients.
5. How much weight have you gained?
58 patients average gain 20 pounds
16 patients.— no change
8 patients lost weight — average 15.2 pounds
13 patients.— did not state
We were surprised to find that eight patients
stated that they had lost weight. On going
over the charts of these patients, we found that
three had been using a weight reducing diet and
that in three other instances by comparing their
weight after operation with their present weights,
they actually had not lost over six pounds.
In an attempt to appraise the result in 95
patients having follow-up studies over an average
period of twenty months, the following criteria
were used:
Excellent One hundred per cent normal
health from gastro-intestinal
standpoint.
Satisfactory No ulcer distress; gastro-
intestinal symptoms so mild
that they do not interfere
with work; no special diet or
medication used.
Improved No ulcer distress; fewer
gastro-intestinal symptoms
than before operation, but
diet and/or medication have
been used to control symp-
toms.
Failure Persistence of ulcer-like dis-
tress or development of
other gastro-intestinal symp-
toms sufficiently severe to
constitute disability.
A summary of the results is as follows:
Excellent Satisfactory Improved Failure
Cases 62 20 10 3
Excellent plus satisfactory — 86 per cent.
Three of the 95 patients were considered to
be in the failure group. Details concerning the
patient who developed the jejunal ulcer, who
had an incomplete vagotomy, have already been
mentioned. The other two patients have had
progress roentgen examinations. There was no
evidence of an ulcer crater, the stomach func-
tioned normally, and motility studies were nor-
mal.
One patient is a retired physician, who is
now residing in Florida. He has symptoms re-
ferable to many parts of the body particularly
the cardio-vascular system, including intermit-
tent ulcer-like symptoms.
1 be Ohio State Medical Journal
The other patient is a 28-year-old registered
nurse, who states that she had epigastric burn-
ing at times, as well as intermittent diarrhea
not to exceed four stools in any twenty-four
hour period. As stated, the roentgen examina-
tion demonstrated an excellent result from the
operation, but she has used antacids at times
and is therefore considered a failure.
The patients who are placed in the excellent
and satisfactory groups are following no special
diet, taking no medicine, and have no signi-
ficant symptoms. It will be noted that 92 pa-
tients included in the first three categories are
free of ulcer distress and are in much better
health than before operation. Only three of the
95 patients are classified as failures.
COMMENTS
It is difficult to appraise the results of treat-
ment in any disease characterized by spontaneous
remissions. An experience of many years is
necessary for the final evaluation of any form
of treatment of peptic ulcer. Members of our
group are conservative in advising surgical pro-
cedures, because at least 85 per cent of our
patients having duodenal ulcer make satisfactory
progress on medical management.
The present report concerns the first 100 con-
secutive patients having bilateral vagotomy
combined with gastro-enterostomy or pyloroplasty
for complicated duodenal ulcer.
We were able to follow 95 patients over an
average period of twenty months.
Renshaw and Beck3 reviewed twenty-five
years’ experience of our staff with conven-
tional surgery, i. e., gastric resection or gastro-
enterostomy alone. The greatest percentage
of recurrence occurred within the first year
after operation.
The patients in the group reported here have
obtained better results than comparable series
of patients having conventional surgery, followed
over a similar period of time.
The mortality rate was 1 per cent.
One patient developed a jejunal ulcer with
obstruction. It apparently was impossible to do
a total vagotomy in this instance. Otherwise,
no patient in this series has developed roentgen
evidence of recurrent ulcer, and no patient has
had a recurrence of obstruction, hemorrhage, or
perforation.
At the present time when elective surgery is
indicated for complicated duodenal ulcer, our
group favors bilateral vagotomy plus gastro-
enterostomy or pyloroplasty.
BIBLIOGRAPHY
1. Collins, E. N., and Stevenson, C. W. : Bilateral
Vagotomy in Treatment of Peptic Ulcer. Gastroenterology,
10:205-215, Feb., 1948.
2. Collins, E. N., Crile, G., Jr., and Davis, J. B. : Fol-
low-up of Vagotomy Plus Gastroenterostomy or Pyloro-
plasty for Ulcer. Gastroenterology, 11 :453-456, Oct., 1948.
3. Renshaw, R. J. F., and Beck, R. H. : Peptic Ulcer ;
Evaluation of Surgical Treatment. Proc. Am. Fed. Clin.
Research, 3 :85-86, 1947.
KEEPING UP WITH MEDICINE
• In Philadelphia a survey of 18 patients who
were the recipients of the blood of a single
donor over a period of three and a half years,
showed four of the 12 who survived for a rea-
sonable length of time developed hepatitis with
icterus. It is suggested that the donor was a
carrier of the virus.
He % H*
• The occurrence after the administration of
sulfathiazole of a rash similar to erythema
nodosum has been reported frequently. But the
drug is looked upon by most wTorkers as a pro-
vocative and not an etiologic factor.
^ ^
• Tetraethylammonium chloride injected in-
travenously has an antipuritic effect similar to
that of other vasodilators.
^ ^ ^
• Today the importance of allergic factors in
precipitating attacks of gout is being stressed.
* * *
• Lange and his associates insist that glomer-
ulonephritis is caused by a continuous organ
specific antigen-antibody reaction.
^ ^
• If we omit the “CORPUS HIPPOCRATI-
CUM,” the writings of Galen represent at least
five-sixths of all of the medical writings surviv-
ing from antiquity.
^ H' %
• From twenty to forty years of age is the
time in which neglected Eustachian tube deaf-
ness becomes the conduction disability of maturity
and the inadequately treated secretory ears be-
come the adhesive deafness of adulthood.
Hi sfc
• The day when the surgeon’s responsibility was
limited to the local injury, and ceased when that
is healed has passed. The patient must be re-
habilitated.
& H: &
• When there is a cough — non-productive, dry,
hacking in character, a streaking of blood at
times, not explained to your complete satisfaction,
take an X-ray plate of the chest looking for a
carcinoma. Here we search for: (1) Localized
emphysema secondary to bronchial obstruction;
(2) or the subsequent atelectasis; or (3) in-
creased density of the hilum with growth in
the wall of a similar bronchus; or (4) a growth
in the periphery of the lung, producing slight
discomfort referable to the pleura.
Hi
• Reiter’s syndrome presents the triad of ure-
thritis, conjuctivitis, and polyarthritis.
& & *
• Jarring of vehicles with few, poor, or no
springs for the protection of riders, is an in-
frequent but important cause of intervertebral
disk syndrome in truck drivers. — J. F.
for January, 1950
35
The Treatment of Sterility: Report of 100
Consecutive Cases
MOSES GARBER, M. D.
STERILITY is a major social problem in the
United States since approximately 10 per
cent of all marriages are barren. This is
exclusive of the childless matings which result
from habitual abortions. The subject of sterility,
therefore, occupies considerable time and atten-
tion of the gynecologist who undertakes the relief
of this distressing condition.
The prerequisite to successful treatment of
sterility is a painstaking and thorough search
for the cause in both husband and wife, since the
responsibility for the sterile mating is almost
equally divided. In the present series of 100
consecutive cases treated, the ratio was 35
male to 65 female (Table I). TeLinde states
TABLE I
Male 27
Female 73
Total 100
Female —
Youngest 18 yrs.
Oldest 45 yrs.
Average Age 29
Average Number of Years Married 5.5
Male and Female Defects 8
Male Defects 27
Aspermia 6
Defective Sperm 21
that in his experience the ratio was nearer to
50 per cent male to 50 per cent female.
In the course of the investigation and treat-
ment it becomes often necessary to consult
other specialists; such as the internist, endocrin-
ologist, urologist and roentgenologist.
It is a known fact that spermatogenesis is
depressed by constitutional diseases and faulty
nutrition, especially protein deficiencies; also
by acute and chronic diseases and intoxications.
The treatment of these depressed nutritional
states and diseases is best handled by the in-
ternist. Similarly, spermatogenesis is affected
by thyroid and pituitary dysfunctions and the
endocrinologist is called upon to correct these
abnormalities; the urologist treats the infective
and obstructive lesions in the sterile male, espe-
cially those of the prostate, since the prostatic
secretions constitute a considerable and impor-
tant part of the seminal fluid.
The collaboration of the various specialties for
the relief of sterility applies also to the female
except for endocrinology which has become by
usage, the field of the gynecologist.
Read before Mt. Sinai Hospital Medical Society, January
13, 1949.
The Author
• Dr. Garber, Cleveland, Ohio, is a graduate
of Western Reserve University School of Medi-
cine, 1910; fellow, American College of Sur-
geons; consultant, in obstetrics and gyne-
cology, Mt. Sinai Hospital.
In the cases to be reported, the following pro-
cedures were carried out before treatment was
begun:
1. Examination of semen as to quantity, vis-
cosity, morphology and endurance. If the
semen was found deficient, the husband was
referred to an urologist for study and treat-
ment.
The wife underwent the following examina-
tions:
a. Detailed general, menstrual and marital
history.
b. Physical and pelvic examination with espe-
cial regard to vaginal and cervical secre-
tions and pelvic tumors, infections and dis-
placements. Gas insufflation for patency
of the fallopian tubes was done. Exami-
nations of urine, blood, serology, and basal
metabolic rate were also done. Special en-
docrine problems involving the pituitary,
thyroid and ovary were investigated prior
to treatment and as far as possible, the
gland causing the dysfunction was deter-
mined.
These examinations have shown clearly that
in many cases, there is more than one factor
concerned in sterility, and the treatment was
varied accordingly.
For the successful treatment of sterility, at-
tention should be paid to minor as well as major
factors. This involves educational, local, con-
stitutional, endocrine, roentgenological and surgi-
cal treatment.
EDUCATIONAL
The proper placement of the seminal fluid in
the vagina is quite important especially in men
of low fertility. In cases of uterine displace-
ment, the external os may be out of reach of
the meatus; for proper insemination, modifica-
tion of posture during intercourse is advisable.
36
The Ohio State Medical Journal
Sexual excesses or intercourse at long intervals
are both conducive to infertility.
Intercourse should be timed to coincide with
ovulation and a period of several days continence
before ovulation time may be helpful.
Unnecessary frequent douching, especially with
certain fragrant douching powders are to be
interdicted. If the acidity of the vagina is
high, a douche of one tablespoon of soda bicarb
to two quarts of water one-half hour before
coitus may be used. Getting out of bed to urinate
immediately following intercourse may result in
the loss of a major part or all of the seminal
fluid.
Removal of phallus from vagina immediately
after ejaculation may result in considerable loss
of seminal fluid, especially in women with a
short vagina and shallow perineum.
LOCAL
Hostile vaginal and cervical secretions may
destroy the viability of the sperm before they
get a chance to enter the cervix. A douche of
Ringers’ solution with 2 per cent glucose before
coitus during the fertile period may be used
to overcome this condition. Cervical plug of
thick inspisated mucus or muco-pus presents an
insurmountable barrier to the ascent of the
sperm. This is to be treated with the cautery.
Caution should be exercised in this procedure
not to destroy the cervical glands completely or
produce stenosis of cervix. Endocervicitis should
be treated although as a rule, it is not as
frequent a cause of sterility as is the cervical
plug.
The constitutional treatment in healthy women
deals mainly with their state of nutrition, obesity
and anemias, if present. A high protein diet is
prescribed for all women. Obesity is rather
common among sterile women and weight re-
duction is undertaken in conjunction with small
doses of thyroid extract when the basal metabolic
rate is within normal limits. Larger doses of
thyroid are given to women with a low metab-
olism. Similarly moderate anemias are treated
with iron. Vitamins E and A are prescribed
on general principles in the hope that there may
be a Vitamin E or A deficiency causing hypo-
ovarianism.
THE ENDOCRINE TREATMENT
A certain number of sterile women present
definite dysfunctions of the pituitary or ovarian
glands. The diagnosis is not always clear but
can be made in a goodly number of cases from
a detailed history, physical and pelvic exami-
nation. The problems in these cases center
mostly around the menstrual function and uterine
hypoplasia: amenorrhea, oligomenorrhea, ir-
regular menses and small or infantile uterus.
These are treated by various combinations of
estrogens, progesterone and chorionic gonad-
otropins. There are no hard and fast rules
to follow in this treatment but generally speak-
ing patience and sufficient treatment succeed in
a considerable number of cases. In cases of
pituitary deficiency, X-ray exposure may regulate
TABLE II
Female Sterility 73
1.
2.
Complete or Partial Tubal Obstruction
Uterine Hypoplasia -
19-25%
17-23%
9-12%
4-4%%
4- 4%%
5- 6%
3
3.
4.
Infected Cervix (Cervical Canal Plugged)
Ovarian Failure _ __ _
5.
Pituitary Obesity
6.
Hypothyroidism
7.
Cystic Ovaries
8.
Fibroid
3
9.
Endometriosis _
2
10.
No Ovulation
2
11.
Anxiety Neurosis
1
12.
P.e-fnsal to Inseminate Wile
1
13.
Acute Antefle-xinn
1
14.
Malignant Hypertension after
Therapeutic Abortion
1
15.
Tight Vagina (Dyspareunia)
1
73
the menstrual function and relieve sterility.
Two cases of successful pregnancies followed
this treatment (Table 2).
SURGICAL TREATMENT
Surgical treatment includes the following:
Repeated tubal insufflation and biopsies, dila-
tion and currettage, stem pessary, removal of
pelvic adhesions, and plastic operations on the
tubes. In cases of partial tubal block, repeated
gentle insufflation may straighten out a tube
distorted by adhesions. In such cases two in-
sufflations a month, several days apart are
done during the fertile period. In case of preg-
nancy following repeated tubal insufflations for
partially obstructed tubes, ectopic pregnancy may
occur (Table 3). A dilatation and currettage
TABLE III
Therapy
Diet and Thyroid 6
Diet and Thyroid+Endocrines 42
Plastic Operations on Tubes I 6
Myomectomy (Followed by Pregnancy) 1
Artificial Insemination 9
X-ray Therapy to Pituitary 2
may correct endometrial hyperplasia, regulate
menses and occasionally result in pregnancy.
In an acutely flexed uterus causing dys-
menorrhea, insertion of a stem pessary may give
relief occasionally but it is questionable whether
this procedure is of benefit in relieving sterility.
On the other hand, the correction of uterine
displacements either by pessary or suspension of
uterus are useful in the treatment of sterility.
In complete tubal occlusion an attempt may
be made to reestablish the patency of the
oviduct by a plastic operation on the tube. In
this series four pregnancies followed plastic
tubal operation and one after myomectomy.
for January, 1950
37
Three of these pregnancies resulted in full term
pregnancies. Endometriosis is usually accom-
panied by sterility. A pelvic operation for en-
dometriosis of an ovary or tube may relieve
the sterility. Artificial insemination of the
wife with her husbands’ sperm in case of cervical
obstruction or hostility may often prove success-
ful. In this series there was one successful
pregnancy in four women, thus inseminated.
In cases of aspermia the wife may be insemi-
nated with the sperm of a donor other than her
husband. It is successful in about 1/3 of the
cases, depending largely upon the fertility of
the donor.
Table I shows the ratio of male and female
sterility as 27 male to 73 female. However,
there were 8 cases in which there were male
and female defects, making the ratio 35 male
to 65 female. The average number of years
married was 5.5, which indicates that a mating
is not treated for sterility until several years
of married life elapsed (usually three years)
without the use of contraception. The youngest
patient in this series was 18 years old and her
sterility was due to complete tubal occlusion.
Table II deals with the causes of female
sterility and it indicates that the most common
causes were tubal block (19 per cent), uterine
hypoplasia (17 per cent), and cervical plug due
to infection (9 per cent) while pituitary, ovarian
and thyroid dysfunction accounted for 13 cases
about equally distributed.
Table III deals with the treatment. It will
be noted that 42 of the 73 women were treated
by diet, thyroid and endocrine preparations.
Nine were artificially inseminated and seven
underwent plastic operations on tubes and uterus,
while two had X-ray treatments of pituitary
gland. There were no cases of X-ray treatment
to ovaries.
Table IV deals with the results obtained in
the various treatments of this series: 31 women
became pregnant resulting in 41 pregnancies.
TABLE IV
Results
Number of Women Who Became Pregnant 31
Total Number of Pregnancies 41
Number of Viable Babies 33
Number of Miscarriages (1 Woman Had 3) 6
Number of Ectopic (Tubal) Pregnancies 2
(One Woman Had 2 Unruptured Ectopies)
(Previously One Ectopic)
Viable Babies after Plastic Operation
(One Following Myemectomy) 3
Viable Babies after X-ray Treatment 2
Number of viable babies was 33, miscarriages
six, ectopics two; three viable babies following
plastic operations and two viable babies after
X-ray treatment.
Table V shows that in six women with aspermic
husbands, four women became pregnant after
insemination and gave birth to six babies, five
of whom were viable and normal; while one
terminated at six months’ delivery due to pre-
mature separation of placenta.
TABLE V
Aspermia — Artificial Insemination
Number of Women Inseminated by Donor 6
Number of Women Who Became Preg-
nant 4
Number of Viable Babies 5
Number of Nonviable Babies 1
(6 Months Premature Separation of
Placenta)
Total Number of Pregnancies from Arti-
ficial Insemination (Donors) 6
Women Inseminated from Husband 3
Viable Babies from Insemination (Hus-
band) 1
There were also three women inseminated
from their husbands with one viable baby.
SUMMARY
One hundred consecutive cases of sterility
were reported with 41 pregnancies in 31 women,
with 33 viable babies, six miscarriages and two
ectopic pregnancies.
Many medical and surgical forms of treatment
and procedures were carried out since more
than one cause was found in most of these cases
of sterility. Attention to minor as well as major
factors as probable causes of infertility was
necessary to obtain good results.
The Sore Mucus-forming Colon ,
One of the commonest complaints of nervous,
tense women is soreness, mainly in the lower ab-
domen. It is associated perhaps with constipation
and usually with the frequent passage of mucus
and gas. I think it is most unfair to show these
women their roentgenograms and to tell them
they have a spastic colon. Every such woman has
a colon which tends to contract down hard on the
left-hand side, and what one should emphasize is
the fact that it is a perfectly normal colon; what
is wrong is only that the nerves are playing tricks
with it. Where I work the roentgenologists never,
from one year’s end to another, make a diagnosis
of a spastic colon; they know that practically all
colons are spas'.ic, so why mention it? As I said,
the big point to make to these persons is that the
colon is perfectly normal, and it is not particularly
subject to any disease such as cancer. The patient
never will come to -any bad end because of the
mucus colics. Another very important point is
not to call this trouble “colitis.” It is not colitis
because the colon is normal. The term “colitis”
should be kept for diseases in which the colon
is inflamed or ulcerated. — Walter C. Alvarez,
Rochester, Minn.; Rhode Island Medical Journal,
Vol. XXXII, No. 11, November, 1949.
38
T he Ohio State Medical Journal
Electro-Mechanical Aids In Resuscitation and Anesthesia*
MR. KENNETH WOLFE and MR. H. J. RAND, III
WE are presenting (1) a new mechanical
respirator operated by electric power;
(2) vacuum cupi electrodes for more ef-
fective massage of the failing heart; (3) an elec-
tric shock apparatus for shocking the fibrillating
heart into standstill from which condition it can
resume a normal rhythm.
MECHANICAL RESPIRATOR
Many devices have been used to provide arti-
ficial respiration but there are few machines
which effectively serve the dual purpose of anes-
thesia and resuscitation. Two of the latter type
in present day use are the respirators designed
and used by Dr. Clarence Crafoord, Stockholm,
Sweden, and by Dr. Frederick R. Mautz, Cleve-
land, Ohio. These machines compress the re-
breathing bag by means of air pressure and the
latter machine requires a source of compressed
air for operation. The first machine has an
electrically driven air compressor but is not
adapted for use with standard anesthesia gas
apparatus. We developed this particular design
embodying an electric power unit and mechanical
compression because we recognized the need for
a respirator which can be used anywhere that
a gas machine can be used. Alternating current
is always present and modern engineering prac-
tice has made its use as safe as the use of com-
pressed air.
The respirator is equipped with a General
Electric one-sixth horsepower explosion-proof
alternating current motor, an explosion-proof
“Off-On” switch, and a standard plug. The ma-
chine must be grounded in accordance with pro-
visions of the local electrical code. The motor
pulley drives by means of a belt a gear reduc-
tion unit, the output shaft of which rotates a
can which in turn moves an aluminium disc up
and down compressing the rebreathing bag
against a stationary upper disc. The upper
disc can be raised or lowered by means of
the “Pressure Control” knob in order to ad-
just the pressure when the oxygen flow into the
system is maintained at a constant value. The
bag is fastened to the two discs by rubber cuffs
cemented to the bag and a slight suction is de-
veloped during the expiratory phase of respira-
tion. The cam is so designed as to produce a
respiratory cycle similar to that of normal deep
breathing. There is a gradual increase in pres-
sure to a peak, a pause consisting of 25 per cent
*Part III of a symposium on “Acute Cardiorespiratory
Failure: Requirements for Successful Resuscitation”, pre-
sented at Annual Meeting of the Ohio State Medical Asso-
ciation, Columbus, April 20, 1949.
of the cycle, and then a sudden release of
pressure. This is the mechanism produced by
the anesthetist as 'she compresses and releases
the rebreathing bag. The mechanical respirator
repeats this cycle at a selected rate, 14 to 28
respirations per minute, as long as needed. The
speed is varied by turning the “Speed Control”
knob which loosens or tightens the driving belt,
thus changing its position in the groove of the
expansion pulley and giving the machine a two
to one speed range. The surgeon, performing-
delicate surgery on the heart or elsewhere in the
chest, can adapt his reflexes to the rhythm of the
machine.
The transition from routine anesthesia by the
closed system with a tracheal tube in place is
easily accomplished.
1. Start the motor and adjust the rate.
2. Remove the rebreathing bag from the gas
machine and make an airtight connection be-
tween the carbon dioxide absorber and the
respirator outlet by means of a short rubber tube.
3. Fill the bag system with oxygen and anes-
thetic mixture. Adjust the flowmeter so as to
maintain a pressure of 10 millimeters of mer-
cury in the bag as recorded on the pressure
gauge.
4. During the operation, small changes in
pressure can be compensated for by adjustment
of the “Pressure Control” knob but large changes
must be taken care of by means of the gas
machine controls. With an air-tight closed
system, there will be very little variation in
pressure except when additional lobes of lung
are collapsed to provide exposure.
MAINTENANCE
Occasional lubrication of the motor pulley is
required. The rebreathing bag can be easily
removed for cleaning. We recommend the use
of water only as many solvents will dissolve the
cement binding the bag and cuffs.
VACUUM CUP ELECTRODES AND ELECTRIC
SHOCK APPARATUS
The second apparatus has two functions: First,
the vacuum cup electrodes aid in providing an
effective heart beat by massage; secondly, the
controlled shock brings all the muscle fibers of
the fibrillating heart into complete standstill
from which condition it can resume a normal
rhythm.
Before the heart can be defibrillated success-
fully, it must be massaged until much of the
dilatation is eliminated, until a good tone re-
jor January , 1950
39
places the flabbiness of the ventricular wall, and
until the color becomes pink showing that oxy-
genated blood is circulating through the heart.
Hand massage alone is frequently inadequate
and does not bring about these conditions.
The apparatus operates on 110 volts alternat-
ing current. The vacuum cup electrodes are
placed on opposite sides of the fibrillating ven-
tricles. Each vacuum cup has its own vacuum
pump and associated controls so that the suction
can be adjusted to the exact amount necessary
to hold it firmly against the ventricular wall.
The power switch actuates the motor driven
pumps and pilot light; the control valves adjust
the amount of vacuum produced as indicated
on the gauges. Approximately 5 inches vacuum
has proven satisfactory on the dog heart and
this adjustment is made with the cups in con-
tact with the ventricular wall. The heart is
now massaged vigorously at a slower than nor-
mal rate so that it can fill and empty as in life.
In a few seconds it will become pink with oxy-
genated blood.
When we are ready to shock the heart, we
turn on the power switch which also actuates a
buzzer and a pilot light to inform the surgeon
that the apparatus is ready for use. The auto-
transformer and the variable resistor are ad-
justed to give approximately one ampere through
the heart. The alternating current voltage is
indicated on the voltmeter and the current on
the ammeter. The surgeon can administer the
shock by means of the switch on the handle or
his assistant can use a switch on the panel
itself. This switch also energizes the pilot light.
If the first shock is unsuccessful, further
massage is carried out, procaine is used on the
surface and in the ventricles, and a second shock
is given at a slightly higher current. If ad-
ditional shocks are necessary, the current is in-
creased gradually for each shock until the maxi-
mum is reached. This increase is obtained by
turning the auto-transformer knob to the right
until the maximum voltage is reached and then
turning the variable resistor handle to the right
to reduce the resistance. When the normal heart
beat returns, it is aided by gentle massage and
stimulated by the injection of adrenalin. Arti-
ficial respiration, by means of the mechanical
respirator, is continued until normal respiration
returns.
CONCLUSION
In this apparatus, we have combined proven
principles of resuscitation in such a manner
that the surgeon has readily available the es-
sentials to revive a failing heart. We have
introduced a new concept in the use of vacuum
cups as an aid in effective massage of the heart.
We have developed a mechanical respirator
which should prove of value in both anesthesia
and resuscitation.
Mass Radiography
I have recorded elsewhere the serious limita-
tions, erroneous interpretations, and liabilities
of mass radiography and the relative poverty of
its contributions to preventive medicine. Un-
doubtedly it has an important propaganda value,
but it is the propaganda of fear by which the
public — yes, and the medical students — are being
frightened into the erroneous belief that active
progressive disease is symptomless and only the
radiology can reveal it. It can be proved to have
been responsible for the infliction of much un-
necessary mental and physical pain.
Mass surveys are essentially bureaucratic regi-
mentation measures designed by officials and en-
thusiasts who appear not to have the knowledge
of the five omissions or the experience to judge
the efficiency of the measures adopted, and, while
they themselves are spared the rigours and anx-
ieties of the general practitioners attending to
the sick, would decry the contributions of these
latter doctors to the reduction of the incidence
and mortality from tuberculosis. Mass radiog-
raphy has not added anything new to our knowl-
edge of radiology of the chest. The evidence ob-
tained by it has been used to re-emphasize the
fact that 4 per 1,000 of the population have signs
of active tuberculosis; but not enough impor-
tance has been placed on the other confirmatory
evidence it has yielded — i.e., that at least ten
times as many persons, or 40 per 1,000, have
had fairly extensive disease and recovered from
it without knowing of its existence and in most
cases without having lost time from work. Had
radiography been applied to all these at the stage
when the appearances suggested activity it would
have inflicted on them the dreaded stigma of
tuberculosis and seriously interfered with their
lives without contributing any good. A little rea-
sonable education in hygiene would have accom-
plished much more, at less expense in money,
equipment, buildings, personnel, and above all in
feelings.
Because there would appear to be conditions
of medical service which permit certain cases of
pulmonary tuberculosis to be overlooked by medi-
cal officers is an indication not that the progres-
sive disease is symptomless but that the clinical
examinations are poor; for when such patients
return home the diagnosis is made by the par-
ents, confirmed as grave by the general prac-
titioner, and registered as deadly by the con-
sultant a few days before death. The greater
the percentage of cases of unknown progressive
tuberculosis discovered by mass radiography, the
poorer the clinical medicine that has been ap-
plied.— James F. Brailsford, M.D., British Medi-
cal Journal, No. 4630, October 1, 1949.
40
The Ohio State Medical Journal
Sight Restoration Program of the Cleveland Society
For the Blind
CHARLES I. THOMAS, M.D.
IN 1944, a member of the Board of Trustees
of the Cleveland Society for the Blind had
the thought that there might be a consider-
able number of people who came under the care
of the Society who possibly might be helped
by medical and surgical aid. This individual
discussed the proposition with Dr. W. E. Bruner,
and it was decided to investigate the records
and evaluate the medical status of each person
who was enrolled in the program of this organ-
ization.
Dr. Bruner asked me to collaborate with him
in this work and the entire program was con-
ducted under his supervision. Our procedure
was as follows.
In order to determine the number of people
who might be helped by treatment, either surgical
or medical, the record of each individual was
carefully examined and those that presented
a favorable diagnosis, or one that suggested the
possibility of sight restoration, was withdrawn
and classified for further examination and study.
It did not take long to realize that a considerable
number of people would fall into the group for
the sight restoration program, and the Society
would be faced with a heavy financial burden
to pay for the hospital care that was necessary
to carry this out.
Funds for this program could not be allocated
from other departments so it was assumed that
the program must have a separate endowment
and these funds must be obtained from outside
interests.
As the Cleveland Society for the Blind is a
community-supported organization, it attempts
to keep the people of Cleveland informed of its
activities. In order to raise additional funds
for the sight restoration program, certain peo-
ple in Cleveland were approached to whom the
program was outlined and explained, and contri-
butions were asked. The response was favorable
and during the first year $10,000 was raised by
donation. This, of course, was only to be used
for sight restoration procedures such as sur-
gical and medical hospital care, nursing service,
medication and eye glasses.
With such a program, a certain amount of
publicity is inevitable, but we feel that this has
always been on an ethical basis and we must
certainly admit that it has been essential in
obtaining the necessary financial aid that makes
the program function.
TWnften^dfV,befA°re tK,Sec.tion on Eye> Ear> Nose an
Throat at the Annual Meeting of the Ohio State Medici
Association, Columbus, April 19, 1949.
The Author
• Dr. Thomas, Cleveland, Ohio, is a gradu-
ate of Western Reserve University School of
Medicine, 1935; diplomate, American Board
of Ophthalmologists; fellow, American Col-
lege of Surgeons; member, American Academy
of Ophthalmology and Otology; and senior
clinical instructor in ophthalmology, University
Hospitals, Cleveland.
In order to show what a program of this type
costs, the following figures are from the financial
statement of the organization: The donations to
date have amounted to a total of $19,704.17.
This is inclusive from February, 1944, to Decem-
ber, 1948. Of this amount, $16,748.70 has been
spent to date. Itemizing the expenditures, we
find the following:
1. Hospital $8,816.47
2. Nursing 5,510.50
3. Research, including laboratory
equipment and technician 1,000.00
4. Eye glasses - 1,071.80
5. Medicines 50.93
6. Photographs 30.00
These figures show that there is a relatively
small balance for further work, but we feel
confident that the program will continue on its
present basis through additional contributions.
In selecting the cases that might possibly
benefit by surgery, the records of 1400 people
were examined, and from these, 332 were selected
whom we believed offered hope of sight restora-
tion. In order to examine and study this group
of cases completely, 658 clinics were held to pick
further from this number those that the sur-
geons felt could be offered treatment. As a
result of this, the number of operations has
totaled 120, and the number of hospitalizations
has been 125, the additional five being for post-
operative complications that developed, which
needed re-admission for treatment.
The following is an analysis of the surgical
procedures carried out.
CATARACTS
The number of cataracts totaled 41. Of this
number, 25 per cent were known to be com-
plicated or secondary cataracts before operation,
and consequently the general pattern of the
extraction had to be altered to meet the situa-
tion. This is a rather high percentage of such
for January, 1950
41
cases but in such a group of patients it should be
expected as many had previous eye diseases of
an inflammatory nature, and others had been
subjected to surgery with poor results so that
further surgery was discouraged. As a result,
this organization contained many who considered
themselves hopelessly blind. In connection with
this, it is interesting to comment on a case of
uncomplicated senile cataract that came to the
attention of the examining doctors. On ques-
tioning this patient it was found that some
twenty years before he was told that cataracts
were developing but that he was not ready for
surgery, and he was advised to wait for a while
until the cataracts became more advanced. His
deficiency in vision led him to the Society for the
Blind and he became taken up in their activities
and the nature of his visual handicap forgotten.
In one of the clinics when we first saw him, his
condition was recognized and after assuring
him that he had waited much more than a suf-
ficient time, namely twenty years, he was
operated for mature senile cataracts, and is now
at work as a machinist.
In general, it may be stated that the results
of the cataract surgery were good, at least com-
parable to any similar group of cataract patients.
IRIDECTOMIES
The number of iridectomies totaled eighteen,
of which eight were optical iridectomies, and
ten were preliminary iridectomies. Five received
sufficient benefit so that further surgery was
unnecessary. The remaining three cases had
corneal transplants. Of the ten preliminary
iridectomies, six' were done before corneal trans-
plants, and the other four were done before
lens extraction as these cases presented secondary
cataracts with synechia.
DISCISSIONS
Seventeen needlings were performed, all of
which were necessary as the result of extra-
capsular lens extraction.
KERATECTOMIES
Six operations for superficial keratectomy were
performed. On all of these patients, the opera-
tion was done as a preliminary procedure before
corneal transplant. The superficial vascularized
layer of cornea was removed in the usual manner
in areas ranging from one quadrant to the
entire area of the cornea. In all of these cases,
Beta radiation was begun after forty-eight hours.
This was applied to the limbus adjacent to the
area of cornea operated, and in all cases it was
effective in preventing the invasion of newly
formed blood vessels.
ENUCLEATION
One case requiring enucleation for absolute
glaucoma was brought to the attention of the
Society for the Blind. This was uneventful.
One repair of an almost complete symblepharon
of upper and lower lids was carried out. Sat-
isfactory cul-de-sacs were restored without trans-
planted mucous membrane by the method out-
lined by Castroviejo. In brief, this consists in
dissecting the superficial corneal layers above
and below back beyond the limbus, and suturing
the free edge to the limbal region. The cul-de-
sac was restored by the freed mucous membrane
and sutures drawn through to the skin.
OPERATIONS FOR GLAUCOMA
This group consists of four trephine opera-
tions, four cyclodialysis operations and one pro-
cedure for iris inclusion. These operations for
glaucoma represent only five patients. One case,
it is interesting to note, had five operations for
chronic simple glaucoma before the intraocular
pressure was satisfactorily controlled. This pa-
tient had two trephine operations, one iris in-
clusion operation, and two cyclodialysis opera-
tions. In spite of the extensive surgery, the
eye is in good condition, and the removal of a
cataract is contemplated. The other cases consisted
of four trephine operations, two of which were
in preparation for cataract extraction where
chronic, simple glaucoma was also present.
CORNEAL TRANSPLANTS
Twenty-seven corneal transplant operations
were performed in this group of cases, and of
this number 80 per cent resulted in clear grafts.
This figure corresponds quite closely to other
authors on the subject. An analysis of the
operated cases is as follows:
1. Interstitial keratitis due to syphilis 8
2. Interstitial keratitis due to tuberculosis 3
3. Interstitial keratitis of unknown eti-
ology 3
4. Gruenows’ Dystrophy 2
5. Corneal leukomas 10
6. Post-cataract uveitis and keratitis 1
27
You are all acquainted with the usually ac-
cepted method of corneal transplant, so the
details of the operative procedures will not be
gone into in detail except to comment on the
operation performed on the aphakic eye.
The donor material for this short series of
corneal transplants was obtained both locally
and from the Eye Bank for Sight Restoration,
the latter organization very generously supply-
ing corneas within a short time following the
request.
The corneal transplant operation, when done
on the aphakic eye, presents a special problem in
procedure which the author would like to out-
line. This was carried out on one case in this
series. The method as described here will appear
in a forthcoming edition of the Archives of
Ophthalmology.
In general, the corneal transplant operation
42
The Ohio State Medical Journal
can be performed successfully on the aphakic
eye, but it presents special problems, both in
regard to the technique employed, and in regard
to the surgical judgment in selecting the cases
to be operated.
These cases can be divided into three groups:
1. Clear corneas that become opaque after the
cataract operation has been done.
2. Corneal scarring due to keratitis follow-
ing postoperative uveitis.
3. Cases presenting both an interstitial ker-
atitis and mature cataract wherein the cataract
operation was done first and the resulting vision
was not as good as had been anticipated.
In cases showing both corneal leukoma and
cataract, wherein it has been determined before-
hand that the cataract does exist, it is a much
simpler and safer procedure to carry out the
corneal transplant first and the cataract ex-
traction later, after a clear central area of
cornea has been obtained. When the operations
proceed in this order, the corneal transplant
offers no special problems.
HowTever, when the surgery is carried out in
the reverse order, or the cataract is removed
first, the operation will progress without com-
plications until the anterior chamber has been
opened and then there will be an overwhelming
loss of vitreous. This fact has been recognized
for many years and reported in the writings of
Rycroft and Somerset, Filitov and Elschnig. If
the lens has previously been removed there must
be something in its place to keep the posterior
segment intact, or as nearly intact as possible.
To remedy this, Filitov devised a spatula for
inserting into the anterior chamber to hold back
the vitreous. However, this spatula requires a
counterpuncture in the cornea which is not de-
sirable, and it does not possess a curve that ap-
proximates that of the cornea, thus to seal
off the opening more securely when grafting.
In order to remedy these two factors, the author
devised the following instruments, which con-
sist of:
1. Two spatulas or blades having an average
corneal curve with rounded ends and measuring
six and seven millimeters in width, and fourteen
millimeters in length.
2. Holder for spatula having flat, grasping
surface and easy release mechanism.
3. Magnet for stabilization of blades.
4. Special six and seven millimeter keratomes.
In brief, the technique of the operation is:
After preparing the central area of cornea
for grafting through the stage of inserting
the sutures, the special keratome is inserted
at the limbus parallel to the proposed area for
grafting. The spatula is then inserted and
carried to the opposite limbus where it is fixed
and held securely to the posterior surface of
the cornea by means of the magnet. The area
that will be replaced by the transplant is re-
moved and the graft inserted. The sutures are
drawn over in the usual manner and the spatula
is removed. The latter incision is closed by a
silk suture.
The advantages of this instrument can be
enumerated as:
1. Ease of management.
2. No counter puncture necessary.
3. The curve of the spatula more or less
simulates the corneal curve which tends to block
the opening.
4. The blades or spatulas that are introduced
are of the same size as the keratomes so that
the fit is tight and prevents leakage of vitreous
through this opening.
In such a small series of cases the complica-
tions were very few, and those usually seen will
not be discussed here as you are all acquainted
with these problems and the methods of dealing
with them. Three cases of postoperative iritis
developed that required hospitalization and treat-
ment. All healed satisfactorily.
However, two of the cases presented a com-
plication not frequently seen, namely corneal
fistula, and the author would like to discuss the
method of handling this problem. One of the
fistulas was very small, and closed following
several cauterizations with iodine. This is the
accepted method of treating such a complica-
tion, and in the smaller fistulas it is usually
successful. Let me emphasize here the need for
prompt action and closure of these draining
sinuses. Failure to do so predisposes the eye
to an increase in intra-ocular tension by the de-
velopment of synechia, and closure of the filtra-
tion angle. The other fistula was quite persistent
and large enough to require special consideration
for closing. This larger fistula resisted the
above method of closure, and consequently
another method had to be resorted to. To
close this, the edges were curetted and a
small piece of mucous membrane was trans-
planted to the fistulous area and sutured
securely to the area. This acted as a scaffold
to allow fibrosis and resulted in complete
closure.
CONCLUSION
In conclusion, it should be stated that the
Secretarial and Social Service Departments of
the Cleveland Society for the Blind deserve and
are given, a great deal of credit for their un-
tiring and faithful service in obtaining and
handling the patients, and in processing and
keeping the vast amount of data necessary in
carrying out this program. Appreciation is
also expressed for the financial support without
which this project could not have been under-
taken.
for January , 1950
43
A Case of Proven Systemic Histoplasmosis With
Apparent Recovery
VALERIE FRIEDMAN, M.D., J. E. BROWN, JR., M.D., and E. V. TURNER, M.D.
Histoplasmosis is a fungus disease
caused by Histoplasma capsulatum rec-
ognized in man in essentially two forms.
The usual form is a subclinical pulmonary in-
fection which on healing leaves areas of calci-
fication similar to healed lesions of tuberculosis.1
Healing is also accompanied by a skin sensi-
tivity to histoplasmin which is analogous to the
sensitivity seen in tuberculosis. In some areas
in the Midwest this type of infection is acquired
by over half the population.2
A rare form of the disease which is seen
especially in infants and children is charac-
terized by widespread systemic involvement and
has been thought to be uniformly fatal. Only
recently has the survival of patients with the
latter form of the disease been recognized
(Bunnell and Furcolow, three cases3 — Blumberg,
one case4). The following case report represents
another instance of non-fatal systemic histoplas-
mosis.
, CASE HISTORY
J. H., an 8-year-old white boy, was first ad-
mitted to the Columbus Children’s Hospital,
August 13, 1948, with the complaints of fever,
headache, and general malaise of four days’
duration. Family history, past history, and
functional inquiry were non-contributory.
This patient lived on a farm and drank pas-
teurized milk and tested well water which had
been reported “safe” for drinking. He oc-
casionally played in a creek draining sink and
bathtub water. He had a dog and a horse and
played among chickens.
He was well until June, 1946, at which time
he developed “mumps.” Following this infec-
tion he had a continuous low grade fever which
lasted until early fall of 1946. The fever was
unexplained, tuberculin skin test was negative,
and roentgenograms of the chest were essentially
normal. The following winter he was in ap-
parent good health. For the past two years the
patient has had an occasional attack of croup
occurring always at night and relieved with steam
inhalation.
Early in June, 1947, he had an attack of
bloody diarrhea diagnosed as amoebic dysentery.
Apparently amoebae were found on one of sev-
eral stool examinations.
Following this he was again in apparent good
health until June, 1948, when he had an illness
characterized by a week of irritability followed
by a week of anorexia, fever, listlessness, head-
ache, and abdominal cramps with ingestion of
food or liquids. A second identical attack oc-
curred in July, 1948. A third similar attack,
which led to his admission to the hospital, had
Printed before the Section on Pediatrics at the Ann
S!nAprn 21, °194°9 State Medical Association at Columb
The Authors
• Dr. Friedman, Los Alamos, New Mexico,
is a graduate of McGill University Faculty of
Medicine, Montreal, 1945; formerly, resident,
Children’s Hospital, Columbus, and instructor
in pediatrics. College of Medicine, Ohio State
University.
• Dr. Brown, Columbus, Ohio, is a graduate
of Harvard Medical School, 1929; diplomate,
American Board of Pediatrics; associate pro-
fessor, pediatrics, Ohio State University Col-
lege of Medicine.
• Dr. Turner, Columbus, Ohio, is a graduate
of Harvard Medical School, 1938; member,
American Academy of Pediatrics; on attending
staff and director of outpatient department,
Children’s Hospital; and asst, professor of
pediatrics. College of Medicine, Ohio State
University.
its onset about August 3, again with a week of
irritability followed by fever (102°-105° F.),
anorexia, and cramps with the taking of food
or liquids.
On physical examination we were presented
with a well-developed, well-nourished, white boy
appearing his stated age of eight years. He
was listless and lethargic. There was a pinched
look about his facies, and he was complaining
of frontal headache. The temperature on ad-
mission was 102.4° F., pulse 100; blood pressure
100/80; respirations 24. Cervical, axillary, and
inguinal lymph nodes were small, “shotty,” non-
tender, and were not felt to be enlarged. No
other lymph nodes were palpable. Eyes, ears,
nose and throat were essentially normal. The
chest was symmetrical and resonant to percus-
sion; expansion was equal on both sides. On
auscultation there was an area of depressed
breath sounds on the right from the mid-
scapular area to the base posteriorly. No rales,
rhonchi, or adventitious sounds were heard.
The heart was of normal size, it was regular in
rate and rhythm, and no murmurs were heard.
The abdomen was flat, and over the right
quadrant it was tender with some voluntary
splinting. The liver was not palpated. The
spleen edge was barely palpable and was very
tender. The remainder of the physical examina-
tion was essentially normal. Our admitting
differential diagnosis was: (1) Salmonella in-
fection; (2) undulant fever; (3) pneumonia.
The results of laboratory examinations on
admission were as follows: Urinalysis: 4 plus
acetone, 8-10 WBC/H. P. F. Serologic test for
syphilis was negative. Agglutination test for
heterophile antibody was negative. Agglutina-
44
The Ohio State Medical Journal
tion tests for Typhoid 0, H, Paratyphoid B,
Proteus 0x19, and Brucella were also negative.
No parasites or ova were seen in repeated stool
examinations. Blood count: Hemoglobin 13.1 gm.
per cent; white blood count 9,750, 60 per cent
Neutrophils with a shift to the left.
By the fourth hospital day the lymph nodes
which had been palpable on admission had en-
larged, and epitrochlear nodes were now pal-
pable. Two successive blood cultures taken
shortly after admission revealed no growth.
The child at this time had the appearance of
one in acute respiratory distress, namely, pinched
facies and extreme flaring of the alae nasi with
inspiration. Because of this appearance a roent-
genogram of the chest was made. This showed
widely dispersed, mottled and streaky infiltra-
tion throughout both lung fields more dense in
the bases and hilar regions which faded off to
the periphery. There was knotty enlargement
of both hilar regions, and a small amount of
fluid was present in the right base. Interpreta-
tion by the roentgenologist was as follows: “The
changes which are present could be on the basis
of simple virus pneumonia. The possibility of
tuberculosis and histoplasmosis along with other
types of fungus diseases are to be considered in
the differential.”
Patch test, intradermal test with weak and
strong tuberculin (PPD) were negative. Intra-
dermal histoplasmin test was strongly positive
in twenty-four hours. Cold agglutination test
was negative. The presumptive diagnosis was
now histoplasmosis.
It was at this time that the child’s first
cousin, his constant companion, a 5 Y2 year old
boy, was admitted with essentially the same
history and physical findings.
The entire first week in the hospital the
patient had a septic type of fever with one or
two daily spikes to 104° and 105° F. Starting
on the eighth hospital day the temperature spikes
gradually decreased, and the temperature re-
turned to normal by lysis at the end of the
second hospital week. The lymphadenopathy
gradually became more pronounced, but at no
time were the lymph nodes tender. The spleen
gradually enlarged to two fingerbreadths below
the costal margin. A peculiar feature was noted
that the abdominal tenderness, especially over
the spleen, was present only during elevations
in temperature. Anorexia was pronounced dur-
ing the first week of hospitalization. The diet
was reinforced with eggnogs and milkshakes,
and the patient was treated symptomatically.
He never coughed, and there was considerable
difficulty in obtaining sputum for analysis and
culture. However, from the time of admission
to about the eighth hospital day his breathing
was shallow, and there was flaring of the alae
nasi. On or about the eighth hospital day he
began to show clinical improvement in that he
ate better, seemed more alert, sat up in bed
and played, and both his appetite and general
disposition improved amazingly. The lympha-
denopathy and splenomegaly persisted through-
out the hospital stay.
Since the diagnosis of histoplasmosis was
merely presumptive, during the second week the
child was treated with intramuscular penicillin
and streptomycin. Streptomycin was also given
by inhalation.
On the seventeenth day of incubation the
initial blood culture demonstrated organisms
which were tentatively identified as Histoplasma
capsulatum. This was later confirmed in the
laboratories of Dr. Samuel Saslaw of the U. S.
Army Medical Center, Washington, D. C. Dr.
Saslaw also reported that histoplasma comple-
ment fixation antibodies were present in a
titer of 1:1280 and the histoplasma collodian
agglutination test was positive in a titer of 1:320.
Another blood culture which had been taken
on the twelfth hospital day also demonstrated
the organism. Attempts to isolate the fungus
from the bone marrow and sputum were unsuc-
cessful. X-ray studies of the chest were re-
peated on the fifth, eighth, and fourteenth hos-
pital days. They showed little change.
The patient was discharged home on the
fourteenth hospital day to remain at absolute
bed rest and to receive a reinforced diet. He
remained at home two weeks and gained four
pounds. He was readmitted because of a re-
currence of fever. Positive objective findings
on the second admission were: (1) “shotty”
cervical, axiliary, and inguinal nodes with pal-
pable epitrochlear nodes; (2) spleen-hard, non-
tender, palpable two fingerbreadths below the
left costal margin. Laboratory findings were as
follows: Urinalyses normal: white blood count
7,600; hemoglobin 11.3 gms.; polys 44 per cent
with a shift to the left; 39 per cent lymphs; 12
per cent eosinophils; 5 per cent monocytes.
Blood, stool, and a lymph node were cultured
for histoplasma, but no organisms were isolated.
The patient did not appear as ill as he had
during the first hospitalization. He was not
as apprehensive; his appetite had improved
considerably; he was alert and very cooperative.
His temperature which was 101.4° F on admis-
sion gradually returned to normal by the fifth
hospital day and remained normal. He was
again given aerosol inhalations of streptomycin
and penicillin. On the ninth hospital day under
a general anesthetic three small lymph nodes
were removed from the right inguinal area.
Microscopic sections of the lymph nodes re-
vealed focal areas which had the appearance
of granulomatous lesions. These areas con-
tained organisms morphologically identical with
Histoplasma capsulatum.
The child was discharged home on the twelfth
hospital day improved. The size of the spleen
had not changed; however, the epitrochlear
nodes were no longer palpable, and the other
lymph nodes had decreased in size.
Since discharge he has remained afebrile; he
has had no complaints; his appetite has been
good, and there has been a satisfactory gain
in weight. X-ray examination of the chest one,
two, and three months after discharge have
shown first a clearing of the patchy infiltration
in the periphery and recently calcification has
become evident in the left hilar glands.
The patient’s cousin, whom I briefly mentioned,
was also proven to have histoplasmosis. His
subsequent course has been equally satisfactory.
He has grown in stature and had an excellent
gain in weight. Roentgenograms now show only
hilar widening.
DISCUSSION
Generalized histoplasmosis in our patient was
characterized by fever, pulmonary infiltrations,
lymphadenopathy, splenomegaly, malaise, an-
orexia, vague gastro-intestinal complaints, and
leucopenia. Other cases have been reported
which in addition demonstrated hepatomegaly,
for January, 1950
45
diarrhea, jaundice, and anemia.5 Examples of
this infection have been reported in children as
young as two and three months.4
In our case the occurrence of a negative
tuberculin test and positive histoplasmin test
indicated the subsequent steps in investigation.
In some cases, however, the histoplasmin test can
remain negative in the face of a severe hist-
oplasma infection.3 Even the serologic tests
(complement fixation and collodion agglutina-
tion) may become negative in long standing in-
fections.6
The crucial diagnostic proof lies in the isolation
and identification of the organism from the
blood, bone marrow, sputum, or gland biopsy.
It may be mentioned that since it takes from
two to three weeks for histoplasma to grow out,
routine cultures in most laboratories would have
been discarded before growth could be expected.
Methods for the isolation of histoplasma have
been discussed by Howell.7
It should be noted that the original pulmonary
infiltrations were merely suggestive of mycotic
infection and that the calcifications were evident
only after convalescence was well established.
While this patient displays pulmonary calcifica-
tions on healing, it does not follow that the large
number of histoplasmin reactors with pulmonary
calcifications have had a similarly severe illness
in the past. Indeed, stories of such illnesses have
been extremely rare in the individuals who have
been discovered by surveys to have pulmonary
calcifications and negative tuberculin and posi-
tive histoplasmin skin tests. This is the basis
for the assumption that the infections which bring
about this roentgenologic and immunologic pic-
ture are subclinical in nature. Here again the
analogy to tuberculosis is quite evident.
Various therapeutic agents have thus far been
unsuccessful in the treatment of histoplasmosis.
We feel that in no way did the antibiotics we
used affect or alter the course of this patient’s
illness.
BIBLIOGRAPHY
. Palmer, C. E. : Non-Tuberculous Pulmonary Calcifica-
tion and Sensitivity to Histoplasmin, Public Health Re-
port, 60:513, May 11, 1945.
o' ^or’ John A.: Non-Tuberculous Calcification,
O.S.M.J., 44:700, July, 1948.
3. Bunnell, Ivan L., and Furcolow, Michael L. : A Re-
port of Ten Proved Cases of Histoplasmosis, Public Health
Report, 63 :299, March 5, 1948.
4. Blumberg, Richard W., Ruchman, Isaac, and Johans-
mann, Ralph J. : Generalized Non-Fatal Histoplasmosis in
an Infant, Pediatrics, 3 :296, March, 1949.
5. Parsons, R. J., and Zarafonetis, C. J. D. : Histo-
plasmosis m Man, Arch. Int. Med., 75:1, 1945.
6. Saslaw, Samuel, Personal Communication.
7. Howell, Arden, Jr.: The Efficiency of Methods for the
Isolation of Histoplasma Capsulatum, Public Health Re-
port, 63:173, February 6, 1948.
Treatment of anuria due to acute toxic nephro-
sis consists primarily of the rigid restriction of
the basal fluid intake to 500 cc. in twenty-four
hours, and of the salt intake to 4 Gm. in twenty-
four hours. Butt & Birchall, Jour. Fla. Medical
Assn., Dec., 1949.
The Story Behind the Word
Some Interesting Origins of Medical Terms
Hospital — This term is derived in English
from the French term “hospitale,” which was
a large house or palace where a guest was re-
ceived. Also from the Latin noun “hospes,”
meaning a guest or host or an entertainer or re-
ceiver of guests. Similar in derivation are the
words host, hostel and hotel. It may be well to
remember that by derivation hospitals are hosts
or hotels for the receiving of the sick.
Nurses — This term comes to us from the
Latin “nutria,” meaning to suckle or feed — to
care for the young — to mother. Literally mean-
ing “a mother to the sick.”
Uvula — This anatomical term for the small
fleshy mass hanging from the soft palate de-
rives its name from the Latin word “uva” or
grape. It was so called from its fancied re-
semblance to a small grape.
Quassia — Said to be so called after a Negro
named Quassy, who first discovered its medi-
cinal qualities. It is a South American shrub
whose wood is extremely bitter.
Plague — Literally this term means a blow.
It is derived from the Greek word “plege,” a
blow, and “plessein,” to strike.
Consumption — A name descriptive of the
course of the disease coming from the Latin
word “consumere.” It literally means to con-
sume, or to wear away.
Tuberculosis — Sylvius first applied the term
“tubercle” to the typical nodular lesions he found
at post-mortem, and from this grew the term
“tuberculosis.” Tuberculosis is a hybrid word,
part Latin and part Greek. It is derived from
the Latin “tuberculum” and the Greek “phyma-
tosis.” “Tuberculum” or “tubercle” means a
swelling or nodule. Phymatosis derives from the
Greek “phyma,” meaning a growth or tubercle,
and the Greek suffix “sis” which is used in form-
ing verbal nouns and denotes a process of pos-
session.
Cocaine — This word comes into our medical
vocabulary from the Spanish word Coca, which
in turn is derived from the Aymara Indian word
“khoka” signifying “the plant.” It was fre-
quently called the “Divine Plant of the Incas”
and the leaves had long been chewed by the na-
tives of Chile, Peru, and Bolivia to relieve
hunger and fatigue.
Catgut — The term “catgut” is supposed to be
a perversion of “kitgut,” or “kitstring;” the
Arabic word “kit” meaning a dancing master’s
fiddle. However, it is probable that at some time
“kit” was misconstrued as “kitten”; thus con-
veying the meaning of a young cat, and thence
the word “catgut.”
— Harry Wain, M.D., Mansfield, Ohio.
46
The Ohio State Medical Journal
Pneumococcic Meningitis: A Case Report — Complications,
Treatment, and Recovery
ROBERT E. SLEMMER, M. D.
THE mortality in pneumococcic meningitis
was 100 per cent1 prior to the use of
chemotherapy. This was reduced to 80 per
cent when sulfonamides were used1 and further
reduced to 40 per cent2 after the discovery and
use of the antibiotics, notably, penicillin.
It is suggested that the mortality will be
further reduced when treatment is begun earlier
using much larger doses3 of penicillin alone.
The following case history is presented in
detail.
CASE REPORT
The Author
• Dr. Slemmer, Cincinnati, Ohio, is a grad-
uate of Hahnemann Medical College of Phila-
delphia, 1933 ; asst, attending neurosurgeon, St.
Mary’s Hospital; instructor in neuro-anatomy,
Univ. of Cincinnati College of Medicine; for-
merly, resident in neurological surgery, White
Cross Hospital, Columbus.
R. R.-483-950.
A nine-year-old white male was admitted to
the Neurosurgical service of Drs. LeFever and
Secrest at White Cross Hospital on the evening
of May 21, 1948.
His chief complaint was nausea, vomiting and
stiffness of his neck.
The history of his present illness revealed that
he was in apparent good health until 2:00 a.m.
the morning of admission, when he suddenly
awakened, vomited, and complained of pain in
his left ear. He became progressively worse until
evening when he became delirious.
A review of his past medical history, as re-
lated by his mother, revealed that he had been
delivered spontaneously after a prolonged labor.
There had been considerable difficulty in getting
him to breathe.
When he was three weeks of age an assymetry
was noted in the frontal regions, the right being
more prominent than the left. His mother also
stated that there had been difficulty in getting
him to swallow since birth.
At seven weeks of age he was admitted to
the neurosurgical service at White Cross where
examination revealed a marked bulging in the
right frontal region. Phenolsulfonphthalein tests
were done. These revealed normal kidney excre-
tion. Following this neutral phenolsulfonphthalein
(Dandy) was introduced into what was thought
to be the right lateral ventricle. There was a
marked decrease in the excretion of the dye. The
diagnosis of a localized cystic arachnoiditis was
made.
A right frontal craniotomy revealed an agenesis
of the right frontal lobe (pole). The left frontal
lobe was visualized beyond the falx. He made
an uneventful recovery.
He walked at two years of age and started
to school when he was six. It was soon discovered
that the vision in his right eye was impaired.
In spite of this he did well and demonstrated
above average accomplishment in his school work.
Except for measles, chicken pox, and appen-
dicitis (1947), he was well until his present ad-
mission.
Physical examination revealed a well-developed,
well-nourished white male lying uncomfortably
Submitted February 10, 1949.
in bed, moaning and crying. His temperature
was 97.3, pulse 102, and respirations 20. Cervical
adenopathy was present. Examination of the
heart, lungs, and abdomen were normal.
Neurologic examination revealed that he was
semi-conscious. Muscle power could not be tested.
The deep reflexes were bilaterally equal and some-
what increased. The superficial reflexes were
present although diminished. There were flexor
responses on plantar stimulation. Funduscopic
examination revealed optic atrophy on the right
and engorgment of the veins around the disc
on the left. There was slight nuchal rigidity
present.
Lumbar puncture revealed a pressure of 380
mm. of water with milky spinal fluid. Smear
and culture revealed pneumococci.
Penicillin “G” (20,000 units) was injected in-
trathecally at the time of the initial puncture.
Eight subsequent injections were made in-
trathecally by barbitage.
Admission urine examination revealed 20 mgm.
of albumin and 1.4 gm. of sugar. Blood examina-
tion showed 13.9 gm. of hemoglobin, 4.9 million
red cells. The white count was 19,400 with 89
per cent neutrophiles, and 11 per cent lympho-
cytes.
Treatment consisted of sulfadiazine, 1 gm.
every four hours and penicillin, 300,000 units in-
tramuscularly, daily.
X-ray of the chest the day after admission
revealed an acute interstitial pneumonitis.
COURSE IN THE HOSPITAL
Four hours after admission his temperature
rose to 102. The pulse and respirations were
likewise elevated. Daily lumbar punctures re-
vealed elevated pressures, cell counts and pro-
teins. There were periods of remission, both
subjective and objective, followed by exacerba-
tions. The temperature ranged between 101 and
104. After two weeks of elevated spinal fluid
pressure his discs gradually became choked. One
month after admission there was very little
change in his condition.
The dose of penicillin was then increased from
300,000 units to 3.6 million units daily. The morn-
ing of the third day after the increased dosage
of penicillin the temperature, pulse, and respira-
tions abruptly became normal and remained so
for January , 1950
47
for the remaining month of hospitalization. The
choking of the discs promptly subsided.
On July 14, 1948, a bilateral sixth nerve palsy
developed, accompanied by a return of increased
pressure and choking. The right pupil dilated
and did not react to light. A right frontal abscess
was suspected.
Bifrontal burr openings were made. On the
right there was a marked increase in pressure.
There was a pseudo-membrane immediately
beneath the dura which was grossly and micro-
scopically an inflammatory exudate. Beneath this
was a cavity filled with cloudy fluid under in-
creased pressure. The cavity was located at the
site of the congenitally absent right frontal lobe.
It was lined with a grayish membrane. This was
completely removed exposing the cortex pos-
teriorly.
Smear and culture revealed no organisms.
Sections showed a suppurative process with ex-
tention into the arachnoid.
A few days after surgery the sixth nerve palsy
cleared and the pupils were equal. They reacted
to light.
flexes were intact. Percussion and vibration in
the right frontal parietal regions caused him to
cry out with pain.
Laboratory examinations revealed 20 mgm. of
albumin in the urine. Blood examination revealed
4.5 million red cells with 12.5 gm. of hemoglobin.
The white count was 11,500 with a normal dif-
ferential. The serum protein was 7.1.
On September 11, 1948, he was taken to
surgery for ventriculography. On the left, the
ventricle was entered without difficulty. On the
right the dura was tough and thickened. Imme-
diately beneath the dura there was a dense
grayish membrane which could not be penetrated
with a brain needle. This membrane was then
incised. At a depth of 5 cm. a firm resistance
was encountered. This was felt to be a tumor.
The burr opening and dura were enlarged to
approximately 5 cm. After removing the tough
outer membrane the entire right cerebral hemis-
phere was seen to be compressed by a reddish
gray mass which was from 1 to 1.5 cm. in thick-
ness. It extended from the occipital region to
the frontal region and from the midline to the
base of the cranium. (Figure 1.) The whole mass
was then removed, piecemeal, revealing that the
entire hemisphere had been so compressed that
mesially one could see the falx, superior and in-
ferior longitudinal sinuses as well as the superior
cerebral veins which were on a stretch as they
drained into the superior longitudinal sinus.
Posteriorly, the tentorium, transverse, and
straight sinuses were seen. Anteriorly, the frontal
region and space of the absent right frontal lobe
could be visualized. The convolutions were ex-
tremely flattened, gray and opalescent.
Immediately after the removal of the mass
the hemisphere began to expand. Spinal fluid
could be seen flowing up over the convexity of
the hemisphere.
Convalescence was uneventful. He was dis-
Figure 1
The patient was discharged, ambulatory, on
the sixth postoperative day without complaints.
He was advised to return in one month for
encephalography.
Encephalography, using helium, was done on
August 24, 1948. This revealed absence of the
subarachnoid markings with filling of only the
left occipital and left temporal horns.
On September 9, 1948, he was readmitted to
the hospital with a chief complaint of headache.
His mother stated that three weeks prior to
admission his writing had become less legible.
On the day of admission his speech became
jumbled and he became drowsy. He screamed
with pain in his head and lost consciousness.
Examination revealed a spinal fluid pressure
of 180 mm. of water. The fluid was clear and
colorless. It contained 6 red cells and 10 white
cells, 6 neutrophiles and 4 lymphocytes. Smear
and culture were negative.
Neurologic examination revealed that he was
semi-conscious. He had a right hemiparesis, right
central facial weakness, and a dilated right pupil
which did not react to light. His tongue pro-
truded to the right. The abdominal reflexes were
hypoactive on the right. There was an un-
sustained ankle clonus on the right with bilateral
extensor responses on plantar stimulation and
bilateral Oppenheim signs. The cremasteric re-
Figure 2
48
The Ohio State Medical Journal
charged from the hospital on the ninth day after
surgery.
He has been followed as an out-patient at
regular intervals. He is doing very well with his
school work. Except for optic atrophy on the
right he has no residual symptoms.
PATHOLOGY DISCUSSION
The gross appearance of the mass at opera-
tion was that of a tumor, possibly a meningioma.
The microscopic examination, however, revealed
chronic inflammation, fibroblastic proliferation,
and necrosis.4 5 6
Pneumococcal meningitis while usually asso-
ciated with penumococcic infection elsewhere in
the body, however, may precede infection else-
where, as in pneumonia.7 Chronic pneumococcic
infections may organize and constrict.8 This ac-
counted for the compression of the right hemis-
phere. In addition to this, blood vessel changes
occurred in the form of an arteritis and phlebitis
Figure 3
(Figures 2 and 3) in the late stage of develop-
ment.9
Cairns and Russell described three stages of
pneumococcic meningitis as found in autopsy
material. The early or acute stage showed
fibrinoid necrosis, the intermediate stage or stage
of stagnation of pus and the late or final stage
where they found proliferative vascular changes
and endarteritis fibrosa with thrombosis.
TREATMENT
A combination of sulfadiazine (89.5 gm.),
intrathecal penicillin (180,000 units), and intra-
muscular penicillin (62,415,000 units) were used.
Formerly the combination as used in this case
was the accepted treatment.2 10 More recently,
in fact during the treatment of this patient, an
exhaustive report3 indicated that it was not
necessary to use the combination. In addition,
the intrathecal use of penicillin was contra-
indicated. In the same paper it was pointed out that
the present dosage was much too small.
It was true in this case that when the dose of
penicillin was increased to 600,000 units every
two hours the meningitic symptoms stopped
abruptly. One could theorize that had the larger
doses been used early, perhaps, the intracranial
complication might not have occurred.
SUMMARY
A case report is presented of an organized'
pneumococcic meningitis which occurred in a nine-
year-old boy with a known agenesis of the right
frontal lobe who recovered following the use
of massive doses of penicillin and operative re-
moval of an organized fibroblastic constricting in-
tracranial mass.
BIBLIOGRAPHY
1. Dandy, W. E. : Lewis’ Practice of Surgery, 1945, VoL
12, pg. 338.
2. Walker, A. E. : Penicillin in Neurology. C. C. Thomas,.
1946, pg. 113.
3. Dowling, H. F. : The Specific' Therapy of Bacterial
Infections of the Central Nervous System. A. M. A. Con-
vention, Section on Nervous and Mental Diseases, June 24,.
1948.
4. Fidler, R. S. : Pathologist, White Cross Hospital, Per-
sonal Communication.
5. Hassin, G. B. : Emeritus Professor of Neurology, Uni-
versity of Illinois, Personal Communication.
6. Courville, C. B. : Director of the Cajal Laboratory, Los.
Angeles County Hospital, Personal Communication.
7. Cecil: Textbook of Medicine, VII ed., 1947, pg. 104,.
119 123
8. Mac Callum : Textbook of Pathology, VII ed., pg. 543.
9. Cairns, H., Russell, D. : Cerebral Arteritis and Phle-
bitis in Pneumococcal Meningitis. J. Path. & Bact., 58 :
649-665.
10. Waring, A. J., and Smith, M. H. D. : Combined Peni-
cillin and Sulfonamide Therapy in the Treatment of Pneu-
mococcic Meningitis. J. A. M. A., 126-418.
The Hollow Needle
This needle has been a mixed blessing. It
must bear the responsibility for spinal anes-
thesia, and for a number of procedures that sub-
stitute blind chemical destruction for clean ana-
tomical removal, such as the injection treatment
of veins, haemorrhoids, hernia, hydroceles, gan-
glia, bursae and other local swellings. On the other
hand, it has allowed the intravenous adminis-
tration of fluids — a method that may be life-
saving, but one that is greatly misused to-
day. Some people never seem able to allow their
patients to use the channels designed by nature
to receive nourishment and to evacuate waste.
Food and fluids given by the alimentary canal
allow the tissues to select and keep what they
want, and to reject what is harmful or surplus
to requirements. Fluids given intravenously by-
pass all the defences set up by the body to pro-
tect itself against excess of any constituent,
against bacterial emtry, against thermal, chemi-
cal, or physical damage; they give the patient,
what the surgeon thinks his tissues need and
what they are damned well going to get. Nearly
all drips set up at the start of an operation are
not merely unnecessary but harmful. At least
half of the drips set up afterwards are an auto-
matic routine or an assurance against worry
rather than a considered form of therapy. —
Sir Heneage Ogilvie, K.B.E., British Medical
Journal, No. 4629, September 24, 1949.
for January, 1950
49
Tuberculosis Abstracts
A Review for Physicians Issued Monthly by the National Tuberculosis Association
WADE HAMPTON FROST in 1937 pre-
sented a thoughtful appraisal of the
question “How Much Control of Tuber-
culosis?” After marshalling the available
evidence, he concluded that in this country we
had already reached a stage at which the bio-
logical balance was against the survival of the
tubercle bacillus and that eventually this disease
would disappear.
A British opinion of the same year was : “It is
idle to speak of the conquest of tuberculosis;
tuberculosis has not been and so far as one can
see never will be conquered.” This opinion was
endorsed recently by Medlar who found many
tuberculous pulmonary lesions unrecognized dur-
ing life in persons in the older age groups com-
ing to autopsy in New York City.
The question of the validity of Frost’s thesis
is of great practical as well as theoretical- im-
portance. His reasoning was briefly this: There
were many and sound reasons for doubting that
the rapid decline in tuberculosis in the preceding
half century had been due principally to the
measures which had been taken for the purpose
of preventing infection. Without question the
factors lumped together under the terms “ad-
vancing civilization and better living conditions”
had played an important role. There was reason
to believe, however, that the decline was due in
some part to the efforts made to control the
disease.
The direct attack has proved to be a more for-
midable undertaking than was at first realized,
but in Frost’s words: “If the effective control of
tuberculosis required complete isolation of all
open cases, . . . the present (i.e., 1937) status
could not be considered encouraging, for . . .
(many) such cases are discovered in a fairly
advanced stage, and the isolation even of cases
known to the authorities is probably less than 50
per cent complete. However, for the eventual
eradication of tuberculosis, it is not necessary
that transmission be immediately and completely
prevented but only that the rate of transmission
be held permanently below the level at which a
given number of infection-spreading cases suc-
ceed in establishing an equivalent number (of
‘open’ cases) to carry on the succession. If the
number of infectious hosts is continuously re-
duced, the end result . . . must be extermination
of the tubercle bacillus.”
He placed a single qualification upon his con-
clusion that “As to the maintenance of this bal-
ance, favorable to us, unfavorable to the tubercle
bacillus, there are, of course, elements of uncer-
tainty, among them uncertainty as to the stability
of our civilization.”
Only 12 years have passed — too short a period
upon which to base inferences in regard to long-
time trends — during which the very existence of
civilization has been threatened. The world has
undergone one of the greatest military, social, and
economic upheavals in history. It is, therefore,
pertinent to review the experience of this decade
and inquire whether the Frost thesis is still
tenable.
Despite their limitations, mortality rates pro-
vide the best available index of the biological
balance over long periods of time. During the
war years, mortality from tuberculosis increased
in most of the western Europe nations involved
in the conflict, while those countries that escaped
the rigors of war were little affected. In western
Germany the rate is still higher than in 1938.
In Belgium and the Netherlands, as in England
and France, the rate rose during the war, but by
1946 was already down to or below the 1938
level. In Denmark, Sweden, Switzerland and
the United States, mortality continued downward
during the war.
It appears, therefore, that the disturbances due
to the war have* been insufficient to effeet more
than a temporary setback in declining death
rates. It would appear then that, where civiliza-
tion is relatively advanced, the biological balance
is still against survival of the tubercle bacillus.
To what extent this is due to indirect socio-
economic causes or indirectly to control measures
is still a difficult question to answer. In the
United States, progress has been made toward
more effective measures of control despite the
war. In the field of specific therapy the most
important contribution was, of course, the dis-
covery of streptomycin which is now receiving
extensive clinical trial. Experience with it thus
far gives hope that eventually an antibiotic may
be discovered which will suppress growth of the
microorganism in the tissues and rapidly ter-
minate the infectious state of pulmonary tuber-
culosis. With such an agent, the seedbed of the
disease could be more rapidly reduced.
Granting continuation or strengthening of con-
trol efforts in addition to favorable socio-economic
developments in a world at peace, it would seem
not unreasonable to expect that the balance,
favorable to us, unfavorable to the tubercle
bacillus, will be maintained and that the decline
in mortality from tuberculosis will be sustained,
even to the point of disappearance from some
areas. There is nothing in the record up to date
that is inconsistent with Frost’s thesis. Is Area
Eradication of Tuberculosis Possible? Editorial,
American Journal of Public Health, June, 19 U9.
50
The Ohio State Medical Journal
The Proceedings of the General Medical Society of
Ohio in 1829
ROBERT G. PATERSON, Ph. D.
AN item of extreme rarity has recently be-
come the possession of the Committee on
'^‘Medical History and Archives of the Ohio
Archaeological and Historical Society. It is the
“Proceedings of the General Medical Society of
Ohio” held in 1829. Mrs. Deitchman, widow of
Dr. Louis S. Deitchman, now of Los Angeles,
California, and formerly of Youngstown, Ohio,
is the donor of the gift.
If one needed a justification for the labors
of the Ohio Committee on Medical History and
Archives it can be found in the story of this
gift from Mrs. Deitchman. In the January, 1938,
issue of The Ohio State Medical Journal, there
appeared an account by the present writer in
The Historian’s Notebook of the “Proceedings”
under discussion.1 The account was based upon
a photostatic copy of the “Proceedings” secured
from the only known extant copy held by the
Army Medical Library, Washington, D. C.
Following this publication a letter was received
from Dr. Deitchman of Youngstown stating that
he possessed a copy of the “Proceedings” and
giving an account of the manner in which he
secured it.2 He rescued it in a wastebasket
that had been brought down from an attic. If
he had not known what it was it would have been
thrown away as trash.
In the May, 1938, issue of The Ohio State
Medical Journal in The Historian’s Notebook a
more complete attempt was made by the writer
to record the early history of medical organiza-
tion in Ohio.3 This account led Dr. Deitchman
to write a detailed account of the “Proceedings.”
This appeared in June, 1938. 4 In this article
Dr. Deitchman wrote, as follows:
“The first meeting of the General Medical
Society was duly ‘holden’ in Dec., 1827, in
Presented at the Sixty-fourth Annual Meeting of the Ohio
State Archaeological and Historical Society, April 23, 1949.
the town of Columbus, as Dr. Paterson states.
Unfortunately the only reference to this
meeting is found in the constitution of the
society, which states that same was adopted
in 1827 and is now, in Jan., 1829, amended.
There is no mention of reading of minutes
of the proceedings of the 1827 meeting or
any other information. What a pity! Let
us hope that somewhere there is a detailed
record of this first meeting of the State
Medical Association.”
Dr. Deitchman, in this quotation, did not
read carefully, or overlooked, a statement made
in the May issue to the effect that the Ohio
Committee on Medical History and Archives
had acquired a copy of the “Proceedings of 1827.”5
This was secured from Goodspeed’s Bookshop,
at Boston, Massachusetts, and so far as present
information reveals completes the printed records
of all state medical organization held in Ohio.
The subsequent developments respecting the
“Proceedings of 1829” may be of interest. As
soon as our Committee learned of Dr. Deitchman’s
holding, correspondence was begun with him to
have him deposit the “Proceedings” with the
Committee. Then World War II intervened
and Dr. Deitchman joined the medical service of
the United States Army as a major in August,
1942. Upon his return in April, 1946, negotia-
tions for the pamphlet were reopened. On
September 4, 1946, he died of coronary occlusion
at age 52. His widow faithfully carried out
his previously expressed intentions.
The entire episode illustrates the profound
truth of Pasteur’s observation that “chance
favors the prepared mind.”
It seems quite fitting that this account should
be written at a time when the Ohio State Medical
Association is gathered in its 103rd annual meet-
ing here in our city. Truly, the more than
for January , 1950
51
7,400 physicians in Ohio stand upon the shoulders
of the early pioneers of medical organization
in Ohio as portrayed in the Proceedings of 1827
and 1829.
BIBLIOGRAPHY
1. Paterson, Robert G. : Early Medical Organization in
Ohio — Its First Publication, O. S. M. J.f Vol. 34, No. 1,
January, 1938, pp. 66-7.
2. Deitchman, Louis S. : Letter in Files of the Ohio Com-
mittee on Medical History and Archives, 1938.
3. Paterson, Robert G. : The First Medical Convention
in Ohio, O. S. M. J., Vol. 34, No. 5, May, 1938, pp. 660-1.
4. Deitchman, Louis S. : Proceedings of the General Medi-
cal Society, 1829, O. S. M. J., Vol. 34, No. 6, June, 1938,
pp. 680-2.
5. The Proceedings of the Medical State Convention,
Begun and Held in the Town of Columbus, December 10,
A. D., 1827, Published by Order of the Convention, Zanes-
ville: Printed by Adam Peters, 1828.
Medicine 100 Years Ago
Professor Howard’s Clinic of the Starling
Medical College: Nov. 10, 1849, No. 21. B. W. E.,
age 3 years, from Columbus. For the last six
months this little boy has had symptoms of stone
in the bladder, suffering very much therefrom.
Three weeks ago, on sounding, a small stone was
detected. Through the consent of the parents,
the little patient was brought before the class
for operation. Complete unconsciousness and
quiet sleep was induced by chloroform. While
the child was in this state, Professor Howard
cut for and removed the stone, within the space
of three minutes. He (the child) was entirely
unconscious of suffering, and did not experience,
in the slightest degree, that constitutional shock
so common and terrible after capital operation
in surgery.
* * *
Number 24. M. D., age 13, male, Franklin
County. Case — Chronic inflammation and thicken-
ing of the periosteum of the ulna, (one of the bones
of the arm) five years’ standing. The part affected
is extremely painful, particularly at night, as is
usual in all similar affections of the bones.
The doctor recommended rest and the persever-
ing use of Iodide of Potassium, with the Emp.
Ammon C. Hyder to the part.
* * *
Number 25. A. L., age 2 years, female, Pick-
away County. Case — Strumous Ophthalmia,
(scrufulous sore eyes). Has decidedly scrufulous
diathesis. Suffers from great intolerance of
light, yet but slight indications of inflammation
of the eye.
Dr. H. assured the class that though this
was very distressing and sometimes obstinate
complaint, a specialty cure might be affected
by nutritious food, exercise in the open air, pur-
gatives and tonics. — Ohio State Journal, Novem-
ber 12, 18U9.
* * *
No. 39. R., aged 3 years, Columbus. Case —
Impetigo Figurata — on the scalp, neck and face.
Prof. Howard made some remarks respecting
the confusion in diagnosis of diseases of the
52
skin growing out of their great numbers, and
the strong resemblance between many of them
and dwelt upon the necessity of becoming familiar
with the leading characteristics of, at least, the
more important classes. The case before the
class was a pustular eruption, a very troublesome
and loathsome disease, sometimes with difficulty
distinguished from others of the same class. The
proper treatment consisted in evacuants and
correctives to the general health, with frequent
ablutions and some preparations of sulphur,
locally applied.
* * *
No. 41. B, a male infant from Columbus.
Aneurism by anastomosis, (mother’s mark) oc-
cupying two thirds of the upper lid of the eye.
Growing rapidly. The professor alluded to sev-
eral plans which have been adopted for the
removal of these obnoxious and unsightly
growths, which usually make their appearance
upon the face. The seton, vaccination, caustic,
etc., have been successively tried, but were
generally unsuccessful. The actual cautery with
hot needles, was now the most approved remedy
for this disease. Three or four heated needles
were passed through the tumor, in the present
case, with but slight pain to the patient. The
object of which was the ultimate obliteration of
the vessels of which the tumor was composed.
* * *
No. 44. Mr. F., aged 45, from Delaware, Ohio.
Case — Dislocation of the Elbow backwards;
seven weeks’ standing. Several unsuccessful
attempts had been made, by a number of very
respectable physicians, to reduce this luxation.
Prof. H. stated that, in the course of twenty
years, he had had a large number of these old
dislocations of the elbow presented for reduction.
Many of them he had attempted to reduce. In
some of the most recent cases he had succeeded,
but in no instance had he succeeded after the
dislocation had been over three weeks’ standing.
The locking together of the bones — the resist-
ance of powerful antagonistic muscles and the
firm adhesions between the lacerated and dis-
placed ligaments, all conspired to oppose reduc-
tion. At the urgent solicitation of the patient,
whose daily bread depended upon the restored use-
fulness of his arm, the doctor consented to apply
Jarvis Surgical Adjuster, in order to afford him a
chance of success. The Adjuster was applied and
extension kept up about an hour, while a portion
of the time, the patient was under the influence of
chloroform. Although the reduction was not
complete, the patient has been able, since the
operation, to flex the arm nearly to a right
angle. Such has been the improvement that,
notwithstanding his intense sufferings, he is
anxious to submit to still another trial. —
Ohio State Journal, Tuesday evening, Dec. b,
18b9.
The Ohio State Medical Journal
The General Practitioner and the Hospital Staff
EDWARD J. McCORMICK, M.D.
The Author
• Dr. McCormick, Toledo, Ohio, is chairman
of the Advisory Committee and a member of
the Executive Committee of St. Vincent’s Hos-
pital, and director of surgery at Maumee Val-
ley Hospital, Toledo. He is a Fellow of the
American College of Surgeons, is a Past-
President of the Ohio State Medical Association
and is presently serving as a member of the
Board of Trustees of the American Medical
Association.
THE general practitioner is the supporting
structure of all medical practice. Only the
uninformed could possibly take exception to
this statement. Eighty per cent of the practice
of medicine is in the hands of doctors in general
practice, who serve loyally night and day at the
bedside, in the home and in the office consulting
room. There is no more heroic saga of service
to humanity by any group of men or women
which can surpass that of the rural or city phy-
sician, who has given his or her life to the health
of the community in which they live and who
recognize early in their careers that self-sacri-
fice in the broader field offers a greater satisfac-
tion than the limited fields of specialization.
To be the family doctor, friend and counsellor
-on all subjects, a community leader and adviser
^places the practitioner of general medicine on
a plane with those to whom the welfare of souls
is entrusted. He is a well-trained medical man,
-frequently possessing a diagnostic sense which
transcends the maize of modern complicated
.'laboratory tests. He is trained in pediatrics, ob-
stetrics and in emergency care and by contact
as well as by study develops a knowledge of psy-
chiatry which cannot be acquired except by the
daily practice of general medicine and an inti-
mate knowledge of the trials, tribulations and
frustrations of his many patients and friends.
His years of college and formal medical train-
ing make him a “standout” among his fellows of
all vocations, because if he is a good family
doctor, he has gained what many men have
missed — a knowledge of his own limitations.
WELL-EARNED PLACE
This is not intended to be a eulogy for those
-in the field of general medicine but an attempt
by one in a specialized field to accord to the
deserving their well-earned place in the field of
medical organization and to impress upon the
profession and hospital executives that without
-general practice there can be no medicine in our
present economy, and to carry to the public the
thought that an unwarranted demand for spe-
. cialty service results in an unnecessary high
.cost of medical care and may well be the seed
and the root whence springs the present hue
and cry for federalization of medicine, threaten-
ing our Democracy and free enterprise system.
Your narrator is not a neophyte in the prob-
lem of the relationship of the general practitioner
to the hospital. It was with satisfaction, as an
officer of the American Medical Association, that
Delivered at the meeting of the Protestant Hospital Asso-
■ ciation, Cleveland, Ohio, September 24, 1949.
I participated in the establishment of the Sec-
tion on General Practice in 1946. I recognized the
desire of large hospitals at that time to establish
general practice sections.
My own activity in the field antedates the birth
of the section on general practice in the A.M.A.
As Secretary and later Chief of Staff of a
hospital of three hundred and fifty beds, I
caused to be written into our constitution
a section titled at that time “The Active
Unassigned Staff.” This change provided for staff
and voting privileges for general practitioners
excepting the care of staff patients and the
teaching of interns and residents. These latter
duties were accorded to the specialty groups in
which the intern or resident was serving.
I am now of the opinion that teaching privi-
leges should be given those general practitioners
who can qualify in some special field and there
are many who have, by work and study, become
experts in various fields though not limited to
any specialty.
At the present time we have many general prac-
titioners on our active staff and our courtesy
staff. The Secretary of our staff and of our
Executive Committee is a general practitioner.
These members are privileged to attend and par-
ticipate in all staff functions and meetings. They
may hold office and serve on committees. Direc-
tors of departments may make use of the talents
of these men on active staff service if they so de-
sire. The provisions of our constitution fifteen
years ago and in its present form provide that
a general practitioner may be elected to senior
staff grade after a definite number of years of
sevice, which roughly approximates the time re-
quired for the surgeon or other specialist to gain
senior staff membership, which in the latter case
is predicated on College membership or Board
recognition in conjunction with a sufficient period
ffor January, 1950
53
of preceptorship and observation to satisfy all
concerned that the specialist is competent and
is actually limiting his work.
JUNIOR MEMBERSHIP
The constitution of our hospital fifteen years
ago provided for Junior membership, a non-voting
status wherein younger men who had not limited
their work or obtained sufficient specialty train-
ing were permitted to work under supervision
or preceptorship in various departments for a
period of five years, during which time he or she
was asked to obtain the necessary credentials
for eventual Senior staff membership in the de-
partment to which he or she aspired, or step
aside and eventually apply for membership on the
unassigned active staff.
In its present revised form, Junior member-
ship is eliminated to provide greater facilities
for our resident teaching program, which we feel
will provide a sufficient number of young men
who will qualify for specialty positions. We
have justified the elimination of our Junior staff
in various specialties upon the fact that most
of the young men who come to us for staff
privileges have already had several years of hos-
pital training and our volume of teaching cases
is sufficient to train specialty residents but not
large enough to give additional training to our
younger practitioners. We also believe that a
general hospital should not attempt to train gen-
eral practitioners as specialists.
Many of the general practitioners on our
Senior staff are former interns and junior resi-
dents. We shall soon have general practice resi-
dencies, as the building program now under way
will enlarge our capacity to approximately five
hundred beds.
PLAN MUTUALLY SATISFACTORY
We have found this plan, which I have outlined
in a rather general manner, to be satisfactory
not only to the hospital but to the general phy-
sician who is accorded recognition. As time
goes on, we will no doubt make additional
changes but after fifteen years of experience, we
are certain that no mistake has been made. For
the good of the public, the profession and the
hospitals, the so-called “Closed Staff” should be
relegated to the oblivion to which it belongs as
far as the voluntary hospitals are concerned.
If the general practitioner cares for 80 per cent
of the sick, he is entitled to care for his patient
in the hospital and seek consultation and help
when he deems the same necessary. It also fol-
lows that if hospitals are to maintain teaching
and special facilities that these should be avail-
able to the great majority of doctors, the heroes
of general practice, and be not confined to interns
or residents.
It is my observation and belief that those in
the general medical field, having received the
recognition to which they are justly entitled,
grow in knowledge by contact and become more
proficient, render better service to their patients
and, because of professional association and ad-
vice, do not attempt to walk where “Angels fear to
tread.” While our consideration, in staff organi-
zation, of the general man may not be perfect,
it has gradually developed over a fifteen-year
period to a point where much has been gained
in proper recognition of the family doctor.
VISIT TO JAPAN
In the summer and fall of 1948 I was fortunate
in that I became a member of a medical group
of five men invited by General Douglas Mac-
Arthur, to make a survey of the medical condi-
tions in Japan. Our experiences on this trip by
air across the Pacific and return, coupled with
an exhaustive survey of medicine in Japan, was
an education. One or two of our observations
are presented to you now as having direct bear-
ing on the relationship of the general practi-
tioner to the hospital, although no parallelism
can be drawn between American medicine and
medicine in Japan or any other country where
government monopoly has existed.
There were in Japan, at the time of the Amer-
ican occupation, 51 second-class medical schools
known as Semmon Gakko Schools. The origins
of these diploma mills were originally normal
schools and were stimulated by the Japanese gov-
ernment contrary to the advice of the better ele-
ment in the Japan medical profession. The idea
was to produce a grade of doctor willing to prac-
tice in rural and occupied areas but not in
Japan proper.
The number of graduates and political pres-
sure eventually changed the original plan and
these men, with some clinical lectures but no
basic science experience or laboratory work or
dissection, were permitted to practice in Japan.
REGULATIONS TIGHTENED
General MacArthur and Brigadier General
Sams have closed some of these schools, others
were put on probation and must reach university
level or be eliminated. Certain of these schools
were connected with 19 universities giving a sec-
ond class medical course in addition to the regu-
lar university medical curriculum.
In 1945, 5,380, or 61.2 per cent of Japanese
medical graduates were from Semmon Gakko
schools. Had this continued until 1949, 8,870
would have graduated in 1949 — 76 per cent from
second-class schools.
ARROGANT PEDAGOGY
Certainly the loss of the war was a boon to
Japanese medicine. There was no intern or resi-
dent service in Japan. In the regular medical
ranks there was an aristocracy of teachers and
54
The Ohio State Medical Journal
researchers who looked down their noses at any
practitioner and who “lost face” if any one could
understand their lectures.
All hospitals were controlled by the govern-
ment, prefectures, municipalities or certain
groups. The staff was on full time, poorly paid
and the general practitioner had no hospital
connection and lost his patient on the hospital
steps. As a result hundreds of three, four, five
or six-bed hospitals were opened by doctors. The
conditions in these hospitals were a challenge to
American imagination and beyond your speaker’s
descriptive attainments. S.C.A.P. moved to close
these .institutions as rapidly as possible and to
make available for qualified members of the pro-
fession the facilities of regular hospitals, poor
though they were.
I narrate these observations to bring to mind
the fact that monopoly and cliques whether in
government, in hospitals, or in the profession,
can have a deleterious and fatal effect on the aims
and purposes of scientific medicine and the public
health. Exclusion does not promote good medi-
cine.
That hospitals should be centers for specialists
only is not tenable. In our eagerness to raise
standards of professional efficiency, we may at
times have been blind to basic facts but it was
never the idea of the American College of Sur-
geons or the Council on Medical Education and
Hospitals of the American Medical Association to
establish a system wherein 80 per cent of our
medical personnel would be denied the advances
necessary to give good medical care to the people.
FAULTY DIRECTION
The editorial page of California Medicine in
one of its 1947 issues sums up the problem in
these words, “The purpose of the American Medi-
cal Association and the American College of Sur-
geons has not been to elimiate capable doctors
from staffs nor to concentrate the practice of
medicine in the hands of a few. The fact that
such a fault seems to be arising is rather the
fault of administration and a failure to analyze
and direct the hospital system.”
The American Board of Surgery, in a resolution
passed December 14, 1946, expressed itself as
follows: “The American Board of Surgery is not
concerned with measures that might gain special
privileges of recognition for its certificants in
the practice of surgery. It is neither the in-
tent nor has it been the purpose of the Board to
define requirements for membership on the staffs
of hospitals. The Board specifically disclaims
interest in or recognition of differential emolu-
ments that may be based on certification.”
E. H. L. Corwin, Ph.D., in his book, “The
American Hospital,” 1946 edition, P. 155, states:
“In the future there will be no excuse to make
a major hospital staff appointment from among
any except those who have met the standards
of their respective specialty boards.” It is
this attitude which has put capable general prac-
titioners in a difficult position. I believe that it is
not the attitude of those concerned with stand-
ardization and better medicine.
A.M.A. STAND
The House of Delegates of the American Medi-
cal Association on December 10, 1946, passed the
following resolution:
“Resolved that hospitals should be encouraged
to establish General Practitioner services. Ap-
pointments to a general practice section shall be
made by the hospital authorities on the merits and
training of the physician. Such a general prac-
tice section shall not per se prevent approval of
a hospital for the training of interns and resi-
dencies. The criterion of whether a physician
may be a member of a hospital staff should not
be dependent on certification by various Specialty
Boards or memberships in Special Societies.”
Teaching institutions and centers should be
the first to lead the way. Theirs is the duty
of teaching sound medicine to all, not to a few.
All of us interested in the future of medicine
must lend our abilities to the creation of more
and better general practitioners and de-emphasize
specialization. The future of medicine in Amer-
ica will be determined by our immediate ap-
proach to this problem.
Those of us interested in doctor-hospital re-
lationship must give earnest thought to the re-
lationship of the general practitioner to the hos-
pital. We must, of course, have a reasonable
quota of specialists and consultants. I am sure,
however, that the man or woman in general
practice will be among the first to demand mini-
mum requirements in the general practice field,
which is the aim of the American Academy of
General Practice. This group is demanding a cer-
tain number of postgraduate hours each year for
the maintenance of membership in the organiza-
tion. If this requirement is rigidly enforced,
the Academy of General Practice will become a
virile organization in the medical field and if it
is neglected, the Academy will eventually “die on
the vine” as progress in the field of general
practice is the main reason for its existence.
It should be our aim and purpose not to ex-
clude but to include in hospital staff organiza-
tion those in non-specialized fields. They can
gain not only greater standing by such affilia-
tion but greater knowledge and the specialty
groups, by contact with the general practice
field, can develop broader horizons and appre-
ciation of the problems of the general medical
field.
IMPORTANCE TO PATIENTS
The real improvement, however, will be to the
patients who will find available good medical
service conveyed to them by men and women in
for January , 1950
55
whom they have great confidence, the result of
intimate contact. The great problem of medical
cost will be partially resolved by more general
and less specialized advice. Much useless ex-
penditure will be prevented when the public
learns that the medical thinking of our grand-
fathers was correct. Their first haven was the
family doctor. Those who wander here and
there, choosing first one specialist and then an-
other upon the advice of friends and acquaint-
ances, never accomplish much from a health
standpoint in the final analysis. Nurses, hos-
pital personnel and technicians are frequently
devoid of any real knowledge of physician and
specialist abilities. The one who does know is
the family physician.
There is no one in the medical profession who
has a greater claim on hospital recognition than
the general practitioner. He or she does not
desire to teach surgery or gynecology or radi-
ology or any other specialty. Nor do they de-
sire promotion above their merits and qualifi-
cations and such recognition should not be ex-
tended. There is, however, a great chasm be-
tween over-recognition and exclusion. Neither is
justifiable. The betterment of the profession,
the expansion of hospital and medical service to
the public and the good of the public health from
a scientific and financial viewpoint demand that
those of us in the fields of standardization, hos-
pital administration and specialty practice
“Render to Caesar the things that are Caesar’s.”
Never in the history of American medicine has
such a course been more necessary than the
present time, as it is conceivable that the funda-
mentals of American Democracy may hang in the
balance.
Opinion of Attorney General
The syllabus of Opinion No. 926 of Attorney
General Herbert S. Duffy is as follows:
“1. A general health district board of health
may enact rules and regulations governing the
quarantine of persons infected with a communi-
cable disease.
“2. A general health district board of health
may enact regulations governing the quarantine
of tuberculosis patients.
“3. Whether a general health district board
of health may impose a quarantine according to
Section 4429, General Code, depends upon the
reasonableness of the proposed regulation in
respect to locale, prevalence of the disease, exist-
ing control measures and the fact and circum-
stances peculiar to the particular case.
“4. Under normal circumstances, in view of
control measures now available, ‘home quaran-
tine’ of tuberculosis patients, according to Sec-
tion 4429, General Code, would seem arbitrary
and unreasonable.”
Veterans Administration
Veterans Administration announced the ap-
pointment of Dr. Harry H. Botts as manager of
the Chillicothe, Ohio, V. A. hospital.
Dr. Botts formerly was manager of the V. A.
hospital in Marion, Ind. Prior to that appoint-
ment, he had been manager of the Chillicothe
hospital.
He succeeds Dr. Cecil B. Shrout who is retir-
ing from his position as manager at Chillicothe
after 32 x/z years of Government service.
* * *
Private dentists handled 84 per cent of the
treatment cases completed during the fiscal year
ending June 30, 1949, under the Federal program
to treat eligible veterans for service-connected
dental conditions.
A statistical report shows 430,271 treatment
cases completed by private dentists and 83,372
by clinics located in V. A. regional offices.
In Ohio the records showed 4,396 treatment
cases completed by V. A. staff dentists at a value
of $245,749; 30,772 treatment cases completed by
private fee-basis dentists at a cost of $2,878,038.
Of examination cases completed in Ohio, 25,010
were by V. A. staff dentists at a value of $292,-
719; 9,913 were by private dentists at a cost of
$136,429.
Teams of doctors and other specialists, set
up to improve the treatment and care of dis-
abled veterans requiring artificial limbs, braces
or other orthopedic devices, have been estab-
lished in 25 cities, Veterans Administration an-
nounced.
The V. A. said that “Orthopedic and Prosthetic
Appliance Clinic Teams” are operating on an
out-patient basis and only for veterans with
service-connected disabilities.
Twenty-three of the 25 clinic teams are
operating in Regional Offices. The other two are
in temporary quarters and will be moved to the
Regional Offices in the cities where they are lo-
cated as soon as space is available.
Veterans who are in need of the services of
these clinics receive transportation to and from
their homes to one of the nearest offices. Offices
in the vicinity of Ohio are at Chicago, Detroit,
Philadelphia, Pittsburgh, and Louisville.
* * *
Veterans Administration announced it has
awarded a $6,985,905 contract for the construc-
tion of a 500-bed general medicine and surgical
hospital in Chicago.
* * *
A recent survey showed that in every V. A. hos-
pital in the nation some form of musical activity
goes on regularly. Of 130 hospitals, 34 had
full-time music specialists.
56
The Ohio State Medical Journal
"Tfene *)t *h t 950 f
Time To Make
Hotel Reservations
for the
1950 Annual Meeting
Medical Association
Cleveland, Ohio .
. . May 16,
17, 18
NAME AND LOCATION
SINGLE
DOUBLE
DOUBLE
TWIN BED
ALLERTON HOTEL, 1802 E. 13th St.
$3.50-6.50
$5.50-10.00
$6.00-10.00
$2.50 R¥
$4.00 RW
AUDITORIUM HOTEL, 1315 E. Sixth St.
$3.50-3.75
$5.50-6.00
$7.50 and Up
$4.50-5.00
$7.00
CARTER HOTEL, PUBLIC SQUARE
$4.75-7.00
$7.00-10.00
$8.00-12.00
CLEVELAND HOTEL (Headquarters Hotel)
$4.50
$6.50-9.00
$9.00-14.00
HOLLENDEN HOTEL, 610 Superior Ave.
$3.50-8.00
$5.50-10.00
$7.00-14.00
OLMSTEAD HOTEL, Superior & E. Ninth
$3.00-6.00
$5.00-8.00
$7.00-9.50
$7.00-9.50
STATLER HOTEL, Euclid at E. 12th St.
$4.00-6.00
$7.00-10.00
$8.00-12.00
HOTEL RESERVATION BLANK
Mail the coupon to hotel selected
Manager Hotel, Cleveland, Ohio
You are requested to reserve the following accommodations during the period of the Annual Meeting
of the Ohio State Medical Association, May 16, 17, 18, 1950, or for such other period as may be
indicated herein.
□ Single Room with Bath □ Double Room with Bath Price
□ Twin Bed Room with Bath □ Suite
Arriving May at A. M. P. M.
PLEASE VERIFY MY RESERVATION
Name
Address
Ohio State
for January, 1950
57
SECOND CALL FOR ENTRIES IN
Sci&ttifcc a*td ScUi&ztiixital £xfa(kt
1950 Annual Meeting, Ohio State Medical Association
May 16-18, Cleveland Public Auditorium
ONE of the outstanding features of the 1950 Annual Meeting of the Ohio State
Medical Association, May 16-18, Cleveland Public Auditorium, will be the SCIEN-
TIFIC AND EDUCATIONAL EXHIBIT. The exhibit held in connection with
the 1949 meeting in Columbus was highly praised by members attending the meet-
ing. Efforts will be made to make the 1950 exhibit even bigger and better than
the one in 1949 and in previous years.
This is a general invitation to members of the Ohio State Medical Association
to participate, as well as others who have display material which will be of scien-
tific value and of general educational value to physicians.
Please note: Exhibit material does not have to be strictly scientific. If it
presents data which will be of general educational value to the medical profession,
it will be considered by the committee which has full authority to accept or reject
applications at its own direction.
On the opposite page will be found an application blank. If you have material
suitable for an exhibit, or know of some colleague or group of physicians having
interesting material to display, send in an application and suggest to others that
they do so.
The Scientific and Educational Exhibit will be in the same hall with the
Technical Exhibit. This will be a grand break for both exhibits.
The firm which handles exhibits for the American Medical Association and which
handled exhibits for the 1949 0. S. M. A. meeting — Advertising Displays and Decora-
tions, Cleveland — will supply the equipment and supervise the erection of the exhibit.
Equipment and facilities similar to that used at A. M. A. meetings will be used.
The accompanying picture shows the type of booth which will be provided.
Type of Booth To Be Used for Scientific Exhibits
Booths will be of uniform color and de-
sign ; solidly constructed of wood and
wTallboard ; skirted with velour. There
will be a shelf. The upper area will be
covered writh taut blue crash fabric for
bulletin board background and will per-
mit the tacking or taping of charts and
specimens without fear of damaging the
exhibits. Fluorescent lights are a part
of the background.
58
The Ohio State Medical Journal
Application
For Space in the Scientific and Educational Exhibit
1950 Annual Meeting • Ohio State Medical Association
Cleveland Public Auditorium Cleveland, Ohio May 16-18, 1950
*pill Out cutd ta:
CHARLES L. HUDSON, M. D„ Chairman
Committee on Scientific and Educational Exhibits
2102 Abington Rd., Cleveland, Ohio
1. Title of Exhibit:
2. Description or nature of exhibit: (attach 200-word description to this blank).
3. Will radiologic viewing boxes be needed? If so, state number and size:
Number of boxes needed Size required
(Please indicate if you plan to furnish own view box.)
4. Will you require shelf space? If so, how much?
5. How much floor space will you require?
6. How much back wall space will you require?
7. How much side wall space will you require?
8. Other material or equipment required:
9. Name of exhibitor:
(Street) (City)
10. Name of institution cooperating in exhibit (if desired) :
Cost of transporting exhibits to the meeting must be borne by individual
exhibitors as well as the costs of cards, signs, etc., which are a part of the exhibit.
The Ohio State Medical Association will provide without cost to the exhibitor
the following: Exhibit space, shelves, sign for booth, view boxes, current, furniture,
decorations, etc., providing all items are approved in advance by the chairman of
the committee. Watchman service will be provided for the exhibit.
for January, 1950
59
Problem of Malpractice . . .
Medical-Legal Authority Warns Physicians That Even Exercise of the
Highest Degree of Skill and Care May Not Ward Off Unjust Claims
AS the author of this article states, ‘‘No
physician is immune to a malpractice suit.”
The thorough discussion of the matter,
therefore, will be of interest to Ohio physicians
as well as to physicians throughout the nation.
The author, Dr. Louis J. Regan of Los Angeles,
is thoroughly competent as an authority on the
subject since he holds degrees both as Doctor
of Medicine and Bachelor of Law. The article
is reprinted from the November 12 issue of
The Journal of the A.M.A.
Malpractice constitutes a real threat to the
members of all the healing professions. Doctors
of medicine were attacked first and are still the
primary targets. In 1937 about 4,000 of them
were sued for malpractice in the United States.
The plague spread to involve dentists, osteopaths,
chiropractors, naturopaths, and nurses. Now,
even veterinary surgeons are being assailed with
malpractice suits with increasing frequency.
Public confidence in the medical professions is
seriously affected by the ill will and misunder-
standing engendered by these frequently un-
founded and sometimes malicious onslaughts
against medical practitioners. Past experience
teaches that in the event of another period of
economic recession it must be anticipated that
the number of claims will greatly increase.
No physician is immune to a malpractice suit.
Obviously a physician cannot be unjustly accused
of malpractice if he cares for every patient with
painstaking attention to the requirements of good
practice. However, the exercise of even the high-
est degree of skill and care will not ward off
the unjust claim. A point has been reached at
which any physician is unwise who does not rou-
tinely take all the available precautions to safe-
guard himself against the unjust accusation of
malpractice.
DUE OR ORDINARY CARE
The law requires that every person act with
due or ordinary care toward his fellows. Failure
so to act constitutes negligence. Due or ordi-
nary care means the degree of care commonly
possessed and exercised by the ordinarily pru-
dent person in the conduct of all his activities.
A standard is thus established which all must
meet. Anyone in everyday activity may be ad-
judged negligent if an injury to another person
or another’s property results from failure to do
something that the average person would do or
from doing something that the average person
would refrain from doing in the same circum-
stances.
There is a legal standard, too, which the pro-
fessional man must meet in carrying out his
professional activities. The standard is always
what the ordinary, reputable practitioner, in the
same field of practice, in the same or in a similar
locality, would do and what he would refain from
doing in a similar case.
The failure of a medical practitioner to meet
the standard of practice, with injury resulting to
his patient, constitutes professional negligence.
Professional negligence is called malpractice by
the courts.
PHYSICIAN-PATIENT RELATIONSHIP
An analysis of physician-patient cases reveals
that the courts almost uniformly hold that a
physician is bound (1) to use reasonable care,
attention and diligence in the performance of
his professional services; (2) to act according to
his best judgment in treating his patients, and
(3) to possess and exercise the degree of skill
and of learning which is ordinarily possessed
and exercised by members of his profession in
the same or in a similar locality. Failure to per-
form his duty in these respects is regarded as
malpractice. But if the physician has fully com-
plied with his duty and has exercised the requisite
degree of care and skill, he is not ordinarily held
liable for mere error of judgment (if there is
any) in the selection of the course of treatment
to be followed. The physician is justified in
his selection of a method of treatment if it is
one that would be approved by even a respectable
minority of his reputable colleagues in the lo-
cality. However, he cannot excuse himself on the
theory of mere error of judgment if he fails to
inform himself of facts by a proper examination
of the patient.
One who holds himself out as a specialist and
who claims to be expert in a particular field of
practice is held to a higher degree of care and
skill than is an ordinary practitioner. He must
possess and exercise the degree of care and skill
commonly possessed and exercised by the special-
ist in the particular field of practice.
Unless he so expressly agrees and undertakes,
a physician is not held to be an insurer or war-
ranter of the results of his treatment. A good
result is not impliedly guaranteed. Nonsuccess
or unsatisfactory results will not alone estab-
lish the elements of legal detriment. This point
is well illustrated in a case1 in which the court
said that a physician cannot be held responsible
for the failure of the patient to respond satis-
factorily to treatment or to make rapid progress
toward recovery if the physician used a treat-
60
The Ohio State Medical Journal
ment which was recognized and customary in
the medical profession and if he employed reason-
able skill and diligence.
The patient must always authorize or consent
to the treatment which is administered. Above
all, there must be consent to operation. Oral
consent is valid, but, obviously, proof of consent
is easier when the authorization is in written
form. With reference to consent, a New York
court in a controlling case2 said that every hu-
man being of adult years and sound mind has a
right to determine w~hat shall be done with his
own body and that a surgeon who performs an
operation without his patient’s consent commits
an assault for which he is liable in damages.
CASE OF STERILITY
In an operation on husband or wife the con-
sent of the one being operated on is sufficient.3
However, in an operation on either husband or
wife which is likely to result in sterility, it is
desirable to secure the written consent of both
the husband and the wife. It should be borne in
mind, too, that it is hazardous to sterilize any
person except on a positive medical examination.
In cases in which an operation is made com-
pulsory by law (such as vaccination or steriliza-
tion4) the law furnishes the consent. If an op-
eration is unlawful, consent to the performance
thereof does not absolve the surgeon from lia-
bility.
The consent of a person non compos mentis is
no consent at law. The consent of the one wTho
stands in the position of guardian to such a
person is required for performance of an opera-
tion. If the patient is a minor, consent to opera-
tion must be obtained from the parents or guard-
ian.
In an emergency which justifies immediate
action for the preservation of the life or health
of a patient, and in which it is not practicable
to obtain his consent or the consent of any one
authorized to speak for him, it is the duty of
the attending physician to perform such opera-
tion as good surgical practice demands without
such consent.5
In the absence of evidence to the contrary
there is a presumption that a physician has per-
formed the duty undertaken by him with reason-
able care and skill. Negligence or want of skill
must be affirmatively proved. The rule is well
established that a physician cannot be held liable
for the death of a patient under his treatment
where there is no evidence to show negligence
or lack of skill on his part to overcome the
prima facie case in his favor. In any case, how-
ever, when the plaintiff proves by a preponder-
ance of all of the evidence that he suffered in-
jury because the physician failed to act in ac-
cordance with the standard of practice in the
community, he may recover a judgment for mone-
tary damages against the physician.
In the ordinary case legal proof of malprac-
tice requires that some physician testify on be-
half of the patient. This requirement is readily
understandable, for only a physician is compe-
tent to say what is or is not good practice,
either in the diagnosis or treatment. A lay
person may state what was done, but only a
physician can testify as to the propriety of the
things done. Ordinarily, then, a malpractice
action will fail unless some physician comes into
court and gives testimony which, in effect, con-
demns the defendant physician’s conduct of the
case.
Expert testimony is unnecessary in actions
based on allegation of operation without con-
sent, invasion of the right of privacy or breach
of warranty to cure or to effect a certain result.
In matters which are within the common knowl-
edge and understanding of laymen, expert testi-
mony is not necessary. Further, whenever a
practitioner acknowledges fault or negligence, by
his own statement or admission, expert testi-
mony may not be required.
EXTRACTS FROM MALPRACTICE CASES
Extracts from a few cases will illustrate the
foregoing comments:
1. In a North Dakota case0 the court said
that, as a general rule, it is improper to submit
a malpractice case to a jury without expert tes-
timony to establish the standard according to
which the jury is to judge the conduct of the
defendant.
2. In a California case7 the court said that
standards of practice of physicians in a com-
munity can be established only by the testimony
of experts.
3. In an Iowa case8 the court said that the
testimony of laymen or nonexperts cannot de-
termine whether or not a physician exercises the
degree of care and skill required of him in the
treatment of a particular patient, for only those
learned in the profession can say what should
have been done or that what was done ought not
to have been done.
4. In a Nebraska case9 it was held that when
a case demands the employment of scientific
technic of which a layman can have no knowl-
edge, a charge of negligence must be proved by
expert witnesses.
5. In a Kentucky case10 the court said that
the right of recovery in a malpractice action can
be established only by the testimony of experts
unless the evidence shows an act or an omission
within the common knowledge and understand-
ing of laymen.
6. In an Indiana case11 it w^as held that when
the patient proves that an incision was closed
over a laparotomy sponge used in an abdominal
operation, expert testimony concerning negligence
of the operating surgeon is unnecessary.
7. In a Kansas case12 it was held that negligence
in not setting or treating a badly dislo-
cated elbow need not be established by a medical
witness, since it is a matter of common knowl-
edge that such an injury needs treatment.
8. In a California case13 it was said that it is
common knowledge that the removal of the uvula
and of a portion of the soft palate is no part of
a tonsillectomy.
for January, 1950
61
9. In Illinois14 a physician was sued as
the result of a burn sustained by a patient
from an electrotherapeutic machine. The plain-
tiff’s mother had stated to the physician that
the plate was loose and that the burn was due
to carelessness. The defendant’s response to her,
“I know it and I can’t tell you how bad I feel
about it,” was admissible as an admission against
interest.
10. In a Washington case15 the court said
that the law is well settled that a physician may
specially contract to effect a certain result and
that he then becomes liable on his contract for
failure to fulfill his agreement.
There is no doubt that a physician has a duty
to make a sufficiently full disclosure of all of the
pertinent facts of a case so that the patient may
be in a position to decide, intelligently, whether
to submit to any original or subsequent treat-
ment. This conclusion is supported in many
cases:
1. In an Oklahoma case16 the point was made
that it is the physician’s duty to exercise the
highest degree of good faith in dealing with his
patients.
2. In a California case17 the court said that
the confidential relationship of physician and pa-
tient imposes on the physician the duty of re-
fraining from fraudulent concealment with re-
spect to matters on which he is consulted by
the patient.
3. In a number of cases18 from several states
the courts have held that, if the attending phy-
sician knows that he cannot accomplish a cure
or that the treatment adopted will probably be
of no benefit, it is his duty to advise his patient
of these facts.
LAW OF NEGLIGENCE
The doctrine of res ipsa loquitur is of increas-
ing importance in the law of malpractice. Res
ipsa loquitur (literally, the thing speaks for
itself) is a doctrine of the general law of neg-
ligence. It is held applicable whenever one per-
son is injured by an instrumentality entirely in
the control of another person, the use of which
does not ordinarily result in injury if the per-
son in control exercises due care.
Generally, as has been indicated, the proof of
a physician’s negligence must be established by
the testimony of medical expert witnesses. The
application of the doctrine of res ipsa loquitur
creates in the case an inference of negligence
on the part of the defendant, and it relieves the
plaintiff of the necessity of proving the alleged
malpractice by the testimony of experts. It
places on the defendant the burden of making
explanation, if he can, to offset the inference of
negligence; and by the majority rule a question
is created for the jury, regardless of any and all
evidence presented by the defendant.
The doctrine of res ipsa loquitur has been held
applicable in the field of malpractice chiefly in
cases which involve (1) slipping instruments,
(2) sponges left in the tissues, (3) burns from
heating modalites, (4) roentgen radiation in-
juries (generally limited to cases wherein the
roentgen ray is being used diagnostically), (5)
infection through the use of an unsterilized
needle or instrument and (6) injury to a portion
of an anesthetized person’s body outside the field
of treatment or operation.
CASES CITED
The doctrine of res ipsa loquitur has been
held applicable in cases such as those which
follow :
1. In a Minnesota case19 a patient’s tongue
was cut by an electrically driven instrument.
2. In a Washington case20 the court held that
a surgeon is negligent as a matter of law when,
in performing an operation, he leaves a sponge
in the wound and there is no possibility of any
good resulting therefrom.
3. In a New Jersey case21 the court said that,
notwithstanding the nurse’s count, a duty re-
mained with the defendant to examine inde-
pendently, to make sure that no foreign body
remained in the patient’s body.
4. In a Montana case22 the surgeon was em-
ployed to remove a fibroid tumor and the ap-
pendix, and the patient sustained a burn on the
chest while anesthetized.
5. In cases from many states23 negligence
was assumed when injury followed diagnostic
use of roentgen rays.
On the other hand, the doctrine of res ipsa
loquitur has been held not to apply in the fol-
lowing cases:
1. In a Minnesota case24 the court said that
the failure on the part of a physician to effect
a cure by treatment and operation was not
ground for the application of the doctrine, since
such failure occurs under the most skillful and
careful treatment.
2. In another Minnesota case25 negligence was
not assumed from a claim that death resulted
from the injection of an anesthetic agent.
3. In a Washington case26 the doctrine was
held not applicable when the patient’s bladder
leaked after an operation for the removal of
the uterus.
4. In a Minnesota case27 the doctrine was
held inapplicable in action against the sur-
geon when expert testimony disclosed that a
lesion discovered on the patient’s thigh after
operation could have resulted from a cause or
causes other than the alleged burn from a hot
water bottle.
5. In an Alabama case28 it was held that the
doctrine does not apply to the mere fact of the
occurrence of a blood infection, no matter how
closely in time the infection may follow a medi-
cal treatment.
TREND WIDENS
There is a threatening and obvious trend
toward extending the doctrine of res ipsa
loquitur to embrace more and more cases. Un-
less this trend is checked, the occurrence of a
bad result will in itself give rise to an infer-
ence that the attending physician was negligent.
In such a situation, every physician who is fool-
hardy enough to practice at all will for all prac-
tical purposes become an insurer of the results
of his treatment.
A physician’s liability for negligence or mal-
practice extends to acts or omissions of his em-
ployees, within the scope of the employment. He
62
The Ohio State Medical Journal
is also, of course, liable for the professional acts
of a partner. Further, he is liable for the acts
of hospital personnel, as far as such acts occur
under his direct supervision and control ; thus
the operating surgeon, and not the hospital, is
liable for negligence in the operating room.
Whenever a medical practitioner enters a
case in response to a request that he render
professional services, he is legally bound to give
(or to see that there are given) such services as
the case requires until they are no longer
needed; he is freed of responsibility only if he
is discharged or if he withdraws from the case.
This responsibility is illustrated in two typical
cases:
In a North Dakota case28 the court said that
part of the physician’s correct treatment of a
patient is the careful and proper determination
of the moment when relation with the patient
shall end.
In an Alabama case30 it was held that when a
physician undertakes to treat a patient whose
condition he knows to be such that without con-
tinuous or frequent attention injurious conse-
quences may result, he must either render such
attention himself or see that some other com-
petent person does so.
In all cases sound professional judgment must
be exercised to provide, in accordance with the
standard of practice, sufficient observation, in-
vestigation and treatment.
Whenever the rendition of professional services
is followed by a less than perfect end result,
a potential malpractice claim exists. When a
poor result is accompanied by an unfounded
suggestion that faulty treatment was adminis-
tered, a malpractice claim can almost automatic-
ally be expected. This analysis of the situation
is not pleasant, but it is realistic. Perhaps little
can be done to eliminate poor results; however,
it is not only possible but imperative that the
factor of unfounded criticism be eliminated.
UNDUE CRITICISM
More than 75 per cent of all malpractice cases
are precipitated by some medical practitioner’s
criticism of the work done or the result ob-
tained by another. Such unethical and destruc-
tive criticism obviously must be stopped.
To be sued for malpractice is a miserable ex-
perience for any physician. His reputation and
his professional integrity are assailed and put in
jeopardy. The mere filing of a malpractice action
is in itself injurious to him. For example, it is
altogether different than being sued for alleg-
edly negligent driving of an automobile. In ad-
dition to the mental and emotional stress and
loss of time to the physician, the increasing
number of unjustified claims is imposing a
mounting burden of costs. Furthermore, and
no less significant, there is inevitably a lower-
ing of public confidence in the medical profes-
sions.
Concrete evidence shows that most of the mal-
practice claims which are brought against mem-
bers of the healing professions are not meri-
toriously founded — that is, the majority of such
claims are not honestly and factually justifiable.
Moreover, the targets of these actions are not
exclusively or generally charlatans or quacks. On
the contrary, more than half of all the defend-
ants in these actions are above the median in
experience, reputation and ability in their re-
spective fields of practice.
These charges of malpractice have become so
common that in certain localities every patient
with a less than perfect end result is a poten-
tial malpractice claimant. If a physician is in-
telligently malpractice-conscious, he must and
will give thought to safeguarding himself while
he is treating a patient, because an unjustifiable
claim may eventuate from the case. This un-
wholesome situation is steadily becoming worse.
Obviously, the public interest is seriously and
deleteriously affected by it.
PREVENTION OF SUITS
Prevention is the best defense against mal-
practice. The following briefly outlined meas-
ures have been found to be effective and have
been recommended, in whole or in part, by all
who have given consideration to the problem of
malpractice:
1. The physician should care for every patient
with scrupulous attention to the requirements
of good medical practice.
2. The physician must know his legal duty
to the patient.
3. The physician must avoid destructive and
unethical criticism of the work of other phy-
sicians.
4. “Ideal” medical records should be kept in
every case: records that would be presentable
when offered in court; records that clearly show
what was done and when it was done; records
that indicate that nothing was neglected and
that the care given fully met the standard de-
manded by the law. If any patient discontinues
treatment before he should, or fails to follow
instructions, the record should show it; a good
method is to file a carbon copy of the letter
which advises the patient against the unwise '
course.
5. The physician should be careful to avoid
making any statement which constitutes or which
might be construed as an admission of fault on
his part. Such an admission, which is usable
against the physician, might be made to a third
party as well as to the patient at any time be-
fore the trial. Such an admission may be made
by an agent or employee of the physician during
the course and within the scope of the employ-
ment. It is important to instruct employees to
make no statements.
for January , IV50
63
6. The physician should exercise tact as well
as professional ability in handling his patients.
A proper professional manner and a sound atti-
tude should be maintained at all times, both
toward the patient and toward the patient’s
family. The attentive physician may early sense
some unsatisfactory and disturbing undercurrent,
which may be prevented by the institution of
protective measures, from developing into some-
thing much more unpleasant. Thus, if the pa-
tient is not doing well, consultation may be sug-
gested; if the patient is dissatisfied or complain-
ing, or if the family’s attitude indicates dis-
satisfaction, consultation should be demanded.
The use of a consultant affords, in any case,
great protection against a malpractice claim.
7. The physician should refrain from over-
optimistic prognoses and should avoid promising
too much to the patient.
8. The physician should advise his patients
of any intended absence from practice and
should recommend, or make available, a qualified
substitute.
9. The physician should unfailingly secure
written consent for operation and for autopsy.
10. There should be careful supervision of
assistants and employees and great care in the
delegation of duties to them.
11. The physician should have some knowledge
of the Statute of Limitations and of its sig-
nificance.
12. In his selection of patients the physician
should limit himself to such fields as are well
within his qualifications. He should keep abreast
of progress in the medical profession.
13. The physician should keep inviolate all
confidential communications.
14. He should frequently check the condition
of his equipment and make use of every avail-
able safety installation.
15. In the treatment of the patient the phy-
sician must not experiment.
16. The physician must be careful to render
sufficient care to his patient in general instruc-
tions, frequency of visits, clinical and roentgen
ray laboratory investigations and the like. More-
over, every precaution should be instituted for
the protection of those caring for the patient and
of all other contacts.
17. The patient must not be abandoned. The
physician-patient relation can be terminated
without liability only in certain ways and under
certain conditions.
18. The physician should never reveal that he
carries professional liability insurance. He
should never write a letter or make any state-
ment with reference to a malpractice claim, ex-
cept on the recommendation of his legal adviser.
Immediately on being advised of even the possi-
bility of suit he should consult with his attorney.
19. The physician should arrive at an under-
standing in the matter of fees. Misunderstand-
ing in this matter, particularly when the ques-
tion of excessive fees arises, contributes an avoid-
able element of risk.
20. The physician should secure legal advice
if he is called to attend a coroner’s inquest
as a witness in a case in which he has been in
professional attendance.
21. The physician should realize that because
of the possibility of error in transmission, it is
dangerous to telephone a prescription.
22. The physician should realize that it is
hazardous to sterilize any patient, except when
a medical indication exists.
23. Except in actual emergency, no female
patient should be examined unless a third per-
son is present. There is no more serious or de-
structive charge in the ‘‘malpractice book” than
that of undue familiarity; and the only way to
avoid claims of this sort seems to be to have
some one else present during all examinations.
CONCLUSION
Those who have realistically viewed the prob-
lem have realized that there is no malpractice
Santa Claus, that the problem will be solved only
by the affirmative and purposeful action of the
professional groups. Physicians must learn what
they may do to safeguard themselves and must
put into effect every possible precaution against
unjust malpractice accusations. The vast ma-
jority of malpractice suits can be avoided by
scrupulous attention to the requirements of good
practice, provided that this attention is accom-
panied by an equally scrupulous care for the
reputation of fellow medical practitioners.
REFERENCES
1. McCartney v. Hyman (Pa.), 4 Atl. (2d) 581.
2. Schloendorff v. New York Hospital, 211 N. Y. 125.
3. Rytkonen v. Lojacono (Mich.), 257 N. W. 703 ; Bur-
roughs v. Crichton, 48 App. D. C. 596.
4. Under Eugenic Sterilization Statutes.
5. 48 C. J. 1131; Jackovach v. Yocum (Iowa), 237
N. W. 444.
6. Whitson v. Hillis (N. D.), 215 N. W. 480.
7. McNamara v. Emmons, 36 Calif. App. (2d) 199.
8. Nelson v. Sandell (Iowa), 209 N. W. 440.
9. Winters v. Ranee (Neb.), 251 N. W. 167.
10. Stacy v. Williams (Ky.), 69 S. W. (2nd) 697.
11. Funk v. Bonham (Ind.), 183 N. E. 312.
12. McMillen v. Foncannon (Ken.), 273 Pac. 237.
13. Thomsen v. Burgeson (Calif.), 79 Pac. (2d) 136.
14. Adamsen v. Magnelia, 280 111. App. 418.
15. Brooks v. Herd (Wash.), 237 Pac. 238.
16. Mattingly v. Sisler (Okla.), 175 Pac. (2d) 796.
17. Pashley v. Pacific Electric Co. (Calif.), 153 Pac.
(2d) 325. .
18. Tvedt v. Haugen (N. D.), 294 N. W. 183; Lewis v.
Durnell (Maine), 24 Atl. 945; Logan v. Field, 75 Mo. App.
594 ; Benson v. Dean, 232 N. Y. 52 ; Mernin v. Cory
(Calif.), 79 Pac. 174.
19. Ellering v. Gross (Minn.), 248 N. W. 330.
20. McCormick v. Jones (Wash.), 278 Pac. 181.
21. Stawicki v. Kelley (N. J.), 174 Atl. 896.
22. Vonault v. O’Rourke (Mont.), 33 Pac. (2d) 535.
23. Lewis v. Casenburg (Tenn.), 7 S. W. (2d), 808;
Shockley v. Tucker (Iowa), 103 N. W. 360; Hamilton v.
Harris (Texas), 223 S. W. 533.
24. Johnson v. Colp (Minn.), 300 N. W. 791.
25. Johnson v. Arndt (Minn.), 243 N. W. 67.
26. Brear v. Sweet (Wash.), 284 Pac. 803.
27. Wallstedt v. Swedish Hosp. (Minn.), 19 N. W. (2d)
426.
28. Woodlawn Infirmary, Inc. v. Byers (Ala.), 112
So. 831.
29. Halverson v. Zimmerman (N. D.), 232 N. W. 754.
30. Jackson v. Burton (Ala), 147 So. 414.
64
The Ohio State Medical Journal
• • •
High Spots of A.M.A. Session
Membership Dues for 1950 in Amount of $25 Authorized; Action Taken
On Measures Pending in Congress; Other Important Business Reviewed
MEETING in conjunction with the In-
terim Clinical Session of the American
Medical Association in Washington,
D.C., December 6-9, the House of Delegates
transacted the following business:
Approved a recommendation of the Board of
Trustees that members of the American Medical
Association pay dues of $25.00 for 1950 to be
collected through the state medical associations
for transmittal to the A.M.A. office at Chicago.
This will be the first time in its history that
A.M.A. has charged membership dues. The
action was taken in compliance with Article
Eleven of the Constitution of the A.M.A. author-
izing the levying of annual dues. Those delin-
quent in payment of the $25.00 membership dues
will forfeit their membership in the A.M.A.
Those desiring to continue as Fellows of the
A. M. A. and receive The Journal of the A. M. A.
will continue to pay fellowship dues direct to the
A.M.A.
FELLOWSHIPS
Since no change was made in the Con-
stitution and By-Laws regarding Fellow-
ship, the eligibility for Fellowship, and
Fellowship dues, will remain the same. In
other words, to be a Fellow a physician
must first be a member in good standing
of the A. M. A. (a dues-paying member) and
must pay $12.00 per year direct to the
A. M. A.
Starting January 1, 1950, a physician
who wishes to be a Fellow will pay $25.00
membership dues and $12.00 Fellowship dues,
a total of $37.00.
Fellows will continue to receive The Jour-
nal of the A. M. A. without additional cost
and will be eligible to be on A. M. A. pro-
grams and be an officer, delegate or com-
mitteeman of the A. M. A.
Members of the A. M. A. will be sent a
membership card and membership certificate
from the A. M. A. office, as soon as his member-
ship dues are received at that office from the
Columbus Office of the Ohio State Medical Asso-
ciation which will be the collection center for
A. M. A. membership dues in Ohio. Also, mem-
bers will be permitted to attend all sessions of
the A. M. A. In the past, only Fellows were ex-
tended this privilege.
In recommending this action to the House of
Delegates, the Reference Committee on Changes
in Constitution and By-Laws, to which the mat-
ter had been referred for hearings, presented
the following statement, enumerating the need
for A.M.A. membership dues:
REASONS ENUMERATED
“The responsibilities of the American Medical
Association are increasing constantly and the
revenues of its publications can no longer meet
the costs of its broadening program. The Amer-
ican Medical Association recognizes the greatly
augmented activities of the constituent associa-
tions and of the component medical societies.
However, it is aware of its own responsibility in
providing aggressive, effective leadership for
the medical profession on a national level. This
leadership includes constructive assistance in
building and improving the many splendid vol-
untary health insurance systems, so that all
who desire or need prepaid medical care may be
provided with it, without political controls or
compulsion.
“The American Medical Association, like other
great national organizations, must depend on
dues from its membership to support its growing
program of service, both to the profession and
to the public.”
PLAN BEING FORMULATED
Details of the collection of the A.M.A* $25.00
dues among members of the Ohio State Medical
Association are now being worked out by The
Council. As soon as a practical procedure has
been set up, notice will be sent to all members
and to the Secretary-Treasurers of all County
Medical Societies, who will be requested to assist
in the collection.
Received a report from the Board of Trustees
that Dr. Morris Fishbein had retired as editor of
The Journal of the A. M. A. and that the editor-
ship has been filled by Dr. Austin E. Smith, who
has been secretary of the Council on Pharmacy
and Chemistry.
It is understood that Dr. Fishbein has accepted
a position as medical consultant to Doubleday &
Company, publishers, and that he also will be
contributing editor of Postgraduate Medicine ,
official journal of the Interstate Postgraduate
Medical Association. Editorship of the nine
special journals published by the A.M.A. has been
taken over by Dr. Richard J. Plunkett. Dr.
W. W. Bauer, long-time director of the Bureau
of Health Education, will be in charge of the
for January, 1950
65
publication of Hygeia, the name of which is be-
ing changed to Today's Health.
Registered opposition to S. 1453 and S. 1411,
now pending in the Congress, in their present
forms. The former is the so-called Federal aid to
medical education proposal and was objected to
on the ground that in its present form it would
give too much power to the Federal Govern-
ment in the running of medical schools. S. 1411
is the so-called Federal School Health Services
measure. It was disapproved in its present form
because it would permit the funds to be used to
provide medical services for any child regard-
less of the financial status of the parents.
COMMITTEE NAMED
Authorized the appointment of a special com-
mittee of five to confer with the American Hos-
pital Association, the Veterans Administration
and various veterans’ organizations on the mat-
ter of establishing a program whereby veterans
with non-service connected disabilities who are
eligible for medical and hospital care at govern-
ment expense would be provided with medical
and hospital insurance coverage under which
such veteran could receive medical and hospital
services from physicians and hospitals of their
own choice.
The House of Delegates at its June, 1949, meet-
ing did not endorse a proposal of this kind but
referred the matter to the Board of Trustees.
The same proposal was introduced at the Wash-
ington, D.C., session. Again, the House of Dele-
gates refused to endorse the resolution, pending
further study by the committee of five which
will be appointed by the Speaker.
HEALTH OFFICERS’ SALARIES
Went on record as advocating that the sal-
aries of full-time public health officials shall be
“commensurate with duties and responsibilities”
of their offices In effect, this endorsed higher
salaries for most full-time public health officials.
Received notice from the Board of Trustees
that A.M.A. representatives will be sent to Eng-
land to study the British National Health Insur-
ance Program.
Adopted resolutions urging the National Se-
curity Resources Board to work out plans imme-
diately for an adequate civil defense program
and advocating the standardization of equipment
used in the procurement and dispensing of blood
and more cooperation between all agencies en-
gaged in blood procurement programs.
Approved the appointment of Dr. Herbert B.
Wright, Cleveland, as a member of the Council
on National Emergency Medical Service, to suc-
ceed Dr. W. M. Craig, Rochester, Minn. Dr.
Wright is president of the Cleveland Academy
of Medicine, member of the Committee on Pub-
lic Relations and Economics of the Ohio State
Medical Association, and an alternate delegate
from Ohio to the A.M.A.
Elected Dr. Andy Hall, Mt. Vernon, 111., the
“General Practitioner of the Year” and awarded
him the Association’s gold medal.
EDUCATION CAMPAIGN
Heard a report from the National Education
Campaign Committee showing that action
against compulsory health insurance has been
taken by 1,829 national, state, and local organi-
zations as a result of the program of public re-
lations. The report revealed that during the
first 11 months of 1949 $2,250,000 in assess-
ments was paid to the American Medical Asso-
ciation.
Of the $2,250,000, $2,050,000 was budgeted and
approved for campaign purposes, leaving $200,000
unbudgeted. Expenditures included $1,045,614
for campaign literature and printed materials;
$139,415 for organization work and $209,122 op-
erational expense.
Of the entire campaign budget, expenditures
for literature and campaign materials totaled
75 per cent; organization work, 10 per cent;
operational expenses, 15 per cent. More than
55,000,000 pieces of campaign literature were
produced and distributed.
A copy of the report will be mailed by
Whitaker and Baxter, national directors of the
campaign, to every physician in the country.
Drs. Schriver, Sherburne, Wiseley, Lincke,
Woodhouse, Skipp, Brindley and Wright, repre-
senting the Ohio State Medical Association, took
an active part in the session. Dr. Paul A. Davis
served as a delegate, representing the Section on
General Practice. Ohio was represented on the
Reference Committee on Credentials by Dr.
Lincke; on the Reference Committee on Sections
and Section Work by Dr. Davis; on the Reference
Committee on Rules and Order of Business by
Dr. Sherburne; on the Reference Committee on
Hygiene and Public Health by Dr. Wiseley.
Reserve Gets Heart Grants
A total of $358,109 in Public Health Service
grants to support heart research and to build
additional heart research laboratory facilities in
universities, hospitals, and other institutions
throughout the country was announced.
The grants include $33,976 to Western Reserve
University for experimental investigations to im-
prove the circulation of the coronary arteries
by Dr. Claude S. Beck, and $3,780 to the same
university for experimental production of arterial
disease conducted by Dr. J. Lowell Orbison.
The International and Fourth American Con-
gress on Obstetrics and Gynecology will be held
at the Hotel Statler, New York City, May 14-19.
Additional information may be obtained from
Dr. Fred L. Adair, 161 E. Erie St., Chicago 11, 111.
66
The Ohio State Medical Journal
Prescribing Barbiturates . . .
State Board of Pharmacy Offers Some Interpretations on the New Law
As It Pertains to the Procedure of Filling Physicians’ Prescriptions
THE State Board of Pharmacy, in session in
Cincinnati on November 16, gave its in-
terpretation of 12 questions submitted to
it as applying to the State Barbiturate Act.
Since the questions all have to do with the filling
of prescriptions, they will be of interest to phy-
sicians as well as pharmacists.
House Bill 308, to regulate the handling, sale,
and distribution of barbiturates in Ohio, be-
came law on August 12, 1949. Its provisions were
given in the July issue of The Journal.
The Pharmacy Board explains that the answers
are the opinion of the board and should not be
construed as a regulation promulgated in accord-
ance with the provisions of the Administrative
Procedure Act.
The 12 questions and the answers given by
the board are as follows:
Question — May a barbiturate prescription
marked only by the prescriber’s order to refill, be
refilled more than once in absence of any des-
ignated number of times.? Answer — One time
only.
Q. — May a prescriber telephone an order to
refill a prescription which he had not previously
marked to be refilled, without being required to
follow it up with a written prescription (a new
original) ? Ans. — No.
Q. — May a prescription issued, filled and filed
prior to August 12, which had been written by
a practitioner and designated refillable for a defi-
nite number of times (the time period for which
has not yet expired) be refilled until time period
specified has expired? Ans. — No.
Q. — May such a prescription, which has been
telephoned to a pharmacist, and not manually
signed by the practitioner, be so refilled, or will
a new original be required? Ans. — New one re-
quired.
Q. — May a prescription written and issued by
a practitioner and filed by a pharmacist prior to
August 12, and which has been designated by the
practitioner to be refilled “ad lib,” “ad inf,” “pro
re nata,” (or abbreviations to the same effect)
be refilled upon demand by the patient; or will a
new original be required? Ans. — New prescrip-
tion required.
Q. — May a currently written prescription (with
specific directions) designated refillable P.R.N.
be refilled for an unlimited number of times?
Ans. — Yes. However, we think the pharmacist
should ascertain, after a reasonable period,
whether the physician still wishes the medication
continued under the original directions for use.
Q. — Will it be lawful for a pharmacist on re-
ceiving a telephoned prescription to make a copy
in duplicate, send the original to the practitioner
for his signature, keep the duplicate on file to
be discarded and replaced by the signed original
when returned by the practitioner? Ans. — Yes.
Q. — Will it be lawful for a practitioner to sup-
ply in advance, or for the pharmacist to use, a
previously signed prescription blank for the pur-
pose of providing an “ersatz” original for the
pharmacist’s file? Ans. — No.
Q. — Will a pharmacist be required by law to
obtain written confirmation or a prescription,
previously telephoned to him by a practitioner;
or to have such written confirmation on file?
Ans. — First part is No. Second part — it is the
practitioner’s responsibility to furnish same with-
in 72 hours.
Q. — Will the failure to receive within 72 hours
a written copy from the practitioner invalidate
the pharmacist’s copy of a prescription previously
telephoned by the practitioner and filed according
to law? Ans. — No.
Q. — Will the absence of such confirmation on
the pharmacist’s file affect the legality of the
patient’s possession of drug supplied on the
practitioner’s telephoned prescription? Ans. —
No.
Q. — Will the practitioner who fails to deliver
to the pharmacist WITHIN 72 HOURS a writ-
ten prescription IN CONFIRMATION of a tele-
phonic prescription, be subject to penalty? Ans.
—Yes.
Research Grants
Public Health Service grants totaling $835,770
for medical and allied research projects at non-
Federal institutions were announced. A total
of 105 projects will be supported at 61 institu-
tions.
Among projects were the following in Ohio,
all at Ohio State University: Clark R. Case,
$500, for studies in surgical nutrition via jejunos-
tomy feeding; A. S. Fox and Q. Van Winkle,
$8,100 for immunogenetic studies of Drosophila
melanogaster; and William G. Myers, $14,875 for
use of radioisotopes to trace organic compounds
of biological significance.
for January , TJ50
67
Fees and Public Relations ...
Committee in California Tackles Delicate Problems Arising Between
Doctors and Patients and Comes Out With Some Practical Solutions
THE following article is reprinted from
The Bulletin of the San Diego (California)
County Medical Society. It was written by
Dr. Ralph B. Mullenix, chairman of the profes-
sional conduct committee of the Society.
It has been reproduced by The Journal because
it poses, discusses, and offers solutions for one
of the most serious problems arising from the
physician-patient relationship.
As the title intimates, public relations on the
part of the medical profession begins the minute
a physician accepts a patient. Whether the
relationship will turn out to be good or bad
depends primarily on three factors: (1) The
quality of the service rendered by the physician;
(2) the diplomacy of the physician in dealing
with the patient, including the question of
charges; and (3) the degree of cooperation shown
by the patient. If these factors are present,
the average physician will have little difficulty
with the average patient in the average case.
* * *
I. INTRODUCTION
The amicable settlement of fee disputes has
become the chief responsibility of the Profes-
sional Conduct Committee, and the Committee
feels it is ready and the time is right for it to
publish to the Society the conclusions it has
reached during recent years of such activity.
In most instances the protested charges have
been fair and reasonable but, sometimes through
misunderstanding, the patient believes he has
been overcharged. Whatever the basis or justi-
fication of the dispute may be, the fact remains
it is a dispute and never ends with the single
patient involved but, as it becomes broadcast
and as similar instances multiply, it develops
into a truly significant public relations prob-
lem, detrimentally affecting all members of the
profession.
Possibly complete solution of this problem
will not come until the matter is taken out of our
hands by governmental machinery and the longer
we remain indifferent to questions such as this
the sooner will state or Federal agencies step
in to handle our business affairs.
II. CLASSIFICATION OF FEE DISPUTES
Fee disputes fall into one or more of the fol-
lowing categories:
A. The financially irresponsible patient de-
mands the best of care but does pot wish qy
intend to pay for it regardless of his ability to
pay.
B. The patient is willing to pay, but his bill,
however fair it may be, far exceeds his original
estimate.
C. The patient believes that similar service
could have been obtained elsewhere at lower cost.
D. Uninformed or ignorant people who have
been fairly charged but, having no knowledge
of fees or the cost of providing medical service,
believe they have been overcharged.
E. Average fees may be entirely out of reach
for some scrupulously conscientious patients in
the lowest income brackets.
F. Personality clashes and incompatibilities
have developed between patient and physician,
and refusal to pay the bill is seized as a retalia-
tory weapon by the aggrieved patient.
G. The patient objects to paying for an ex-
amination that failed to produce a diagnosis
or for treatment which did not effect a cure.
H. In a few instances patients have been in-
excusably overcharged.
III. THE REMEDY
A. Discussion of Fees — Discussion of fees prior
to rendering a proposed service will reduce
disputes to a minimum. A patient who knows
what the service is going to cost will have had
the opportunity to:
I. Protest the fee.
2. Defer treatment and make inquiry else-
where.
3. Explain his financial status and perhaps
request and receive a reduction.
4. Arrange with the doctor a plan of periodic
partial payments if necessary.
5. Terminate his relation with the doctor and
seek service elsewhere.
Many physicians naturally object to opening
the discussion of fees with potential patients for
fear of appearing too much interested in financial
reward, or of losing the patient to a less ex-
pensive competitor. It is quite certain that we
will offend an occasional patient if we all
adopt this practice of fee discussion. Every
office will develop its technique of handling this
delicate problem, but handle it we must. Whether
the matter be broached bluntly by the physician,
or even by the receptionist prior to the first
consultation, or whether the physician can tact-
fully turn the conversation so that the patient
will himself open the discussion, will depend on
the wishes of the individual doctor. The time-
68
The Ohio State Medical Journal
worn practice of evading the patient who has
plainly asked for an estimate of charges is
mentioned only to be condemned.
Agreement having been reached prior to per-
formance of a service, the patient will usually
realize that he has no basis for later protest
of the fee. Referring back to the main cate-
gories of fee disputes listed above, it is seen
that we have dealt effectively with the chief
offenders, categories A, B, C, D, and E. These
include (1) the financial deadbeat, (2) the pa-
tient who just didn’t think it would cost that
much, (3) the one who thinks he could have
gotten it more cheaply elsewhere, (4) the un-
informed and ignorant who have no knowledge
of average or proper fees, and (5) the conscien-
tious patient who simply cannot afford average
standard fees.
B. Publication (to physicians) of average fee
schedule — Such a schedule would indicate aver-
age charges for a certain locality. It should
and would serve as a guide for the doctor who
seriously attempts to make proper charges and
would protect him from stepping too far out of
line to his later detriment. It has long been the
right of a physician to evaluate his own services
and for this reason rigid adherence to a fee
schedule probably should not be demanded and
probably could not be enforced. It should serve
as a balance wheel for the entire local profession.
Such a schedule is now in preparation in San
Diego County.
C. Thoughtful explanation of the patient’s
problem — Many patients have been disturbed and
angered by alleged brevity, impatience,
brusqueness, and even crudeness in their brief
contacts with their physician. The willingness
to explain patiently the problems of diagnosis
and treatment, carefully avoiding frank or im-
plied assurances of cure, will almost eliminate
the remaining categories of fee disputes. Per-
sonality conflicts will then, for the most part,
disappear, and the patient will believe he has
received what he paid for.
D. Other measures — Other measures will in-
clude education of physicians to the importance
of the problem and, in a few instances, pressure
of some sort may be necessary to bring into
line the very few who continue to injure the
standing of the whole profession by charging
excessive fees.
In some localities a “fee complaint bureau”
has been established to which the public has
been invited to bring their complaints. Our
committee feels the establishment of such a
bureau would be evidence that we had failed in
our attempt to correct our faults by education
and persuasion and that such a “bureau” can
remain unnecessary and undesirable indefinitely
if the basic principles herein proposed are care-
fully followed by all.
Federal Grants Will Advance
Cancer Research in Ohio
Two $300,000 Federal grants for cancer re-
search facilities have been made in Ohio — one at
Ohio State University and the other at Western
Reserve University.
They are the largest of 14 Public Health
Service grants, totaling $2,174,900, made for
the construction of cancer research facilities
at hospitals, universities and other institutions
throughout the Nation.
Dr. Charles A. Doan, dean of the Ohio State
University College of Medicine, has been des-
ignated to oversee the Columbus program. Dr.
Herman A. Hoster, associate director of cancer
research at the University, is chairman of the
research construction committee, which is plan-
ning construction of a laboratory building in the
new medical center on the campus.
The new laboratory will bring together under
one roof an extensive cancer research program
now in operation in small, inadequate labora-
tories scattered over the campus.
It is significant also that the Ohio General
Assembly at its last session made a $100,000
biennium appropriation toward cancer research
at Ohio State University.
The other grant of $300,000 was made to
Western Reserve University School of Medicine
and University Hospitals. Dr. Joseph T. Wearn,
dean of the Medical School, and Dr. W. B. Sey-
mour, director of University Hospitals, have been
designated to administer the program in Cleve-
land.
Plans are under way to use the grant for
construction of a floor on the new building to be
erected at the University Medical Center. The
project will relieve crowding of the five cancer
research projects now in operation and permit
expansion of the university center’s cancer re-
search program.
The grants are in the form of outright gifts
with no strings attached except that they are
designated for construction.
Chronic Illness Commission
Dr. Norton L. Levin, Albany, Department of
Health, has been appointed director of the Com-
mission on Chronic Illness. Leonard W. Mayo,
New York, is chairman of the commission created
last May. It originated under sponsorship of
the A. M. A., the American Hospital Associa-
tion, the American Public Health Association
and the American Public Welfare Association.
The National Society for the Prevention of
Blindness has announced the appointment of John
L. Fortson as director of public relations. He
will be in charge of an intensified program of
public education on all phases of sight conser-
vation.
for January, 1950
69
• • •
On the Firing Line
Shots at Truman-Ewing Compulsory Sickness Insurance Scheme;
Ammunition For Doctors in Speeches Against Federalized Medicine
. . The Supreme Court long ago ruled that
there was nothing inconsistent with the due
process of law guarantee in the Constitution if
the government saw fit ‘to regulate that which
it subsidizes.’ From the beginning of Presi-
dent Roosevelt’s New Deal this kind of develop-
ment has been noticeable. Government aid means
government control.” — The Columbus Dispatch.
* * *
“It is apparent that the Federal govern-
ment is headed toward an extended era of
chronic deficit spending, which may continue
until the public debt crushes us into national
insolvency.” — Senator Harry F. Byrd (D.-
Va.), as quoted by Fletcher Knebel in the
Cleveland Plain Dealer.
* * *
“Many old people have rushed in for ‘free’
dentures whether they needed them or not. The
result is that children whose teeth could have
been saved are being neglected.” — Dr. Raymond
E. Myers, dean and professor of restorative
dentistry, University of Louisville , after a two-
month survey of National health program in Eng-
land and Scotland.
%
“Well over a billion dollars of the cost of
the health system is paid out of general
taxation. It is one reason why British pay
the world’s highest income and sales taxes.
Indirectly, it is a factor in the high costs
which have cut sales of British goods in
world markets.” — The late E. T. Leech,
Editor, The Pittsburgh Press.
* * *
“. . . Over the head of the farmer hangs a
threat perhaps more serious than that applied
to the worker. The farmers are paid heavy
subsidies to produce more food. But there is a
regular inspection of every farm and a record
kept of its produce. If the farmer falls short
of the kind of job expected of him in following
the instructions from London he gets a warning
and if he does not mend his ways the govern-
ment will walk in, put a price upon his
property, pay him for it and put him off the
farm, which then passes into the hands of a
government manager.” — John T. Flynn, The Road
Ahead.
“With the Federal government in the saddle,
armed with the mighty weapon of the income
tax, two results are almost inevitable: First,
the complete subjugation of the States, and
second, the socialization of our economy. With
relentless precision and frightening speed, the
Federal government has seized most of the
sources of taxes. The States, defeated at every
point, have stultified themselves by accepting
handouts in the form of state aid.” — Raymond
Moley in the Columbus Dispatch.
* * *
“Our first line of defense is not on the Rhine.
Our first line of defense is a sound, solvent
American economy. We cannot keep that eco-
nomy sound and solvent merely by official state-
ments.”— James F. Byrnes, former Secretary
of State in Readers Digest, September, 19 49.
* * *
“The Welfare State is just another version
of the old Feudal State ... it is founded on
a lack of faith in people.” — John McPherrin,
editor, The American Druggist.
* * #
“A top Federal Agency official declared today
that the administration’s proposed national health
plan would provide ‘all kinds’ of medical devices,
including wigs, glasses, false teeth, to patients if
a doctor ordered them.” — International News
Service report in The Columbus Dispatch, quot-
ing John L. Thurston, Federal Security Admin-
istration assistant administrator, December 12,
191,9.
sfc & S*:
. . at a time when the Federal govern-
ment is unable to make both ends meet even
with a $40,000,000,000 income, compulsory health
insurance alone would pile up to $12,000,000,000
a year more on the sagging backs of the tax-
payers!”— Napoleon Henry County (O.) Signal.
* ❖ *
“Ewing currently is on a tour of Europe to
study state medicine as it has been developed in
the Scandinavian countries and in Europe. . . .
The tenor of his report can be forecast rather
accurately from an interview given the press
in London the other day in which he said he
was convinced from what he had seen of the
British plan that the Truman scheme would be
‘good for America’.” — The Columbus Dispatch,
December 12, 1949
CLIP THIS MATERIAL FOR REFERENCE
70
The Ohio State Medical Journal
A large benign chronic ulcer
with steep side walls as seen
in barium-filled shadow on
the lesser curvature of the
stomach.
When your patient is on a special diet, as in the man-
agement of peptic ulcer, gallbladder disease, obesity,
etc., there may be insufficient fecal bulk for encouraging
the normal peristaltic reflex.
M E T A M U C I L® is the highly refined
mucilloid of a seed of the psyllium group, Plantago
ovata (50%), combined with dextrose (50%).
SEARLE
RESEARCH IN THE SERVICE OF MEDICINE
for January, 1950
71
Licensed Through Endorsement By
State Medical Board
The Ohio State Medical Board has issued li-
censes to practice medicine and surgery in Ohio
to the following physicians, through endorsement
of their licenses to practice in other states:
October 4, 1949 — Fred B. Aurin, Cincinnati,
Johns Hopkins Univ.; Oscar Baumgarten, Cleve-
land, Univ. of Basel, Switzerland; Lewis A. Bean,
Gallipolis, Univ. of Mich.; Vincent F. Bolton,
Uhrichsville, Hahnemann Medical College; Frank
A. Brown, Toledo, Meharry Medical College;
Herschel L. Browns, Lakewood, Univ. of Mich.;
Nathan Cedars, Columbus, Univ. of Rochester;
Patrick B. Cestone, Youngstown, St. Louis Univ.;
Emma M. W. Clarke, Cleveland, Univ. of Pitts-
burgh; Wm. T. Collins, Cincinnati, Univ. of Mich.
Theodoro de la Torre, Dayton, Maryland Medi-
cal College; Charles R. Frazerk, Jr., Toledo,
Meharry Medical College; Victoria S. Friedman,
Cleveland, Univ. & Bellevue Hospital Medical
College; Robert P. George, Akron, Northwestern
Univ.; Louis Z. Gordon, Cincinnati, Wayne Univ.;
Izydore Gottlieb, Murray City, Jagiello Univ.,
Poland; Max Devillo, Springfield, Univ. of Kansas.
Wm. McK. Jefferies, Mayfield Heights, Univ.
of Virginia; Wm. R. Johnson, Cleveland, Yale
Univ.; Paxton L. Jones, Youngstown, Duke
Univ.; John K. Leach, Canton, Albany Med.
College; Avard C. Long, Cleveland, McGill Univ.;
Walter Lowenstein, Columbus, Univ. of Leipzig,
Germany; Daniel W. Mathias, Akron, Western
Reserve Univ.; George D. McAfee, Cincinnati,
George Washington Univ.; Robert D. Mercer,
Cleveland, Univ. of Mich.; George L. Morris, Jr.,
Hillsboro, Temple Univ.
Thomas R. Nolan, Cleveland, St. Louis Univ.;
Joseph P. Ohlmacher, Sandusky, Rush Medical
College; Daryl McC. Parker, Hollansburg, North-
-western Univ.; Walter Pavluk, Parma, George
Washington Univ.; Edward L. Ringer, Bryan,
Univ. of Pittsburgh; Elmer R. Swanson, Middle-
burgh Heights, Univ. of Pittsburgh; Anthony M.
Tanno, Cleveland, St. Louis Univ.; Joseph E.
Tomayko, Youngstown, Georgetown Univ.
Rupert B. Turnbull, Jr., Cleveland, McGill
Univ.; Keith E. Weller, Delaware, Univ. of
Mich.; Frederic B. Western, Apple Creek, Univ.
of 111.; Roger D. Williams, Columbus, Duke Univ.;
Herbert L. Wormhoudt, Cincinnati, State Univ.
of Iowa.
Professional examinations for the selection of
candidates for appointment to the grade of lieu-
tenant (junior grade) in the Medical Corps of
the Navy will be conducted at all naval hospitals
in continental United States during the period
January 16-20. Mid-western candidates will be
examined at the U. S. Naval Hospital, Great
Lakes, Illinois.
New Members of O. S. M. A.
Following are the names of new members
of the Ohio State Medical Association, since
November 1, 1949. The list shows the county
in which they are affiliated, city in which they
are practicing, or temporary addresses in cases
where physicians are taking postgraduate work.
BUTLER COUNTY
Arnold Gross, Hamilton
Jack I. Smith, Ross
(Venice)
CUYAHOGA COUNTY
Donald T. Book,, Cleveland
Carl N. Brudzynski,
Garfield Heights
Hatcher A. Day, Cleveland
Victor G. DeWolfe, Cleve-
land
Russell P. Dreyer, Cleve-
land
Barbara O. Remetey,
Cleveland
Joseph M. Ryan, Cleveland
Alan E. Smith, Cleveland
Robert S. Stockton, Cleve-
land
John L. Toth, Jr., Cleve-
land
Theodore J. Werb, Cleve-
land
Joseph C. Wiggins, Cleve-
land
DARKE COUNTY
Richard A. Welsh, North
Star
GUERNSEY COUNTY
Robert D. Crouch, Cam-
bridge
HAMILTON COUNTY
George D. McAfee, Cin-
cinnati
LORAIN COUNTY
William F. Lord, Elyria
SCIOTO COUNTY
Carl H. Laestar, Ports-
mouth
Ralph W. Lewis, Ports-
mouth
Spencer K. Miller, Scioto-
ville
SENECA COUNTY
Quentin B. Smith, Tiffin
STARK COUNTY
John J. Douglas, Canton
Charles L. Kagay, Canton
Meiling Will Guide Policies of
Consolidated Military Journals
Dr. Richard L. Meiling, of Columbus, recently
appointed director of medical services for the
Military Establishment, will establish general
policies for the guidance of the consolidated
professional medical publications of the armed
forces, Secretary of Defense Louis Johnson has
announced.
The U. S. Armed Forces Medical Journal,
Medical Technicians Bulletin of the U. S. Armed
Forces, will replace the Bulletin of the U. S.
Army Medical Department and the TJ. S. Naval
Medical Bulletin. The Air Force, whose separate
medical department was created last July, has
not had a similar journal. The new publication
will begin with the January issue and will be
issued monthly.
The Medical Technicians Bulletin of the U. S.
Armed Forces will be a supplement of the medi-
cal journal and will be published bimonthly.
Women practitioners net an average annual
income of $7,929 (male doctors average $11,036).
They devote nine hours a day to their medical
practice (one hour less than men), spend an
equivalent of 41 days a year in postgraduate
study (eight days more than men). They allow
25 days a year for vacations (to men’s 16 days).
Only 12 per cent are in full specialty practice
(as against 31 per cent of men). — Medical
Economics.
72
The Ohio State Medical Journal
The Dutch painter, Vincent Van Gogh, one of the masters of Post-Impressionism,
suffered from the psychic equivalent type of epilepsy. During one of his many
periods of confusion he cut off one of his ears and presented it to a lady friend.
Comparative studies have shown that in some cases better control of grand mal as well as petit
mal seizures can be obtained with Mebaral than with corresponding doses of other antiepileptic
drugs. Mebaral produces tranquillity with little or no drowsiness. It is particularly desirable not
only in epilepsy but also in the management of anxiety states and other neuroses. The fact that
Mebaral is almost tasteless simplifies its administration to children. Average dose for children V2
to 3 grains, adults 3 to 6 grains daily. Tablets V2, V/2 and 3 grains.
E B ARAL*
Brand of Mephobarbital
for January, 1950
73
0
T -w -n 1 n • Comments on Current Economic and Social
111 UUl 131111011 • Questions and Professional Problems;
, j: Suggestions Regarding Organized Activities
FEW HAVE BEEN ABLE TO
ESCAPE THE TAX COLLECTOR
Since the time for filing income tax returns
and the payment of income taxes is approach-
ing, physicians would be wise to read carefully
the article published in the December issue of
The Journal, pages 1197-1202, unless they have
already done so.
Why physicians should be extremely careful
and accurate in making returns was emphasized
in an earlier article — pages 1098-1099 of the
November issue.
Whether they like it or not, physicians and
other self-employed persons who do not pay
taxes through a payroll deduction method are
given special attention by income tax inspectors.
Persons who have to pay taxes may not like
it and if they think taxes are too high or un-
reasonable they have a right to try to remedy
the situation through the ballot box. On the
other hand, so long as tax laws are the laws
of the land, each citizen is legally and morally
obligated to comply with them. If he doesn’t,
he runs the chance of getting nipped. If he gets
nipped, he must accept the blame. Publicity on
convictions for tax evasions is harmful to the
individual and to his particular business or pro-
fessional group.
No one has found a way as yet to escape the
Grim Reaper at some time along the way. Few
have been successful in escaping the tax collector,
although some have tried it to their sorrow.
AN INVESTMENT WHICH IS
SOUND AND WARRANTED
Those who are carrying on a hate campaign
against the A. M. A. have raised their hands in
holy horror at the announcement that for the
first time in its existence of more than 100
years, the A. M. A. has decided to charge mem-
bership dues.
Some of the criticism comes from labor brass
and braid which has caused a good laugh among
those who know what labor organizations charge
for the privilege of being a member.
Others who criticize the charging of member-
ship dues should know better. How many organ-
izations exempt their members from paying
something for the privilege of belonging and for
the opportunity to receive services from the
organization? Because of the many and varied
services which it performs for the benefit of its
members and the public, the A. M. A. does not
have to make an apology for charging member-
ship dues — which it should have been doing long
ago.
Any member has a perfect right to disagree
with some policy which his local, state or national
medical society may have on some specific issue.
On the other hand, the society can’t be wrong
on every issue. It should get credit for some
achievements. For that reason, the member
should be expected to make a contribution for
the right to share in the good things and for the
right and opportunity to try to have the policy
with which he disagrees, modified, if the policy
happens to differ from his own views on the
matter.
If the medical profession lets the flanking at-
tack which the welfare state bosses have
launched, using the membership dues question
as a base, split its ranks and muddle its thinking,
it’s a dead duck. Aside from its activities in the
field of legislation, the A. M. A. performs so
many beneficial services for members and citizens
alike that a contribution in the form of member-
ship dues can be regarded as a sound investment
in anybody’s book, even though it may not please
everybody all the time.
INSPECTION OF HOSPITALS
FOR CASUALTY HAZARDS
A nation-wide voluntary inspection of all hos-
pitals has been inaugurated under the sponsor-
ship of the National Board of Fire Underwriters
in cooperation with the American Hospital Asso-
ciation, American Medical Association, the Asso-
ciation of Casualty and Surety Companies and
the National Association of Insurance Agents.
Inspection of Ohio hospitals will be under the
direction of the Ohio Inspection Bureau, co-
operating with the Fire Prevention Association
of Ohio and various casualty company associa-
tions. Qualified representatives of these organ-
izations will make inspections at hospitals where
the management is willing to cooperate.
This program is being carried on as a public
service without cost and without any commercial
aspects of insurance, the Ohio Inspection Bureau
has announced, it being purely in the interest
of preventing injuries and loss of life from fire
and other perils. Confidential reports on the
findings and recommendations for correcting con-
ditions that affect safety to life in the hospital
will be transmitted only to each hospital con-
cerned.
It is quite obvious why physicians can, and
should, give this project their wholehearted
support. Is your hospital going along with this
program? Wouldn’t it be wise for it to take
advantage of this opportunity to have expert
advice on how it stacks up and how it can
74
The Ohio State Medical Journal
WHY MANY LEADING
NOSE AND THROAT
SPECIALISTS SUGGEST
Where smoking is a factor in a throat condition,
the physician may advise 77Don7t Smoke/7
But where the patient persists, many eminent
specialists suggest "Change fo Philip Morris77. . .
the one cigarette proved definitely less irritating.**
Perhaps you too will find it advantageous
to suggest to your throat patients
77 Change to Philip Morris.77 For your
own smoking as well. Doctor, in fact for all
smokers, Philip Morris is by far the wisest choice.
PHILIP MORRIS
Philip Morris & Co., Ltd., Inc.
119 Fifth Avenue, N. Y.
IF YOU SMOKE A PIPE ... We suggest an
unusually fine new blend— Country Doctor Pipe
Mixture. Made by the same process as used in
the manufacture of Philip Morris Cigarettes.
*Co mpletely documented evidence on file.
** Reprints on Request:
Laryngoscope, Feb. 1935, Vo I. XLV, No. 2, 149-154; Laryngo*
scope, Jan. 1937, Vol. XLVII, No. I, 58-60; P roc. Soc. Exp.
Biol, and Med., 1934, 32,241; N. Y. State Joum. Med., Vol.
35, 6-1-25, No. II, 590-592.
for January, 1950
75
correct conditions which could be dangerous
to the life of patients, physicians and hospital
employees? Why don’t you discuss it in a staff
meeting and consider requesting your hospital
board to cooperate?
EDITORS ONLY PRINT THE NEWS;
THEY DON’T MAKE IT
The House of Delegates of the Ohio State
Medical Association in 1948 authorized presenta-
tion of a pin and certificate to members and
former members who had served 50 or more
years in the medical profession.
What started as a sort of “token of apprecia-
tion” within the profession has created public
interest beyond any possible expectation. The
state headquarters, with the cooperation of
county societies and doctors throughout the state,
has compiled a list of more than 400 of these
oldsters in the profession.
The newspapers, to use a colloquialism, have
eaten up the stories about these presentations.
The Headquarters Office almost daily is receiv-
ing clippings from newspapers throughout the
state with multiple-column pictures and columns
of print devoted to the veteran doctors of their
communities, pegged on these presentations.
The newspapers get a lot of unwarranted
criticism about playing up the morbid, the
bizarre and the sensational. But, like those
closely associated with the press know, give them
something good to write about and they’ll jump
at the opportunity.
OFFERS FOR HELP IN CAMPAIGN
NEED CAREFUL SCREENING
Every good product has its by-product, some
of which may be good and some not so good.
We are not surprised, therefore, to hear that
the A. M. A. headquarters itself and its Na-
tional Education Campaign headquarters are be-
ing bombarded by agencies with wares or ser-
vices to sell in connection wuth the campaign.
Many local societies and individual doctors
are being subjected to the same pressure, as
queries into the State and National headquarters
indicate.
Obviously the national headquarters is not
passing up a bet, and is carefully screening and
evaluating every offer. The State office in Co-
lumbus is doing the same with many requests.
Some of the demands are coming from bona
fide groups performing excellent work. Some,
on the other hand, are merely from agencies
or others who are trying to jump on the band-
wagon.
As an example of these offers, one firm is
offering prepared stickers for doctors to buy
directly from them at $25 per thousand. The
National headquarters is furnishing doctors (out
of campaign funds) a sticker which serves the
same purpose at a cost of 80 cents per thousand.
A bulletin from the Chicago office states:
“The many demands on physicians and allied
professions, for money contributions for purposes
supposedly connected with our campaign to pre-
serve the American medical system, are a
great drain on individuals and a scattering of
shot that should not be wasted.”
Obviously neither the medical profession as
a group, nor the individual doctor wants to
pass up any opportunity to recruit help in
our campaign to preserve the American system
of medicine. Nor would we antagonize anyone
who may honestly feel he is making a contribu-
tion to the cause.
On the other hand, individual doctors and
local societies should consider carefully each
offer to determine that it adds constructively to
the campaign and does not duplicate effort.
MEDICAL COVERAGE FOR
THE INDIVIDUAL
Discussing health insurance in an editorial,
The Columbus Citizen recently said:
“Blue Cross and Blue Shield are performing
an extraordinary service in this field but vast
numbers of people are unable to obtain these
policies. What the country needs is a health in-
surance policy which can be bought over the
counter by the individual, just as he buys life,
fire and automobile insurance. If the insurance
companies can work this out they will be doing
the country a great service — and increasing
their own profits.”
In our opinion, the medical profession will
agree with 90 per cent of that statement. It is
just as anxious as anyone to see the people
blanketed with voluntary prepaid hospital and
medical care coverage.
However, this kind of coverage can’t be sold
exactly as other types of insurance for the
reason that the actuarial risk can’t be deter-
mined quite as definitely. For that reason,
care has to be exercised in signing up the “in-
dividual” risk in contrast to signing up “groups”
where the bad risks are offset to some extent by
the good ones.
Also, it is actuarially true that the premium on
one person has to be somewhat higher than
the premium on persons making up a group.
This creates the problem of keeping the cost to
the contract holder at a figure which he can
afford, or is willing, to pay.
Exponents of wide-open sale of health insur-
ance coverage must keep in mind that no one
is going to help the Blue Cross, Blue Shield, or
the insurance company meet deficits. They are
on their own. They must have the funds avail-
able to meet claims. These funds come from
the insured. Unlike the government they can’t
look to general taxation to help them meet their
76
The Ohio State Medical Journal
SIMILTAC
so similar to human breast milk
that there is no closer
equivalent
1. SAVES TIME AND MONEY— one can of Similac
supplies 116-oz. of formula— 20 calories an ounce
at an average cost of less than 9/lOths of a cent
per ounce.
2. SAVES TIME AND MONEY -no milk modifiers
needed with Similac; its higher vitamin content
must be considered; helps avoid costly compli-
cations of ordinary formula feedings.
3. SAVES TIME AND MONEY— easily prescribed,
easily prepared— simply 1 measure of Similac to
2 oz. of water.
SIMILAC FOR GREATER INFANT FEEDING VALUES
BABIES THRIVE ON
EASILY DIGESTED SIMILAC
WITH ITS ZERO CURD TENSION
SIMILAC DIVISION • M & R DIETETIC LABORATORIES, INC.
3 SAVES
YOU
TIME
COLUMBUS 16, OHIO
for January, 1950
77
bills. To do that would be to ask for, and get,
bureaucratic and political control.
Blue Cross and Blue Shield plans are carry-
ing on controlled experiments in individual and
community enrollments. Basic facts are being
assembled and studied. In our opinion, the
whole problem of providing coverage for the in-
dividual— the non-group individual — will be met
eventually by the voluntary agencies. That’s
the real solution.
WHO SAYS IT’S NOT A
POLITICAL ISSUE?
In a statement to the press, National G. 0. P.
Chairman Guy G. Gabrielson said the issue on
socialized medicine may overshadow the fight
on the Taft-Hartley Law during the 1950 elec-
tion campaigns.
This means, so far as the medical profession
is concerned, that physicians are going to have
to take more interest than in the past in the
activities leading up to the general election in
November, 1950. They might as well get set for
it now.
The first thing for them to do is to register
to vote; see that members of their families are
registered to vote; see that friends and ac-
quaintances are registered to vote. The job
of analyzing the qualifications of candidates for
public office and working for those who measure
up, will come when the fireworks start.
PHYSICIANS CAN MAKE OR BREAK
THE BLUE CROSS PLANS
The necessity of continuing cooperation be-
tween members of the medical profession and
Blue Cross is an absolute must if that plan is
to achieve its purpose of providing those with
limited incomes a means of insuring their fam-
ilies against unpredictable hospital bills.
Hospitals and doctors went into a huddle on
the problem of meeting financial losses of that
organization at this year’s annual meeting of
Blue Cross. The question of meeting financial
loss by raising fees or limiting benefits was
raised. Hospitals and doctors were reluctant
to take either step, feeling that it might en-
courage subscribers to favor the government’s
so-called “free program.”
The Iowa State Medical Association made an
analysis to determine the reasons for the high
cost of Blue Cross members’ hospitalization and
came out with some good points, which the local
medical advisory of Hospital Care Corporation
has handed on.
Results of Iowa’s analysis show two sources
of possible abuse. One is in hospitalization for
diagnostic purposes only, whereas Blue Cross
was organized to take care of emergency hospital
needs and the services which go with such needs.
The second possible source of abuse lies in the
prescribing of costly drugs, laboratory services,
oxygen, and physiotherapy, on which there is no
limit set in the policy. Some of the charges
made to Blue Cross for these services have been
staggering.
“The whole plan of hospitalization insurance
will be ruined if the present abuse continues,”
the Iowa report states. “It is felt that the
physician must have the moral fortitude to tell
his patient he is not entitled to diagnostic ser-
vices under his contract, and he should remember
that, regardless of whether the patient has in-
surance or not, if his bill is too large, he will
be more inclined to look with favor on govern-
ment insurance.
“Under the Blue Cross Plan, physicians hold
the whip hand. They can make or break it . . .”
TAX AND TAX, AND
GIVE ORDERS!
Of the forty billion dollars collected by the
Federal Government in the fiscal year, 1948,
five and one-half billion were returned to the
states. Ohio taxpayers paid in $2,665,707,099
and got back $236,982,646, or nine per cent.
All of which indicates several things:
It’s costing too much to run the Federal
Government.
The states are being gypped.
There should be a reapportionment of taxes,
to leave the states and local governments a
fairer share of taxes.
Until reapportionment is achieved, the Federal
Government is going to continue to tell the states
and local units how to run their affairs as they
will continue to be dependent on the U. S. for
money.
MAYORS OF OTHER CITIES
PLEASE NOTE!
The Mayor of Springfield has announced that
the city’s new board of health, authorized by a
city ordinance, will be picked from a list of
eligibles submitted by the Clark County Medical
Society, according to a story in the Springfield
Daily News.
His Honor apparently is tackling the question
from the right angle. We hope the plan works.
Such a deliberative body should be able to come
up with some excellent nominees and without
political complications. Moreover, such a move
is bound to stimulate future interest on the part
of the medical profession in the activities of the
board.
Mayors of other cities please note!
78
The Ohio State Medical Journal
Buckeye News Notes . . .
Cincinnati — Dr. Edwin Khuon was the subject
of a feature article in the Cincinnati Times-
Star. He has been in practice for 56 years.
Cleveland — Dr. Walter C. Alvarez of Rochester,
Minn., spoke before a meeting of the Cleveland
Health Museum on the subject, “How To Get
Along With Your Nerves.”
Columbus — A plaque commemorating James
E. Bauman’s 57 years with the Ohio Department
of Health was presented by fellow workers in
the Department. Mr. Bauman retired recently
as assistant director, chief of the division of
administration and secretary of the Public Health
Council.
East Liverpool — Dr. Milton Wolpert addressed
the local Kiwanis Club on the subject of popular
and scientific use of drugs.
Marietta — Dr. W. S. Hawn was named college
physician for Marietta College.
Nelsonville — Dr. Blaine Goldsberry of Athens
spoke on “Socialized Medicine” before the Rotary
Club.
New Concord — Dr. Walter K. Chess spoke be-
fore the local Grange on the subject of So-
cialized Medicine.
New London — Dr. Courtland B. Meuser of Ash-
land spoke on the subject of “State Medicine”
at a meeting of the New London Rotary Club.
Newark — Three local doctors presented a panel
discussion on student health before the St.
Francis de Sales P.-T. A. They were Dr. Carl
L. Petersilge, Dr. G. A. Gressle and Dr. R. Gil-
bert Mannino.
Ravenna — Dr. Edgar A. Knowlton of Mantua
was named a member of the Portage County
Board of Health to fill the seat left vacant by
his father, the late Dr. Edgar H. Knowlton.
St. Clairsville — Dr. Homer S. West is retiring
as Belmont County Health Commissioner at the
age of 70.
Willard — Dr. Harry Wain of Mansfield, Rich-
land County health commissioner, spoke before
the local Rotary Club. He discussed the history
of preventive medicine leading to modern pub-
lic health systems and warned against govern-
ment control of both curative and preventive
medicine.
Zanesville — Dr. Paul A. Jones addressed the
local Rotary Club as special speaker in a pro-
gram arranged by Dr. George C. Malley.
Zanesville — Dr. George C. Malley spoke on the
subject of the National Compulsory Health In-
surance program at a meeting of the St. Thomas
Holy Name Society.
INGLESIDE FARM INGLESIDE HOME
Hospitals for Nervous and Mental Disorders
VIEW AT INGLESIDE FARM
THE FARM - Chardon, Ohio
Telephone Chardon 355
Medical Director, Neil T. McDermott, M.D.
THE HOME - 8821 Euclid Ave.
Cleveland, Ohio Cedar 5416
Mabel A. Woodruff, Director
Facilities for
Chronics and Convalescents
for January, 1950
81
Do You Know? . . .
The Veterans Administration will offer 259
internships to qualified graduates of recognized
medical schools in 13 of its hospitals beginning
July 1, 1950.
^
Dr. Louis H. Bauer, Hempstead, N.Y., Chair-
man of the Board of Trustees of the American
Medical Association, spoke on “Nationalized
Medicine” at a meeting of the Columbus Rotary
Club, November 21. He was introduced by Dr.
C. C. Sherburne, a Past-President of the Ohio
State Medical Association and a delegate to the
American Medical Association.
s|:
“GP — Published by the American Academy of
General Practice”, is the official name of the
Academy’s projected journal. The April, 1950,
issue will be Volume 1, Number 1.
^ sk ^
The Geauga County Medical Society, of which
Dr. Isa Teed Cramton has been secretary for
many years, was the first society in the state
to have a 100% record in payment of 1950 State
Association dues.
sfc %
A school of hospital administration has been
established at the Medical College of Virginia,
Richmond. The new course will consist of 18
months of training. The course at Virginia is
the twelfth such program to be established.
* >;:
British Health Minister Aneurin Bevan turned
down a bid for higher pay for doctors in the
National Health Service. Each doctor now gets
a head fee of 18 shillings ($2.52) a patient per
year. The profession asked for 30 shillings
($4.20).
>!-
The Bureau of Economic Research and Sta-
tistics of the American Dental Association re-
ports that in mid-1949 the United States had a
total of 86,904 dentists, an average of one den-
tist for each 1,727 residents, compared with a
dentist-population ratio of one dentist for each
1,817 persons in 1947.
%
Dr. Robert S. Dinsmore has been appointed to
succeed the late Dr. Thomas E. Jones as chief
of staff of surgery at the Cleveland Clinic.
^ ^ ^
Dr. Margaret O’Neal, Zanesville, is the new
health commissioner of Muskingum County, suc-
ceeding Dr. Beatrice T. Hagen, who retired after
more than 20 years in that post.
* * *
The Tenth Annual Congress on Industrial
Health, sponsored by the Council on Industrial
Health of the American Medical Association,
will be held in the Roosevelt Hotel, New York
City, Feb. 20-21. The sessions will feature dis-
cussions on industrial medical service, environ-
mental hygiene and human relations in business
and industry. For detailed information write
Dr. Carl M. Peterson, Council Secretary, 535 N.
Dearborn St., Chicago 10.
%
Dr. Richard L. Meiling, Director of Medical
Services, Office of the Secretary of Defense, led
a discussion on “National Economy, Unification
and the Physician”, at the annual meeting of
the Society of U.S. Medical Consultants in
World War II, held in Washington, D.C., No-
vember 14.
❖ ❖
New officers of the Ohio Heart Association
are: Dr. A. Carlton Ernstene, Cleveland, presi-
dent; Dr. Wm. H. Bunn, Youngstown, vice-
president; Dr. Floyd P. Allen, Cincinnati, sec-
retary-treasurer, and Dr. D. L. Mahanna, Colum-
bus, recording secretary. The Association will
be an affiliate of the American Heart Association
and will have headquarters in Columbus.
* * *
Dr. Robert Vogel, Sparta, is the new health
commissioner of the three-county district of
Delaware, Union, and Madison counties. He suc-
ceeds Dr. W. S. Ramsey who is now health com-
missioner of Greenville and Darke county.
s*c s|c 5$:
Eleven persons in each 1,000 in Ohio were
getting relief aid of one kind or another last
June, according to a Congressional survey. Only
three states — Rhode Island, Michigan and New
York — have a higher percentage of their popu-
lation on general assistance rolls. The national
average was 7.6.
# % %
The University of Kansas School of Medicine
now requires 11 weeks of training in rural medi-
cine as a pre-requisite for graduation. Senior
students will spend this time as observers in the
offices of general practitioners in Kansas towns
of under 2,500 population. Thirty-nine preceptors
chosen from a list of 200 physicians submitted
to the school by the Kansas Medical Society
will provide board and room for the students
in return for their assistance.
❖ * *
Dr. Stanley Dorst, dean, University of Cin-
cinnati College of Medicine, is a member of a
committee appointed by the Board of Trustees
of the American Medical Association, to go
to England to make a study of medical educa-
tion as it now exists under health legislation
initiated by the Labor government.
82
The Ohio State Medical Journal
Incorporated • Philadelphia 3, Pa.
for January, 1950
83
Rural Doctor Shortage . . .
Ohio Farm Bureau and Ohio Grange Resolutions Express Concern and
Urge That Facilities for Education of Medical Students Be Enlarged
THE concern of Ohio’s farm organizations
about the problem of supplying more doc-
tors for rural areas was demonstrated re-
cently when the delegate bodies of both the
Ohio Farm Bureau Federation and the Ohio State
Grange approved resolutions on this subject at
their respective annual meetings.
Meetting November 28, 29, and 30 in Colum-
bus, the Farm Bureau delegates issued the fol-
lowing statement:
“Since figures show that not enough doctors
are being graduated at present to replace the
loss of older doctors and since the population
is increasing at a rapid rate, we urge that ade-
quate medical facilities for training be provided
in order that this acute need for doctors might
be met in rural areas.
“While we are opposed to Federal so-
cialized medicine, we feel that it might
result unless the medical profession itself
assumes greater responsibility for provid-
ing needed medical services.”
The Grange, which met December 12-15 in
Columbus, recommended that “the number of
students allowed to prepare themselves for the
medical profession be sufficient to care for the
rural needs in Ohio.”
OPPOSED SOCIALIZED MEDICINE
The resolutions committee of the Ohio Farm
Bureau Federation received resolutions from 16
county farm bureau organizations, urging the
state organization to go on record against so-
cialized medicine.
The Farm Bureau delegates also: .
1. Urged each county to complete a study of
health conditions, problems, and facilities, in-
cluding ways and means of improving local
health, and looking toward any enabling legis-
lation that may be necessary.
2. Commended the Ohio Committee on Public
Health for the study of state and local health
departments and recommended that the Ohio
Farm Bureau cooperate with its recommenda-
tions.
3. -Recommended a voluntary reorganization
of public health districts patterned after the
recommendations of the Ohio Ho'spital Survey
Committee.
4. Asked that the duties of the health com-
missioners be made mandatory when they affect
important health services, and urged close co-
operation of Farm Bureau Home and Community
Committees and health commissioners.
5. -Approved a resolution recommending that
the Federal, State and local health authorities,
in cooperation with professional groups, farm
organizations, and others, be urged to take
every possible legal, legislative and professional
action necessary to bring rabies under control
and to complete eradication.
6. Insisted that the inspection and licensing
of public eating places be under the supervision
of the State Department of Health rather than
under the State Fire Marshal.
7. Urged that all school personnel, handlers
of food in public eating places, and all those
who assist in the processing of food be required
to have annual health examinations, including
chest X-rays.
8. Commended the State Departments of
Health and Education for their jointly initiated
program of teacher training and certification in
health, physical education, recreation and safety;
urged that County Farm Bureaus help promote
the introduction of health courses into all rural
schools; and encourage teachers to attend the
extension courses and workshops provided by the
State Universities for training in health educa-
tion.
MISCELLANEOUS RESOLUTIONS
Miscellaneous actions asked that County Farm
Bureau Committees cooperate with County
Tuberculosis and Health Associations and local
health departments in eradicating tuberculosis;
that County Farm Bureau home and community
committees cooperate with cancer associations
in promoting education concerning importance
of early diagnosis; and supported the national
program for the prevention and cure of social
diseases, urging its complete development in
Ohio.
OTHER GRANGE ACTION
The Grange, which traditionally acts upon
fewer and more general resolutions than does
the Farm Bureau, took no other actions concern-
ing health other than the one above on medical
training, and another, on restaurant inspection.
The latter inferred that sanitary inspection
should be a responsibility of the State Depart-
ment of Health, rather than the State Fire Mar-
shal, who should inspect for fire hazards only.
The University of Michigan School of Public
Health, Ann Arbor, offers its first Inservice
Training Course in Air Pollution, February 6-8.
The School offers a series of inservice, non-credit
training courses, of which the course in air pollu-
tion is the 33rd.
84
The Ohio State Medical Journal
more physicians are satisfied
The development of the new improved Biolac supplies a long-sought need in infant
nutrition. To accomplish this, Borden scientists surveyed our present nutritional knowledge.
They then tested more than 500 formulations. Having decided on the formula that
would best supply the normal infant’s nutritional requirements in their most assimilable
form, a modern plant w~a» constructed in 1949 so that the new formula could
also benefit from the most up-to-date techniques and control in processing equipment.
A Biolac formula that is both new and improved is thus made available.
For up-to-date, complete
infant nutrition, prescribe
new improved j
Biolac
a development of
The Prescription Products Division
The Borden Company
Biolac is intended for prescription by every physician with infants among his patients.
It satisfies the physician’s demand for a complete
food to which only vitamin C need be added.
That means it is simplicity itself to prepare
and provides the maximum in formula
safety for the infant.
And yet, for all these advantages,
Biolac costs no more.
Ingredients: nonfat dry milk
solids, dextrins-maltose-
dextrose, lactose, coconut oil,
destearinated beef fat, lecithin,
sodium alginate, disodium phosphate,
ferric citrate, vitamin Bi,
concentrate of vitamin A and D
from fish liver oils, and water.
Homogenized and sterilized.
Dilution : one fluid ounce to one and a half
ounces of boiled water for each
pound of body weight.
Biolac is available in 13 fluid ounce tins.
The Borden Company, Prescription Products Division
350 Madison Avenue, New York 17
for January, 1950
85
In Memoriam
• • •
Robert Harvey Cook, M. D., Oxford; Medical
College of Ohio, Cincinnati, 1894; aged 78; died
Nov. 24; former member of the Ohio State
Medical Association and the American Medical
Association through 1941; vice-president of the
Butler County Medical Society in 1931; member
American Psychiatric Association. Dr. Cook re-
tired several years ago from active practice in
Oxford where he was active in the affairs of
Miami University. Recently he was awarded
the Ohio State Medical Association’s 50-Year
Pin and Certificate at special ceremonies by the
Butler County Medical Society. Surviving are
two sons, Dr. Malcolm 0. Cook of Hamilton
and Dr. George H. Cook of Iona, Mich.
Earl Wellington Euans, M. D., Columbus; Ohio
Medical University, Columbus, 1897; aged 78;
died Nov. 26; former member of the Ohio State
Medical Association and the American Medical
Association through 1948. Dr. Euans spent his
entire professional career in Columbus where
he retired several years ago. He was a mem-
ber of the Presbyterian Church and several
Masonic orders. One brother survives.
George Bennett Faber, M. D., Columbus; Uni-
versity of Louisville School of Medicine, 1921;
aged 62; died Nov. 14; former member of the
Ohio State Medical Association and the Ameri-
can Medical Association in 1926. Dr. Faber,
formerly with the Ohio Industrial Commission,
retired from practice many years ago. Surviving
are his widow, a son and a daughter.
Leroy R. Fast, M. D., Paulding; Barnes Medical
College, St. Louis, Mo., 1898; aged 82; died
Nov. 24; member of the Ohio State Medical Asso-
ciation and the American Medical Association;
president of Paulding County Medical Society,
1920, 1927, 1931, 1939, 1940; vice-president, 1926;
delegate 1922-25, 1929, 1930, 1933-38, 1941-43;
chairman of the legislative committee, 1926,
1933-34. Dr. Fast had retired about a year ago
after a lifetime practice in Paulding and vicinity.
He was a veteran of World War I, during which
he served with the Medical Corps overseas.
Surviving are two daughters, two sisters and two
brothers, one of whom is Dr. T. P. Fast of
Grover Hill.
Ira B. Gordon, M. D., Cleveland; Pulte Medical
College, Cincinnati, 1891; aged 79; died on or
about Oct. 26; former member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association through 1948.
Louis Guberman, M. D., Cincinnati; University
of Berne (Switzerland) Faculty of Medicine,
1935; aged 40; member of the Ohio State Medi-
cal Association and the American Medical Asso-
ciation. Upon returning to the United States,
after studying in Europe, Dr. Guberman spent
two years at Mercy Hospital in Williamson,
W. Va. He began practice in Cincinnati after
taking the board examination in 1938.
William Barnes Litten, M. D., West Bedford;
Columbus Medical College, 1880; aged 93; died
Nov. 23; former member of the Ohio State Medi-
cal Association and a Fellow of the American
Medical Association through 1948. Dr. Litten
began his practice in West Bedford in 1881 and
continued until 1946 when he retired. Recently
he was awarded the Ohio State Medical Associa-
tion’s Pin and Certificate for more than 50
years of medical practice. Dr. Litten’s practice,
especially in the earlier years, took him into
Licking, Holmes, Knox, Tuscarawas and Musk-
ingum Counties as well as Coshocton County.
In addition to his medical work, he had many
civic interests. He was one of the organizers
and directors of the Coshocton bank now known
as the First National Bank. He was active also
in promotion of such projects as road improve-
ment, education, the Red Cross, and was a life
member of the Methodist Church. Surviving
are his widow, and two daughters.
Joseph A. Murphy, M. D., Columbus Medical
College, 1890; aged 81; died Dec. 11; former
member of the Ohio State Medical Association
and the American Medical Association in 1914.
A practicing physician in Columbus for approxi-
mately 60 years, Dr. Murphy held the office of
county coroner for several terms beginning in
1905 and again from 1921 to 1931. He was a
member of several Masonic orders and was
active in the Methodist Church. Surviving are
his widow, two sons, four daughters, a brother
and a sister.
William Elmer Radcliff, M. D., Caldwell;
Indiana Medical College, School of Medicine of
Purdue University, Indianapolis, 1906; aged 75;
died Nov. 30; member of the Ohio State Medi-
cal Association and a Fellow of the American
Medical Association; vice-president of the Wash-
ington County Medical Society in 1944; its presi-
dent in 1945; delegate, 1942, 1946 and 1947. Dr.
Radcliff had practiced medicine in Caldwell and
vicinity for approximately 37 years. He held
membership in several Masonic orders. His
widow survives.
Clarence Scott Ramsey, M. D., Springfield;
Jefferson Medical College of Philadelphia, 1900;
aged 74; died Nov. 15; member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association; president of the Clark
County Medical Society in 1935. Dr. Ramsey
F6
The Ohio State Medical Journal
Gentle, Effective Action
Phospho-Soda (Fleet's* action is prompt and thorough, free
from any disturbing side effects. That's why so many modern
authoritative clinicians endorse it... why so many thousands
of physicians rely on it for effective, yet judicious relief of con-
stipation. Liberal samples will be supplied on request.
*Phospho-Soda (Fleet) is a solution containing in each 100 cc. sodium biphosphate 48 Gm. and sodium
phosphate 18 Gm. Both 'Phospho-Soda' and 'Fleet' are registered trade marks of C. B. Fleet Company, Inc.
for January , 1950
87
served his entire professional career in Spring-
field.
Samuel Rosenfeld, Jr., M. D., Columbus; Rush
Medical College, University of Chicago, 1936;
aged 42; died Dec. 7; member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association. In addition to his pri-
vate practice, Dr. Rosenfeld was an associate
professor in the Ohio State University College
of Medicine, and was active in the work of the
Columbus Cancer Clinic. He was a member of
the Temple Israel Congregation. Surviving are
his widow, two sons, a daughter, his father,
two brothers and four sisters.
Elmer C. Sill, M. D., Hamilton; Medical Col-
lege of Ohio, Cincinnati, 1888; aged 83; died
Nov. 13; former member of the Ohio State Medi-
cal Association and the American Medical Asso-
ciation through 1923. Dr. Sill began his prac-
tice in Hamilton in the early 1890’s, and recently
was honored by the Butler County Medical So-
ciety by being presented the 50-Year Pin and
Certificate of the Ohio State Medical Association.
One son survives.
James Hickman Swan, M. D., Painesville;
Northwestern University Medical School, 1923;
aged 59; died Nov. 23; member of the Ohio
State Medical Association and the American
Medical Association. Dr. Swan practiced for
several years in Cleveland before moving to
Painesville in 1942. The son of a medical mis-
sionary in China, he had a colorful background
of experiences in the Orient. He was a member
of the Presbyterian Church. Surviving are his
widow, a daughter, a son and two brothers, one
of whom is Dr. Charles A. Swan of Cleveland.
Carl Tuttle, M. D., Berlin Heights; Western Re-
serve University School of Medicine, 1884; aged
88; died Nov. 27. Dr. Tuttle served his entire
professional career in Berlin Heights and vici-
nity. In addition to his professional work, he
found time to pursue several hobbies, especially
as a naturalist. Surviving are a daughter-in-
law and a sister.
Engineer Named
Appointment of W. Waldo Towne as chief basin
engineer of the Ohio and Tennessee Drainage
Basin was announced by the Federal security
administrator. The Basin is a field operation
of the Federal Security Agency’s Public Health
Service, with headquarters in Cincinnati.
One of his duties will be to assist States lying
in the Ohio and Tennessee Drainage Basin area
in developing comprehensive programs aimed at
preventing or abating pollution of the basin’s
water resources. This activity is required by
the Water Pollution Control Act of 1948, which
establishes the authority for a national water
pollution control program.
V. A. Can Pay But One Fee Unless
Separate Service Is Rendered
Physicians caring for veterans under the Ohio
Veterans Medical Care Program can be paid but
one fee on the occasion of one visit, unless there
is ample justification for an additional fee on the
basis of additional service, according to notices
being sent to physicians by the Veterans Admin-
istration Regional Offices at Cleveland and Cin-
cinnati which are based on a ruling from the
U. S. Comptroller General.
Physicians should bear this in mind in obtain-
ing authorizations and in billing the Veterans
Administration.
Following is a letter over the signature of Dr.
H. P. Timberlake, chief medical officer of the
Cleveland Regional Office, which explains in
some detail the ruling and its effect:
“The General Accounting Office, under the di-
rection of The Comptroller General of the United
States, is now sending notices of exceptions to
Veterans Administration Regional Offices, calling
attention to a decision that ‘Fees for both office
visits and injections may not be allowed when
services are rendered jointly.’ Even though au-
thorized and paid, they will ask for recovery
of the additional fee from either the participat-
ing physician or the Veterans Administration
physician who authorized the service, unless an
explanation is furnished which is acceptable to
the General Accounting Office.
“This means jthat the Veterans Administration
physicians issuing authorities can authorize but
one fee on the occasion of one visit, unless there
is ample justification for the additional fee on
the basis of additional service. The greater of
two possible fees is allowable. Furthermore, the
additional service must be adequately explained
on the Report of Treatment Rendered (Form
2690a) in order to justify the payment of the
voucher.
“Although the inquiries at present usually in-
volve combining Fee Schedule Items 0014 and
0056 with Items 8110 and 8111 (Visits and
Injections), this will apply also to other possible
dual requests; such as, combining a visit fee with
an X-ray therapy fee or physical therapy fee.
“With respect to outstanding authorities, many
months may elapse before the Veterans Admin-
istration receives a notice of the exception, so
some designated physicians may be asked to
furnish justification from old records if the re-
port in the Veteran’s treatment folder is in-
adequate.
“If expensive drugs or biologicals used in in-
jections cannot be obtained conveniently from
a V. A. pharmacy or a cooperating pharmacy
and are actually furnished by the physicians,
billing at actual cost may be added to the state-
ment.”
88
The Ohio State Medical Journal
• • •
The Seal of Acceptance denotes that
the nutritional statements made in
this advertisement are acceptable to
the Council on Foods and Nutrition
of the American Medical Association.
And the Meat They Eat
The established relationship between sound dietary planning
and a state of maintained good health emphasizes the nutri-
tional importance of meat, man’s favorite protein food.
Not only does meat taste good, but of greater significance,
it provides a host of nutritional benefits. Developments in the
field of nutrition* have proved that complete protein— the
kind that meat supplies in abundance— aids in building and
maintaining immunity, hastens recovery after acute infectious
diseases and following injury and burns, promotes health
during pregnancy, aids in the growth and development of
husky children, and is needed to maintain everyone in top
physical condition.
No matter from what walk of life your patients come, and
whether their pocketbooks demand economy or permit satis-
faction of that urge for the fanciest cuts, meat gives them full
value for their money.
*McLester, J. S.: Protein Comes Into Its Own, J.A.M.A. 139*897 (April 2) 1949.
for January, 1950
American Meat Institute
Main Office, Chicago. ..Members Throughout the United 9tates
89
Activities of County
First District
(COUNCILOR: D. W. HEUSINKVELD, M. D.,
CINCINNATI)
CLERMONT
Dr. David W. Heusinkveld, Cincinnati, Coun-
cilor of the First District of the Ohio State
Medical Association, presented 50-Year Pins and
Certificates to two doctors at the Nov. 16 meet-
ing of the Clermont County Medical Society.
Those who received the awards are Dr. A. C.
Roberts of Loveland and Dr. J. P. Allen of
Williamsburg.
Dr. E. 0. Swartz, Cincinnati, President-Elect
of the Association, also was a guest of honor
at the meeting.
The meeting was held at the home of Dr. and
Mrs. F. S. Skeen in Batavia.
HAMILTON
Dr. Harry Eagle, National Institute of Health,
Bethesda, Md., spoke on the subject, “The Ther-
apeutic and Prophylactic Use of Penicillin/’ at
the Dec. 6 meeting of the Academy of Medicine
of Cincinnati.
Included in the scheduled program of the
Academy for January and February are the fol-
lowing speakers and subjects:
Jan. 3 — Dr. Jacob E. Finesinger, University
of Maryland, Baltimore, “The Psychiatric Aspects
of Fatigue.”
Jan. 17 — Dr. Herrman L. Blumgart, Harvard
Medical School, Boston, “The Pathogenesis of
Angina Pectoris.”
Feb. 7-8 — Dr. Lawson Wilkins, Johns Hopkins
University, Baltimore, (the B. K. Rachford Lec-
ture), “Endocrine and Other Factors Concerned
in Somatic Growth and Development,” and “The
Endocrine Problems of Sexual Development.”
Feb. 21 — Dr. Henry Schwartz, Washington Uni-
versity School of Medicine, St. Louis, “Surgical
Relief of Pain.”
Societies . . .
HIGHLAND
The Highland County Medical Society honored
five doctors at a banquet in Hillsboro for a half-
century or more of service in the medical profes-
sion. Fifty-Year Pins and Certificates of the
Ohio State Medical Association were presented
at the meeting to Dr. W. H. Wilson, Greenfield;
Dr. Thomas W. Roberts, Belfast; Dr. John A.
Mercer, Greenfield; Dr. J. C. Larkin, Hillsboro;
and Dr. Robert W. Pratt, Hillsboro. Drs. Mercer,
Larkin and Pratt were unable to be present at
the meeting.
Second District
(COUNCILOR : M. D. PRUGH, M. D., DAYTON)
CLARK
Dr. C. Rollins Hanlon, Johns Hopkins Univer-
sity, spoke on “Surgery in Congenital Cardio-
vascular Disease,” at the Nov. 21 meeting of the
Clark County Medical Society at the Ker-Deen
Inn.
DARKE
On Dec. 6, at the meeting of the Darke County
Medical Society in Greenville, Dr. Merrill D.
Prugh, Dayton, Councilor of the Second District
of the Ohio State Medical Association, presided
at presentation of Fifty-Year Awards to Drs.
Brice F. Metcalfe, Orlando P. Wolverton and Wil-
liam C. Gutermuth.
Dr. Giles Wolverton, Dayton, placed the pin
on the lapel of his father, while Dr. J. E. Gil-
lette, Versailles, placed the pin for his father-in-
law, Dr. Gutermuth. Dr. R. D. Dooley, Dayton,
president of the Second District, gave a short
talk.
GREENE
The brick-laying ceremony at the site of the
new Greene County Memorial Hospital Nov. 20
was the occasion for presentation of 50-Year Pins
and Certificates to three Greene County physi-
RESTHAVEN
A strictly modern convalescent hospital, specially
designed and scientifically equipped for the spe-
cialized care of the aged, convalescent, or cancer
patient.
Accredited by American Medical Association.
Complete cooperation to the attending physician.
For descriptive folder , call or write
M. YOUNG, Business Manager
Telephone FA. 2535 or FA. 4893
813 Bryden Road Columbus, Ohio
90
The Ohio State Medical Journal
& milk modified
;• WALtSse s DEXTf^
^Si ®mmm m &*.?**■
NORMAL DILUTION
Dextrogeir + Water = Formula
T 1 fl. oz.
^ (50 Cals.)
1 y2 fl. ozs. 2V4 fl. ozs.
(20 Cal.
per fl. oz.)
cawniOM
fooos AHO
■UTttTIOM
k's'' ADVERTISED TO THE MEDICAL PROFESSION ONLY
THE NEW YORK POLYCLINIC
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345 WEST 50th STREET MEDICAL EXECUTIVE OFFICER NEW YORK CITY 19
for January, 1950
91
cians. They are Dr. C. W. Miller, Osborn; Dr.
C. E. Ream, Towersville and Dr. L. L. Taylor,
Yellow Springs. Dr. C. K. Schloss, Osborn,
president of the Greene County Medical Society,
made the presentations. Dr. Miller was unable
to be present at the meeting, but a representative
accepted the award for him. Dr. R. Kent Finley
of Dayton was principal speaker at the occasion.
MIAMI
Dr. Melvin Oosting of the Troy and Piqua
Hospitals presented a clinical session on the pri-
mary points of consideration in the diagnosis of
anaemias at the Dec. 2 meeting of the Miami
County Medical Society, at the Stouder Memorial
Hospital, Troy.
MONTGOMERY
Two scientific papers were presented before
the Eye, Ear, Nose and Throat Section of the
Montgomery County Medical Society on Nov. 8.
Dr. J. T. Bickmore, Dayton, spoke on “Nasal
Physiology,’’ and Dr. M. W. Sloan, also of Day-
ton, spoke on the subject, “Surgery and Orthoptic
Treatment of Children with Eye Muscle Condi-
tions.”
The following Section officers were elected: Dr.
Robert A. Bruce, Dayton, president; Dr. A. W.
McCally, Dayton, vice-president, and Dr. L. N.
Shroder, Greenville, re-elected secretary-
treasurer.
Third District
(COUNCILOR: J. CRAIG BOWMAN, M.D.,
UPPER SANDUSKY)
AUGLAIZE
Members of the Mercer County Medical So-
ciety were guests of the Auglaize County Medical
Society at a meeting on Oct. 13. Speaker for
the occasion was Dr. H. C. Weisenbarger of Lima
who spoke on the subject of kidney and bladder
pathology.
HANCOCK
Dr. J. Craig Bowman, Upper Sandusky, Coun-
cilor of the Third District of the Ohio State
Medical Association, presented the Association’s
50- Year Pins and Certificates to three doctors
at the November meeting of the Hancock County
Medical Society. They are Dr. T. W. Wilson,
Findlay; Dr. R. N. Lee, Mt. Blanchard, and Dr.
W. F. Lehr, Arlington.
HARDIN
Dr. Dwight M. Palmer, Ohio State University
College of Medicine, addressed a meeting of the
Hardin County Medical Society at Kenton on
Nov. 17. Dr. Palmer’s discussion was in the
field of psychiatry and neurology.
LOGAN
The Logan County Medical Society held a
dinner meeting at Hotel Ingalls, Bellefontaine,
on Nov. 4, at which Dr. Joseph L. Morton of
Columbus was guest speaker.
MARION
Dr. J. Craig Bowman, Upper Sandusky, Coun-
cilor of the Third District of the Ohio State Medi-
cal Association, presented 50-Year Pins and Certi-
ficates to eligible doctors at the Nov. 8 meeting
of the Marion County Academy of Medicine.
Those who received the awards were: Dr. Charles
W. Jacoby, Dr. Richard L. Morgan, Dr. Herman
S. Rhu, Sr., Dr. Neuman Sifritt, Dr. Arthur J.
Willey, all of Marion, and Dr. Benjamin D.
Osborn of Waldo. Dr. Albert Starner was unable
to be present, but his pin and certificate were
given to Dr. A. E. Morrison, president of the
local society, for conveyance.
Fourth District
(COUNCILOR: CARLL S. MUNDY, M. D., TOLEDO)
WOOD
Dr. William H. Rheinfrank of Perrysburg, Dr.
Frank D. Halleck of Bowling Green and the
widow of the late Dr. William H. Price of Stony
Ridge were the recipients of gold medals and
Certificates of Distinction in honor of the phy-
sicians having been actively engaged in the
practice of medicine for over 50 years. Mrs.
Price received the Medal for her deceased hus-
band.
The presentation was made by Dr. Paul F.
Orr of Perrysburg at the regular meeting of
the Wood County Medical Society held at the
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The Ohio State Medical Journal
Midway Night Club, Dixie Highway, Perrysburg.
The physicians were joined by their wives and
members of the Auxiliary, representatives of the
Press and friends.
Mrs. Florence Price, widow of Dr. William H.
Price, expressed her great appreciation of the
honor paid her husband. She was accompanied
by her son, Dr. Frederick F. Price, of Stony
Ridge. Dr. Halleck and Dr. Rheinfrank responded
briefly attesting their gratitude. Mrs. H. W.
Mannhardt, president of the Auxiliary, spoke
of the new scholarships available to graduate
nurses for further work.
Dr. Carll S. Mundy, chairman of the Rural
Health Committee and Councilor for the Fourth
District of the Ohio State Medical Association,
gave the paper of the evening on “Medicine
Past and Future.”
Dr. Mundy reviewed the progress of medicine
since the turn of the century emphasizing the
increasing interest in preventive measures and
the newer drugs and procedures. He spoke of
the changes wrought in practice by the im-
proved transportation enabling physicians to
cover a much wider territory in the care of the
sick. Many compliments were expressed on
Dr. Mundy’s clear discussion of social medical
progress.
At the business meeting Dr. Raymond N.
Whitehead of Bowling Green was elected presi-
dent; Dr. J-. R. McAuley of Perrysburg was
elected vice-president, and Dr. Roger A. Peatee
of Bowling Green secretary-treasurer.
Fifth District
(COUNCILOR: FRED W. DIXON, M. D., CLEVELAND)
CUYAHOGA
A series of Sunday afternoon health lectures,
open to the public is being sponsored by the
Academy of Medicine of Cleveland at the Medi-
cal Library Auditorium. Included in the sched-
ule are the following:
Jan. 15 — “Tales That Dead Men Tell,” Dr.
Alan R. Moritz; Feb. 5 — “Atomic Energy in
Medicine,” Dr. Hymer L. Friedell and Dr. George
L. Sackett; Feb. 26 — “Viruses, Man’s Smallest
Living Enemies,” Dr. John H. Dingle; March 19
— “What Makes Your Baby Grow,” Dr. Richard
G. Hodges. All speakers are of Western Reserve
University School of Medicine.
The Academy scientific program for December
included the following:
Dec. 2 — Clinical and Pathological Section —
“Auricular Fibrillation as a Toxic Complication
of Pneumonia,” Drs. Frederick Geist and Henry
A. Zimmerman; “Exertion Hemoglobinuria,” Dr.
Bert Peppercorn and Dr. Zimmerman; “Fulminat-
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for January, 1950
93
mg Infectious Hepatitis,” Drs. Donald Adair,
Arthur F. Young and Zimmerman; “Action of
Digitalis in Patients With Large Hearts and
Congestive Failure,” Drs. Joseph M. Ryan and
Zimmerman.
Dec. 7, Pediatric Section — “Experimental Pro-
duction of Macrocytic Anemia,” Dr. Charles D.
May, University of Minnesota Medical School.
Dec. 9 — Experimental Medicine Section of the
Academy and Section of the Society for Experi-
mental Biology and Medicine — “BAL and Test-
osterone Proprionate of Mercuric Chloride Poison-
ing,” Drs. Richard P. Levy, Thomas W. Moir
and Max Miller; “Production of Diabetes With
Vitamin C Derivatives,” Dr. J. W. Patterson;
“Methylene Blue Potentiation of Alloxan Dia-
betes,” A. Lazarow, Ph. D., S. Stephens and J.
Liambeis. All of the foregoing speakers are of
Western Reserve University.
Dec. 16 — Regular Academy Meeting — “What’s
New in Drugs?” by Dr. E. M. K. Geiling, Uni-
versity of Chicago.
LAKE
Four Lake County physicians were honored
with the 50- Year Pin and Certificate of the
Ohio State Medical Association at the Nov. 29
annual Lake County Memorial Hospital staff
dinner. Dr. Fred W. Dixon, Cleveland, Coun-
cilor of the Fifth District of the Ohio State
Medical Association, made the presentations in
the name of the Association. Those who received
pins are Dr. Phrania Chesbrough, Willoughby;
Dr. Jules Verne Winans, Madison, and Dr.
Chauncey 0. Hudson, Painesville. Dr. Michael
H. Carmody was honored posthumously.
Sixth District
(COUNCILOR: PAUL A. DAVIS, M. D., AKRON)
COLUMBIANA
Officers of the Columbiana County Medical So-
ciety for the coming year are: Dr. Ralph J.
Starbuck, president; Dr. R. J. McConnor, vice-
president; and Dr. Harold F. Hoprich, secretary-
treasurer. All are of Salem.
STARK
Among members of the Stark County Medical
Society eligible for the 50- Year Pin and Certi-
ficate are the following who were presented
the awards at a meeting of the Canton Academy
of Medicine:
Dr. C. A. Crane, Dr. F. E. Hart, Dr. G. E.
Paolazzi, Dr. J. A. Schirack and Dr. W. A. White,
Sr. Presentations were made by Dr. Carl A.
Lincke, Carrollton, President of the Ohio State
Medical Association. Dr. Esther Tyrrell and
Dr. Herman Welland were unable to be present
to receive the awards.
TRUMBULL
The annual postgraduate day of the Trumbull
County Medical Society was held at the Ameri-
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The Ohio State Medical Journal
can Legion Hall in Warren on Nov. 16. Included
on the scientific program were four doctors
from the University of Michigan Medical School:
Dr. H. R. Morgan who discussed the manage-
ment of intestinal upsets; Dr. S. W. Hoobler
who discussed treatment of elderly patients
with heart ailments; Dr. R. L. Haas whose
subject was in the field of obstetrics and
gynecology; and Dr. H. K. Ransom who spoke on
ulcerative colitis and other diseases of the colon.
Seventh District
(COUNCILOR: R. J. FOSTER, M. D., NEW
PHILADELPHIA)
BELMONT
The Dec. 15 meeting of the Belmont County
Medical Society was held at the Belmont Hills
Country Club. Included on the program was
the showing of a film entitled “Treatment of
Gastric Ulcers,” by Dr. Peter Lancione of Bellaire
and a talk by Dr. H. E. Hathhorn, Youngstown,
on the subject, “Water and Electrolyte Balance.”
After dinner with the Auxiliary, Wayne L.
Mays, Representative from the 18th Congres-
sional District, discussed experiences on his
recent trip to Europe.
COSHOCTON
Three Coshocton County doctors were honored
with 50-Year Pins and Certificates of the Ohio
State Medical Association at a dinner meeting
of the Coshocton County Medical Society and
their wives. The three doctors are Dr. E. M.
Wright, Coshocton; Dr. E. U. Marquand, Coshoc-
ton, and Dr. W. B. Litten, (since deceased). Of
the three, only Dr. Wright was able to be pres-
ent at the meeting. Dr. R. J. Foster, New Phila-
delphia, Councilor of the Seventh District of
the Ohio State Medical Association, made the
presentation.
TUSCARAWAS
Three doctors. Dr. E. B. Shanley, New Phila-
delphia, Dr. D. W. Shumaker of Dover, and Dr.
R. A. Wilson of Dennison, were honored at the
Nov. 16 meeting of the Tuscarawas County
Medical Society for fifty or more years of service
in the medical profession. The dinner meeting
was held in the Elks dining room in New Phila-
delphia.
Dr. C. D. Kurtz of New Philadelphia, also
eligible for the award, was unable to attend be-
cause of illness.
Dr. R. J. Foster, New Philadelphia, Councilor
of the Seventh District of the Ohio State Medi-
cal Association, made the presentation in the
name of the Association.
Dr. Carl A. Lincke, Carrollton, President of
the Association, gave a congratulatory talk to
the 50-year doctors. Dr. C. M. Dougherty, presi-
dent of the local society, presided.
Guest speaker for the evening was Dr. Donald
B. Effler, Cleveland, who discussed chest surgery.
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During the dinner, a trio composed of Jeanne
Ball and Mrs. Foster Flora of New Philadelphia
and Gilbert Roehm of Dover provided music, while
vocal selections were given by Miss Margaret
Ann Davis and James Baker accompanied by Mrs.
Ruth Jurgens, all of Dover. Dr. E. C. Davis, Jr.,
was program chairman.
The following officers were elected for the
ensuing year: Dr. William E. Hudson, New
Philadelphia, president; Dr. Vincent C. Nipple
of Midvale, vice-president, and Dr. H. F. Wherley,
New Philadelphia, secretary-treasurer.
Eighth District
(COUNCILOR: CHESTER P. SWETT, M. D., LANCASTER)
FAIRFIELD
Dr. Mel A. Davis, Columbus, spoke to mem-
bers of the Fairfield County Medical Society at
a luncheon meeting in Hotel Lancaster on the
subject, “Early Recognition of Cancer.”
Walter E. Brehm, Millersport, representative
of the Eleventh Ohio Congressional District,
spoke at the Dec. 13 meeting.
GUERNSEY
Dr. Wilmer G. Lane, Cambridge, was honored
at a meeting of the Cambridge Rotary Club by
being presented the 50-Year Pin and Certificate
of the Ohio State Medical Association. The
presentation was made by Dr. Chester P. Swett,
Lancaster, Councilor of the Eighth District of
the Association. Dr. George F. Swan spoke in
behalf of the Guernsey County Medical Society
at the conclusion of which he presented to Dr.
and Mrs. Lane in the name of the members a
bouquet of flowers.
At the Nov. 17 meeting of the Society, Dr.
J. W. Camp spoke on the subject, “Diagnoses
and Treatment of Rheumatoid Arthritis.” Drs.
F. G. Lawyer, Earl E. Conway and M. C. Mc-
Cuskey were appointed a committee to arrange
for a Christmas party for members and wives.
Election was held at the Dec. 1 meeting of
the Society with the following officers elected:
Dr. Reo M. Swan, president, and Dr. F. Gordon
Lawyer, secretary-treasurer. The elected dele-
gate is Dr. Robert A. Ringer and the alternate,
Dr. Benjamin S. Gillespie. The scientific pro-
gram was in charge of Dr. C. F. Shively who
gave a talk on “Erythroblastosis Fetalis.”
LICKING
Members of the Licking County Medical So-
ciety and the Auxiliary met for dinner at the
Granville Inn on Nov. 29, after which they went
to the Ohio Power Building where Dr. Robert
E. S. Young, Columbus, spoke on the subject of
“Socialized Medicine.”
MUSKINGUM
Four physicians were honored at the Dec. 1
Christmas Party of the Muskingum Academy of
Medicine by being awarded the Ohio State Medi-
cal Association 50- Year Pins and Certificates.
They are: Dr. W. C. Bateman, Dr. G. W. Mc-
Cormick, Dr. L. R. Culbertson and Dr. E. M.
Brown, all of Zanesville. Dr. Beatrice T. Hagen,
retiring county health commissioner, was honored
for her many years of service in that capacity.
Dr. Chester P. Swett, Lancaster, Councilor of
the Eighth District of the Ohio State Medical
Association, made the presentations.
Ninth District
(COUNCILOR: J. PAUL McAFEE, M. D„
PORTSMOUTH)
HOCKING
On the occasion of his 82nd birthday, Dr. A..
K. Smith of Logan was presented the 50-Year
Pin and Certificate of the Ohio State Medical
Association by Dr. J. Ward Doering, president of
the Hocking County Medical Society, and Dr..
Owen F. Yaw, secretary. The ceremony of the
presentation was in Dr. Smith’s office where he
still practices.
SCIOTO
Four local physicians were honored at the
annual banquet of the Hempstead Academy of
Medicine on Dec. 1 at the Chez Paree. Dr. J.
P. McAfee, Councilor of the Ninth District of
the Ohio State Medical Association, made presen-
tations of the Association’s 50-Year Pins and
Certificates. The awards were presented to Dr.
W. A. Ray, Dr. A. L. Test, Dr. D. A. Berndt,.
and Dr. J. W. Fitch.
New president of the Academy is Dr. L. B.
Hatch of South Webster, who was installed to
succeed Dr. Ross M. Gault. Dr. R. L. Wagner
was installed as vice-president, succeeding Dr.
Chester H. Allen, and Dr. C. L. Pitcher was
reinstalled as secretary- treasurer. The Woman’s
Auxiliary gave a pictorial presentation as a
feature of the program. Chairman and toast-
master for the occasion was Dr. Clyde W. Everett.
Dr. Arthur S. Jones of Huntington, W. Va.,
was guest speaker at the Dec. 12 meeting of the
Academy where he spoke on the subject, “After
Treatment of Poliomyelitis and Other Orthopedic
Conditions.”
Eleventh District
(COUNCILOR: JOHN S. HATTERY, M. D., MANSFIELD)
LORAIN
Presentations of the Ohio State Medical Asso-
ciation's 50-Year Pins and Certificates to eligible
members were made at the Dec. 13 meeting of
the Lorain County Medical Society in Pueblo.
The presentations were made by Dr. John S.
Hattery, Mansfield, Councilor of the Eleventh
District of the Association. Those who received
pins are: Dr. F. B. Gregg, Wellington; Dr. H.
J. Austin, Elyria; Dr. George Gill, Elyria; Dr.
0. B. Monosmith, Lorain; Dr. S. V. Burley,
96
The Ohio State Medical Journal'
Lorain. The award was made posthumously
to the late Dr. Emil J. Heinig.
MEDINA
Dr. Claude S. Perry, Columbus, was guest
speaker at the Nov. 17 meeting of the Medina
County Medical Society. His subject was “Office
Ophthalmology.”
Three members of the Society were awarded
the 50-Year Pins and Certificates of the Ohio
State Medical Association at the Dec. 15 meet-
ing of the group at Wadsworth Municipal Hos-
pital. They are Dr. R. L. Johnson of Wadsworth,
Dr. Harry Streett of LeRoy, and the late Dr.
H. P. H. Robinson of Medina.
RICHLAND
A combined meeting of the Richland County
Medical Society and the active staff of Mansfield
General Hospital was held at the hospital on
Nov. 17. A dinner meeting was followed by a
scientific program. Speaker on this occasion
was Dr. Laurence S. Fallis, of the Henry Ford
Hospital, Detroit, Mich. His subject was “Sur-
gical Diseases of the Pancreas.”
WAYNE
Four Wayne County physicians were awarded
the 50-Year Service Pins and Certificates of the
Ohio State Medical Association. They are: Dr.
Lincoln A. Yocum, Wooster; Dr. Seymour G.
Boor, Creston; Dr. William D. Wise, Orrville;
and Dr. R. C. Paul, Wooster.
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(Editor’s Note — The reports for Scioto, Trumbull and
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ALLEN
Fifty-five tables were in play at the annual
benefit card party given by the Auxiliary to the
Lima and Allen County Academy of Medicine
on Nov. 16. The scene of the benefit was the
Nurses’ Home at Memorial Hospital. Individual
table awards were given. Arrangements were
in charge of Mrs. James McBride and Mrs.
Donald English. Proceeds go to the auxiliary’s
nursing scholarship fund.
ASHTABULA
The first meeting of the 1949-50 season of
the Woman’s Auxiliary to the Ashtabula County
Medical Society was a tea on Oct. 11 at the
home of the President, Mrs. Frank Veroni. Fol-
lowing the business meeting, Mrs. John Guernieri
entertained with piano selections. Tea was
served by the hostess who was assisted by Mrs.
Paul Longaker, Mrs. E. N. Wright and Mrs.
H. A. Tagett.
On Nov. 8, the Ashtabula Auxiliary held a
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for January, 1950
97
dinner meeting at the Hotel Cleveland at Con-
neant. Mrs. C. T. Risley served as chairman of
arrangements, assisted by Mrs. S. E. Gates,
Mrs. J. G. Constantine and Mrs. R. C. Irving.
Members discussed plans for the Thanksgiving
dance on Nov. 26 at the Hotel Ashtabula.
George Nash of Gansie Doll Hospital was the
speaker and displayed several dolls.
General chairman of the Thanksgiving dance
was Mrs. William H. Eberle. Proceeds of the
dance have been applied to the nurse scholarship
fund which the auxiliary has established. It is
planned to make the dance an annual event.
CHAMPAIGN
Another new county auxiliary was added to
the roster of state membership when the
Woman’s Auxiliary to the Champaign County
Medical Society was organized on Nov. 29, at
a luncheon in Urbana. Mrs. George Cooper-
rider, state president-elect, and Mrs. E. P.
Greenawalt district director, met with the wives
of the Champaign County physicians to assist
them in their organization.
Mrs. V. R. Frederick was elected president;
Mrs. F. E. Lowry, vice-president; Mrs. F. R.
Grogan, secretary and treasurer.
CLARK
On Nov. 10, the Woman’s Auxiliary to the
Clark County Medical Society entertained at a
musicale and tea held in the Nurses’ Residence
of Springfield City Hospital. Mrs. T. M. Hayes,
chairman of Ways and Means, supervised the ar-
rangements for the benefit assisted by a com-
mittee of seven. Guest artist was Howard
Tuvelle, talented fifteen-year-old pianist who
won top honors in the 1949 Young Artists’
Competition sponsored last May by the Spring-
field Symphony Orchestra. Also on the program
were numbers sung by the nurses’ choir under
the direction of Mrs. John E. Foster.
Members of the Clark County Auxiliary joined
their husbands at an informal dinner party
on Dec. 7 at the Springfield Country Club. Guest
speaker was Harry E. Northam of Chicago,
executive secretary of the Association of Physi-
cians and Surgeons. Mrs. M. B. Martin was
hospitality chairman.
ERIE
The November luncheon and meeting of the
Erie County Auxiliary featured the history and
workings of “The Welcome Wagon,” a popular
service originated by T. W. Briggs.
During the business session conducted by the
President, Mrs. Carl E. Swanbeck, committee
chairmen submitted reports and three new
members were given the auxiliary pledge. The
new members are Mrs. E. J. Baxter, Mrs. H.
E. Snedden and Mrs. L. G. Parker. Then fol-
lowed the introduction of transfer member, Mrs.
J. Ohlemacher, formerly of Jamestown, Pennsyl-
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GYNECOLOGY — Intensive Course, two weeks, start-
ing Feb. 20. Vaginal Approach to Pelvic Surgery,
one week, starting March 6.
OBSTETRICS — Intensive Course, two weeks, starting
March 6.
PEDIATRICS — Intensive Course, two weeks, start-
ing April 3. Personal Course in Cerebral Palsy,
two weeks, starting July 31.
MEDICINE — Intensive General Course, two weeks,
starting April 24. Hematology, one week, starting
May 8. Gastro-Enterology, two weeks, starting
May 15. Liver & Biliary Diseases, one week, start-
ing June 5. Gastroscopy, two weeks, starting Mar. 6.
DERMATOLOGY — Formal Course, two weeks, start-
ing May 8. Informal Clinical ' Course every two
weeks.
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98
The Ohio State Medical Journal
vania. Plans were announced for a Christmas
tea for the nursing staffs of Good Samaritan
and Providence Hospitals.
FAIRFIELD
The Auxiliary to the Fairfield County Medi-
cal Society met on Nov. 14 at the Hotel Lan-
caster. Dessert was served and then a short
business session followed, at which Mrs. F. W.
James, president, presided. A comprehensive
legislative report was given by Mrs. H. M.
Amstutz, in which all the current bills before the
present Congress were discussed. During the
social hour, bridge was played. Hostesses for
the occasion included Mrs. A. M. Kelly, Mrs.
James, Mrs. J. A. Geer, Mrs. A. B. Van Gundy
and Mrs. Charles Clark.
FRANKLIN
The Woman’s Auxiliary to the Columbus
Academy of Medicine held a day-long series of
special events on Nov. 21 at the Deshler-
Wallick Hotel. A book review opened the. day’s
activities at 10:30 a. m. An English breakfast
was served at noon. An afternoon bridge party
featured a style show of furs. Proceeds from
the day were turned over to the auxiliary’s
project which provides occupational therapy sup-
plies to hospitals and other institutions in Frank-
lin County.
In charge of arrangements were Mrs. Joseph
H. Geyer, general chairman; Mrs. Joseph S.
Stevens, ticket chairman; Mrs. Ben R. Kirkendall,
prize chairman; Mrs. Zeph J. R. Hollenbeck,
book review chairman; Mrs. Bruce C. Martin,
breakfast chairman.
JEFFERSON
The Jefferson County Auxiliary played hostess
at a dinner meeting on Nov. 10 at the Steuben-
ville Country Club for the Jefferson County
Medical Society. Three doctors of the Steuben-
ville district were honored that night for a
half-century of service in the medical profession.
They were Dr. J. E. Miller, Dr. I. C. Foster and
Dr. J. F. Young.
Covers were laid for 55 with a Thanksgiving
theme used for table decorations. The committee
in charge of arrangements included Mrs. E.
Weinman, program chairman; Mrs. Robert
Puncheon, Jr., and Mrs. S. Harris. Mrs. Albert
Sunseri was social chairman; she was assisted by
Mrs. Fred Harrington, Mrs. Ernest Perri and
Mrs. David Greenberg.
LAWRENCE
Another new auxiliary to be welcomed is that
of the Lawrence County Medical Society which
was organized on Dec. 2. On that date, the
doctors’ wives of Lawrence County met at the
home of Mrs. W. F. Marting, with Mrs. George
Cooperrider, state president-elect. Mrs. Cooper-
rider explained the importance and advantages
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99
of the auxiliary, and after a period of discussion,
the decision to organize was unanimous. Meet-
ings are to be held on the third Monday of
each month. The newly elected officers include:
Mrs. George N. Spears, president; Mrs. John A.
Dole, president-elect; Mrs. V. V. Smith, vice-
president; Mrs. F. R. Stewart, secretary- treasurer.
LICKING '
Thirty members of the Licking County Medi-
cal Society and their wives met at Granville Inn
for dinner on Nov. 29. The group later went
on to the Ohio Power building to hear Dr.
Robert E. S. Young of Columbus speak on so-
cialized medicine. In the audience, besides the
medical society and its auxiliary, were druggists,
nurses, dentists and hospital personnel. Dr.
Young pointed out the pitfalls that the various
countries have fallen into as a result of their
attempt to socialize the practice of medicine.
LUCAS
An open tea featured the Nov. 15 meeting of
the Woman’s Auxiliary to the Toledo and Lucas
County Medical Society at the Woman’s Club.
Friends and guests of auxiliary members were
invited to hear Judge Paul Alexander talk on
“What Is Happening to Family Life?” Mrs.
Harry Conn of the program committee introduced
the speaker. The auxiliary’s public relations
group also worked with the Family Council and
P. T. A. Council in bringing a physician speaker
to address an open meeting that was held in the
Academy of Medicine building on Nov. 17.
OTTAWA
Thanksgiving and Christmas tray decorations
for Magruder Hospital patients were made by
members of the Woman’s Auxiliary to the Ottawa
County Medical Society when they met on
Nov. 17 at the home of Dr. and Mrs. LeRoy
Belt. After a short business session, a program
was presented by Mrs. C. R. Wood who conducted
a discussion of the “Voluntary Way.” The
women also assembled tuberculosis seal envelopes
that evening.
RICHLAND
The auxiliary to the Richland County Medi-
cal Society held a luncheon and social meeting
on Dec. 5 at the Women’s Club. Forty members
and one guest were present. Christmas ap-
pointments decorated the luncheon tables. Mrs.
F. J. Heringhaus, president, conducted the busi-
ness meeting. Mrs. Russell Barnes reported that
the ice cream and candy sent to the Richland
County Home was enjoyed and appreciated by
the residents.
It was announced that the auxiliary will assist
the Health Department with clerical work con-
nected with the hearing program. A new mem-
ber, Mrs. Kenneth Werts, was welcomed into the
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The Ohio State Medical Journal
group. Following the business meeting, bridge
was played.
SANDUSKY
Harry C. Heffner, author and lecturer, spoke
on “Health — the American Way” in a special
program held at the Memorial Hospital Nurses’
Home on Nov. 29, sponsored by the Sandusky
County Auxiliary.
This meeting was open to the public. Mr.
Heffner presented his ideas as a layman re-
garding the health insurance program, and pro-
vided a detailed and informative outline of the
vital issue facing the United States citizenry
today. “Compulsory health insurance isn’t just
a threat to health,” he pointed out, “it is a threat
to freedom.”
At the conclusion of Mr. Heffner’s talk, it was
announced to auxiliary members that a Christmas
party had been planned at the home of Mrs.
F. L. Moore on Dec. 16.
SCIOTO
The Scioto County Auxiliary voted, at its
November meeting, to start a special nurse re-
cruitment fund, the proceeds from which will
be used to sponsor a deserving girl from the
Hillcrest Home for Children in Scioto County
through nurse’s training. The meeting was held
at the Four Keys in the form of a luncheon on
Nov. 9. Mrs. W. A. Ray, president, presided
at the business session. A social hour concluded
the meeting. A bake sale was also a feature
of the afternoon.
TRUMBULL
The first session of the fall season for the
auxiliary of the Trumbull County Medical So-
ciety was a joint dinner meeting with the mem-
bers of the Medical Society at the El Rio on
Sept. 24.
Dr. R. P. Ostergard introduced the guest speak-
er, Dr. Samuel Spector, assistant professor of
pediatrics at Babies’ and Children’s Hospital in
Cleveland. Following the lecture, the individual
groups adjourned to their respective business
meetings.
Mrs. D. R. Mathie, president, introduced her
new officers: president-elect, Mrs. A. W. Beale;
vice-president, Mrs. Clyde Muter; correspond-
ing secretary, Mrs. Allen Shaffer; recording
secretary, Mrs. John Thomas; treasurer, Mrs.
Charles Mathias.
The auxiliary met on Oct. 21 at the Trumbull
Country Club for a luncheon meeting. Mrs.
Mathie presided over the business period. Miss
Janet Zizelman of Cleveland spoke on “Contem-
porary Modern Interior Decoration.” She was
introduced by Mrs. E. G. Kyle, program chair-
man. Miss Brant of Harding High School, rep-
resenting the citizenship committee, talked on the
school levy.
TUSCARAWAS
The Woman’s Auxiliary to the Tuscarawas
County Medical Society held its September meet-
ing at the home of Dr. and Mrs. William Hudson.
Mrs. M. W. Everhard, president, presided at
the business meeting. A nominating committee
headed by Mrs. C. J. Miller was appointed. Plans
for the winter season were discussed.
WILLIAMS
Mrs. J. A. Maxwell has been elected president
of the recently formed Auxiliary to the Williams
County Medical Society. Other officers include:
Mrs. R. K. Ameter, president-elect; Mrs. Victor
Boerger, vice-president; Mrs. J. R. Riesen, secre-
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tary; Mrs. W. L. Hahn, treasurer. Mrs. Ameter
and Mrs. Maxwell were hostesses at a luncheon
held on Oct. 11 at the Hotel Elder. This was
followed by a business meeting at the home of
Mrs. Ameter. Guests were Mrs. George Cooper-
rider, state president elect, and Mrs. Cyrus
Wood, district director. Meetings will be held
once each month.
The Woman’s Auxiliary to the Williams County
Medical Society held its November meeting at
the home of Mrs. J. A. Maxwell at Montpelier.
It was announced that Mrs. R. K. Ameter and
Mrs. Maxwell had attended the annual conference
for presidents and presidents-elect held in Octo-
ber in Columbus. Later in the evening, the doc-
tors joined their wives at the Maxwell home.
A. M. A. Council Warns Against
Unwise Use of Cold Tablets
The Council on Pharmacy and Chemistry of the
American Medical Association warned against
indiscriminate use of antihistaminic substances
now being widely promoted for prevention and
treatment of colds.
“The council recognizes the evidence that has
been accumulated relative to such uses but it
is not convinced that this is sufficient to war-
rant the positive statements that are being
made,” the Council said.
“Cases already are reported and records show
that about one-third of those who take these
drugs become drowsy or even fall asleep while
at work or in occasional cases even when driv-
ing cars or operating machinery.
“Experience with these drugs is not yet long
enough to know whether or not they are harm-
less when used over long periods of time. Fur-
thermore, the amounts taken in persistent colds
may be definitely beyond what has been estab-
lished as safe.”
COMING MEETINGS
Ohio State Medical Association, Annual Meet-
ing, Cleveland, May 16-18.
American Medical Association, Annual Session,
San Francisco, Calif., June 26-30.
National Conference on Rural Health, Kansas
City, Mo., Feb. 3-4.
American Academy of General Practice, St.
Louis, Feb. 20-23.
American Association for Thoracic Surgery,
Denver, Colo., April 15-19.
American College of Physicians, Boston, April
17-21.
American College of Radiology, San Francisco,
Calif., June 25.
American Pediatric Society, French Lick, Ind.,
May 8-10.
National Tuberculosis Association, Washing-
ton, D. C., April 25-28 .
INDEX TO ADVERTISERS
Abbott Laboratories 5
American Meat Institute 89
Ames Company, Inc. 80
Ar-Ex Cosmetics, Inc. 101
Ayerst, McKenna & Harrison, Ltd 15
Bell, Kathryn S., Inc. 100
Borden Company 85
Bowen, Charles F., M. D. 100
Bowman Bros. Drue Company 99
Camel Cigarettes 18
Chicae Med. Soc. 23
Cincinnati Sanitarium 12
Clinical and Patholoeical Laboratory 99
Columbus Orthopaedic Appliance Company 98
Cook County Graduate School of Medicine 98
Davies, Rose & Co., Ltd. 7
Eaton Laboratories, Inc. 16
Elm Manor Sanitarium 101
Endo Products, Inc. 20
Fairfield Nursine Home 93
Fleet, C. B., Company, Inc., 87
Hanger, J. E., Inc. 95
Harding Sanitarium 13
Holland Rantos Company 21
Ingleside Home, Inc. 81
Lederle Laboratories 3
Lilly, Eli, & Company.: Insert Between
Pages 24 and 25
Luzier’s Inc. 6
McMillen Sanitarium 12
Mead Johnson & Company Back Cover
Medical Protective Company 94
Medico Press 95
Mercer Sanitarium 13
Merck & Company, Inc. 79
Miller, W. H., M. D 97
M & R Dietetic Laboratories, Inc. 77
Neil Training School 101
Nestle’s Company, Inc. 91
New York Polyclinic Medical School 91
Norton Infirmary 22
Num Specialty Company 103
Oak Ridge Sanatorium 14
Inside Back Cover
Philip Morris & Company 75
Pogue, Mary E., School 93
Quincy X-Ray & Radium Laboratories 103
Radium Emanation Corporation 23
Resthaven 90
Rupp & Bowman Company 94
Sawyer Sanatorium 1
Schering Corporation 19
Searle, G. D., & Company 71
Squibb, E. R. 17
Stoneman Press. 22
U. S. Army Medical Dept. 24
Van Wagner Co 92
Wendt-Bristol Company 97
Wickhaven Sanitarium 13
Windsor Hospital 13
Winthrop-Stearns. Inc. 73
Wyeth, Incorporated 83
Zemmer Company 103
102
The Ohio State Medical Journal
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^Ue Plufiiciati'i. feoohlUell
By JONATHAN FORMAN, M. D.
A Textbook of Physiology, edited by John F.
Fulton, M. D. ($10.00. W . B. Saunders Com-
pany, Philadelphia) , is the sixteenth edition of
the old, old Howell Physiology which your re-
viewer used when he was in school 40-some years
ago. It has a new editor and a whole new list
of collaborators which keep it still one of the
best texts for medical men.
Health Guides and Guards, by Francis P. Wall
and Louis D. Zeidberg ($4.00. Fourth Edition.
Prentice-Hall, Inc., New York City), is an effort
to keep up with the strides made in sanitation
during the war years and to meet the demand
upon the authors. This book has been revised
three times in the last thirteen years. This
speaks for the quality of the text.
A Textbook of Surgery, by American Authors,
edited by Frederick Christopher, M. D. ($13.00.
Fifth Edition. W. B. Saunders Company, Phila-
delphia). Our fellow members, Beck of Cleve-
land; Altemeier of Cincinnati; Curtis of Co-
lumbus; Harbin of Cleveland; Herrmann of Cin-
cinnati; Hoerr of Columbus; and Zollinger of
Columbus, have all contributed chapters on sub-
jects in which they are especially interested.
The authors again have successfully based their
material on the tried and the true.
Change of Life — A Modern Woman’s Guide,
by F. S. Edsall ($2.00. Woman’s Press, New
York City). From the viewpoint of one who has
to listen to so many otherwise intelligent women
talk about their age as though there was
something pathologic about age itself, this book
gives those who are able to profit by what they
read, an excellent bit of advice.
Arterial Hypertension, by Irvine H. Page, M. D.,
and Arthur Curtis Corcoran, M. D. ($5.75. Sec-
ond Edition. Year Book Publishers, Inc., Chicago),
is a practical manual for the care of the patient
with hypertension presented for those of us who
are interested in such patients but not to the
exclusion of patients with other afflictions.
These Ohio physicians have made us deeply
obligated to them.
Clinical Audiology, by Maurice Saltzman, M. D.
($5.00. Grune and Stratton, Inc., New York
City), deals with physics and psychology in an
attempt to clear up some of the problems of im-
paired hearing and diseases of the ear. The
author is a well-known expert in this narrow
field of hearing.
Atlas of Surgical Operations, by Elliott C. Cut-
ler and Robert M. Zollinger, illustrated by Mil-
dred B. Codding ($9.00. Macmillan Company,
New York City), is a revised edition of this ex-
cellent atlas and contains 30 new procedures in
addition to the original ones, about half of
whose plates have been redrawn to their im-
provement.
Acute Laryngotracheobronchitis, by A. Harry
Neffson, M. D. ($5.00. Grune and Stratton, Inc.,
New York City), is the first monograph on
“croup” in years. The author tries, in this small
volume, to clarify the approach to the problem
connected with this disease. He presents a de-
tailed description of the disease. The reading of
this book should give the pediatrician, the laryn-
gologist, and the family physician a clearer under-
standing and thus equip each of them to handle
such cases better.
May’s Manual of Diseases of the Eye, revised
and edited by Charles A. Perera, M. D. ($5.00.
Twentieth edition. Williams and Wilkins, Balti-
more, Maryland). In my student days I studied
the seventh edition and now we have the twen-
tieth. It still is in demand the world over as
the best manual on the eye.
Intelligence and Personality Factors Associated
with Poliomyelitis Among School Children, by
E. Larkin Phillips, Isabel R. Berman and Harold
B. Hanson, is monograph serial number 45 in
volume xii of the Society for Research in Child
Development. These workers found a significant
difference in these children. They feel that the
severity of the disease was more important than
the amount of hospitalization and the effects
of illness more important than those of treat-
ment in the psycho-social sense.
Diagnosis and Treatment of Brain Tumors and
Care of the Neurosurgical Patient, by Ernest
Sachs, M. D. ($15.00. Second Edition. C. V.
Mosby Company, St. Louis, Missouri) . Originally
written on a demand from the author’s students
for a text from his pen and revised to date, it
stands as one of the best text in its field.
An Atlas of Amputations, by Donald B. Slo-
cum, M. D. ($20.00. C. V. Mosby Company, St.
Louis, Missouri), planned and written by an
orthopedic surgeon who had a large experience
with amputees in the war and since. This oldest
of the surgical specialities — amputation — has
been brought up to date for the civilian surgeon.
Diseases of the Heart, by Charles K. Friedberg,
M. D. ($11.50. W. B. Saunders Company, Phila-
delphia), is an integrated and comprehensive ex-
position of heart disease in all of its aspects
in a well-illustrated text of 1080 pages.
The Ohio State Medical Journal
112
An Atlas of the Blood and Bone Marrow, by R.
Philip Custer, M. D. ($15.00. W. B. Saunders
Company, Philadelphia), contains 285 illustra-
tions with 42 in color. This book summarizes
the clinical features of the various blood diseases
and calls attention to adjunct laboratory tests
so that the blood and marrow pictures can be
integrated and too much reliance will not be
placed upon the pictures by themselves.
The New Gould Medical Dictionary ($8.50.
Blakiston Company, Philadelphia, Pennsylvania)
is a comprehensive volume with 252 illustrations
on 45 plates, 129 in color. It represents the
first medical dictionary to be built around a
University faculty — our own Western Reserve.
Written by 80 contributors, edited by scholars,
it marks a new era in dictionary making.
Normal Values in Clinical Medicine, by F. Wil-
liam Sunderman, M. D., and Frederick Boerner,
D. V. M. ($14.00. W. B. Saunders Company,
Philadelphia). Here is a concept and a book
that we have been needing for a long time in
medicine. It gives us the range of values which
can be accepted as standard — “The Norm”- —
t
and so we can tell whether our results fall
inside or outside these ranges and are, therefore,
normal or abnormal. It is a large volume, as
you would expect, of some 838 pages.
Doctor and Patient and the Law, by Louis J.
Regan, M. D., LL. B. ($10.00. Second Edition,
C. V. Mosby Company, St. Louis, Missouri), has
been enlarged through the treatment of at least
a dozen new situations and subjects, such as
“Adverse Party Called as Witness.” All of the
original material has been augmented by the
addition of relevant decisions of the various
courts of jurisdiction. Every physician should
read the chapters on malpractice.
Antibiotics, edited by George W. Irving, Jr.,
Ph. D., and Horace T. Herrick. ($6.75. Chemical
Publishing Company, Inc., Brooklyn, New York),
has been published under the auspices of the
U. S. Department of Agriculture Graduate School
and is a collection of lectures presented and
sponsored by the School. They have to do largely
with the basic facts rather than the details
of their use. It makes, therefore, an excellent
book of reference.
The Chicago-Cook County Health Survey
($15.00. Columbia University Press, New York
City), was conducted under the direction of the
U. S. Public Health Service with the help of ten
local agencies and some $50,000 of the com-
munity’s money. Because of its magnitude, this
survey represents a landmark in the evolution
of cooperative community efforts towards the
benefits of a complete and comprehensive at-
tack on the sickness problem of a metropolitan
area. It is, therefore, a book which every
physician interested at all in the public nature
of disease should have access to and should con-
sult. It belongs, therefore, in most public and
professional libraries.
Social Medicine: Its Derivations and Objectives,
edited by Iago Galdston, M. D. ($2.75. The
Commonwealth Fund, New York City), presents
the proceedings of the New York Academy of
Medicine’s Institute on Social Medicine, 1947.
Outstanding men with viewpoint from the ex-
treme left to an equal distance on the right have
been presented in an orderly and logical fashion
to cover this ever-advancing concept that dis-
ease is the product of the total environment and
so all of the patient in all of his situations must
be studied and recognized if we are to escape
with more than our skins once our bodies have
broken down under the impact of the unfavor-
able factors in our environment.
Stedman’s Medical Dictionary ($8.50. 17th
Edition. Williams & Wilkins Company, Balti-
more, Maryland) has enjoyed a top position for
many years. Now for the 16th time it has been
revised and brought up to date as a working
tool for every physician and his secretary.
The Eye and Its Diseases, by 92 International
Authorities, edited by Conrad Berens, M. D.
($16.00. Second edition. W. B. Saunders Com-
pany, Philadelphia), contains new chapters on
illumination, physiologic chemistry and gonios-
copy. Most of the previous chapters have been
rewritten and several new faces appear among
the contributors.
Clinical Biochemistry, by A. Cantarow, M. D.,
and Max Trumper, M. D., ($8.00. Fourth Edition.
W. B. Saunders Company, Philadelphia, Pennsyl-
vania), as in the previous editions attempts to
translate the progress of Science into clinical
practice. The text has undergone extensive re-
vision and many additions have been made.
The Hygiene of the Breasts, by Clifford F.
Dowkontt, M. D., ($2.50. Emerson Books, Inc.,
New York), deals with the meanings, purposes,
functions and methods of care of the breasts of
women. In these modern days, we physicians are
apt to overlook the ornamental as well as the
functional role of the breasts. The recognition of
this is of importance, however, both to the
physician and the manufacturer of garments and
other intimate devices for improving the care of
these organs. All in popular language and with
sound advice against self-diagnosis and self-
treatment.
Hospital Zone, by Elizabeth Seifert ($2.95.
Dodd, Mead & Company, New York), is a novel
by the author of Thus Dr. Mallory and Young
Dr. Galahad. It is a love story dedicated to all
the heroes of that long battle fought after the
war. Good reading!
for February, 1950
113
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The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association, a scientific society, non-profit corporation, with a definite
membership, for scientific and educational purposes.
Vol. 46 February, 1950 No. 2
Jonathan Forman, M. D., Editor
Charles S. Nelson, R* Gordon Moore,
Managing Editor — Bus. Mgr. Asst. Managing Editor
Acute Appendicitis
C. R. LULENSKI, M. D.
The Author
• Dr. Lulenski, Cleveland, Ohio, is a grad-
uate of University of Michigan Medical
School, Ann Arbor, 1936; diplomate, Ameri-
can Board of Surgery; fellow, American Col-
lege of Surgeons; member of visiting surgical
staff. St. Alexis Hospital and courtesy surgical
staff, St. Luke’s Hospital, Cleveland.
APPENDICITIS is the most frequent disease
necessitating a major operation as treat-
ment. In spite of improvements in diag-
nosis and operative technique and in spite of
the advent of chemotherapy and antibiotics,
deaths still occur from appendicitis, both in the
unoperated and in the operated cases. Some
fatalities can be attributed to the tardiness of
the patient in coming to the doctor, but many
others are avoidable by improving judgment,
technique, and supportive therapy. Periodic sur-
veys are valuable to determine if progress is
being made. To adequately measure progress,
morbidity as well as mortality must be considered.
As an approach to this problem the experience
of St. Alexis, a 234-bed hospital, was analyzed for
a ten-year period. Trends in treatment were sur-
veyed with an accompanying evaluation of the
results. An analysis was made of the immediate
postoperative temperature readings on all non-
perforated acute appendicitis with a comparison
of the ones with buried and the ones with open
stumps. To the author’s knowledge, no such
study has been reported. Conclusions arising
from this may clarify the long-standing argu-
ment as to whether one should or should not
bury the stump. Burying of the stump in these
cases was accomplished by chromicized or plain
catgut ligature to the base of the appendix fol-
lowed by amputation. After this the exposed
stump was cauterized with phenol and cleansed
by alcohol. It was then buried by a seromuscular
silk suture applied to the cecum at three-eighths
to three-fourths inch from the appendico-cecal
junction.
DIAGNOSIS
The diagnoses listed are those found on patho-
logical section, operation or autopsy. Only the
acute appendicitis cases have been included in
Submitted February 24, 1949.
the postoperative temperature analysis. The ap-
pendices that are labeled chronic appendicitis,
fibrosis of the appendix and “no pathological
diagnosis” allow for too many factors and possible
other diseases for any proper conclusions to be
made. Furthermore, acute appendicitis was con-
sidered only if the appendix comprised the pri-
mary abdominal pathology. That is, certain acute
catarrhal appendicitis and acute appendicitis
cases were excluded if the primary final ab-
dominal disease was of another organ. The acute
appendicitis cases were subdivided into two
classes of non-perforated and two classes of per-
forated appendicitis; namely, (1) acute appen-
dicitis or acute catarrhal appendicitis in which
the inflammation is confined to the mucosa or
mucosa and submucosa; (2) acute suppurative,
necrotizing or gangrenous appendicitis in which
there is diffuse infection, pus and necrosis; (3)
acute appendicitis with perforation with abscess
formation; and (4) acute appendicitis with per-
foration with generalized peritonitis.
The study of the diagnostic symptoms and
signs revealed the facts of well-established knowl-
edge. However, there were some interesting points
that merit attention. In the 1,462 cases of acute
appendicitis of all types over 85 per cent were
hospitalized in the first attack. A definite number
121
of these patients’ first symptom was nausea or
nausea and vomiting rather than some type of
abdominal distress. This usually was found to
be in the acutely obstructive type and signified
a fulminating process. Postoperatively, in the
drainage cases the fever subsided a few days
before the discharge ceased. If the elevated
temperature continued in spite of no drainage,
it usually meant some complication other than
the local disease.
TREATMENT
The treatment given was in accordance with
recognized surgical principles. There were many
minor variations due to the many surgeons who
performed. From 1939 through 1946 many acute
suppurative appendicitis cases and the perforated
cases were given sulfonamides locally and
parenterally. In 1944 through 1946 the parenteral
sulfonamides were replaced or supplemented by
penicillin. There was much individual variation in
the use of drainage and in burying of the ap-
pendiceal stump.
Review of the recent literature1’2,3,4 indicates a
McBurney type of incision and burying of the
stump are preferred. The question of incision is
not in point here because only the hospital stay
is being observed. However, from the standpoint
of exposure, least contamination of the peritoneal
cavity and the later incidence of hernias, a
McBurney type of incision is superior to others.
STATISTICAL STUDY
There has been a progressive though irregular
decrease in the mortality in the different types
of acute appendicitis with an over-all percentage
of 2.2 per cent for the ten-year period. For the
last five years the mortality is 1.1 per cent. Most
of the deaths were in the acute appendicitis
with perforation group.
In the acute appendicitis with perforation, of
which there were 158 cases, there were 23 deaths
or 14 per cent mortality. In the last five years
this has been decreased to 10.3 per cent. This
table shows there is a progressive lessening in
mortality, but in spite of present chemotherapy
and antibiotics, the fatalities from the acute ap-
pendicitis with perforation group comprise a
sizeable percentage. Some of this mortality can
be explained on the basis that 65 per cent of all
the acute appendicitis with perforation cases
did not enter the hospital until over forty-eight
hours after the onset of the disease.
Over 85 per cent of all the types of acute
appendicitis entered the hospital during the first
attack. In the 728 acute appendicitis cases without
perforation in the last five years there were four
deaths or a mortality of .5 per cent.
During this ten-year study there were 2,758
chronic appendices removed with 14 deaths or
a mortality of .5 per cent. These figures compare
favorably with statistics reported in the medical
literature during the past few years.1,2,3,4,6 These
figures likewise indicate that it is difficult to
lower the immediate postoperative ‘mortality
significantly below .5 per cent.
TREATMENT OF STUMP
The treatment of the stump was studied in
all of the non-perforated acute appendicitis
cases. In this series the percentage of stumps
buried decreased from 50 per cent in 1937 to
9 per cent in 1946. For the ten-year survey there
were 25 per cent buried and 75 per cent left
open. In order to ascertain whether or not this
was a logical trend, temperature readings post-
operatively were analyzed on all of the cases of
acute appendicitis without perforation. The
temperature taken for the three days after the
operation was the highest recorded for each of
the successive twenty-four-hour periods. It was
believed that the temperature disturbance was
the best objective evidence of reaction that was
available on all patients. From this survey it
was noted that for the first forty-eight hours
postoperatively the temperature reaction was on
the average .4° lower in the buried instances.
In the 12 deaths in the non-perforated acute ap-
pendicitis, only two had the stump buried and
in one of these the death was proved to be due
to pulmonary embolus. Meyer, Requarth and
Kozoll3 indicate a higher incidence of complica-
tions in the unburied appendiceal stump cases.
ANALYSIS OF DEATHS
There were 49 deaths all told and 14 were
in the group of chronic appendicitis cases. These
14 cases involved eight deaths due to extra-
abdominal complications, i.e., five pulmonary
embolism, one pneumonia, one pulmonary edema,
and one diabetes mellitus. The only buried stump
case was the death due to pulmonary edema.
All six remaining deaths were due to peritonitis
and in all the stump had been left unburied.
There were two autopsies. One postmortem was
on a death on the thirteenth day postoperative
and showed a cecal fistula at the edge of the
stump (probably due to crushing of tissue
proximal to the ligature). The other was on a
death seventeen days postoperative, and revealed
chronic fibrinous peritonitis with many adhesions
to the stump. A closed loop obstruction of a
segment of small bowel was the immediate cause
of death.
In the 1,304 non-perforated acute appendicitis
cases there were twelve deaths. Of these there
were two due to pneumonia, one to atelectasis,
one to pumonary embolism, two to shock (in one
case an abdominoperineal resection had also been
done with death at thirty-six hours postoperative
and the other was at twenty-four hours post-
operative with some evidence of internal hemor-
rhage having occurred). Of the remaining six,
five had peritonitis (one of these five also had
122
The Ohio State Medical Journal
pulmonary embolus), and the sixth had intestinal
obstruction. There were 3 autopsies in this group
of 12 and one was of the peritonitis group show-
ing acute generalized peritonitis with death on
second postoperative day. A second autopsy was
on a case of pulmonary embolism on the tenth
postoperative day. The third autopsy was on the
eighth day postoperative and showed a pulmonary
embolus as the immediate cause of death but
there also was a localized peritonitis at the
cecum. The appendiceal stump was open and
connected the infected fluid with the inside of
the cecum.
There were two deaths in this group in patients
with buried stumps. One was on the second post-
operative day with the abdomen negative and
with X-rays of the chest showing much consoli-
dation. The other was on the fourth postoperative
day with evidence of ileus and possible obstruc-
tion. Thus in five of the six deaths with peri-
tonitis the stump had not been buried and in the
two autopsied cases the unburied stump was the
cause of pathology.
In the acute appendicitis with perforation the
question of burying the stump does not enter
because in the majority no appendectomy was
done. In this group there were 23 deaths. Of
these there were 20 due to peritonitis and one
each due to pulmonary embolism, cardiac failure
and cerebral hemorrhage. There were six autop-
sies in the 20 peritonitis cases corroborating the
clinical impression. Thus the percentage of un-
avoidable catastrophies in this group was small.
DISCUSSION
This analysis of a ten-year experience with
operations for acute appendicitis, has been an
objective one to decide what policies should be
followed in the future to lower the morbidity
and mortality. Disturbances in temperature im-
mediately postoperatively, and the causes of
death were reviewed in respect to causative fac-
tors and particularly referable to whether the
stump had been buried. The above information
was chosen because it is completely objective
and was obtainable on every patient that was
surveyed. The specific causes of death are not
nearly as objective because there were only 22
per cent autopsies. However, the clinical diag-
nosis in each death indicated whether or not
peritonitis was present. Subsidiary studies were
made on the causes of death, particularly on
the possibly avoidable causes.
From the physiologic standpoint it appears that
the stump of the appendix should be buried in
all cases in which there isn’t free pus at the
cecum. The gastro-intestinal mucosa is diligently
peritonealized at every other point and it seems
illogical to make an exception of the appendiceal
mucosa. Tying the base of the appendix and
leaving the stump exposed is definitely more
prone to cause difficulty because the autopsied
cases reveal cecal fistulas and a higher incidence
of deaths due to peritonitis in the open group.
There was one instance of unburied stump (using
chromic gut) in which on the eighth postoperative
day the stump was entirely open. Additional
cases showed many adhesions at the open stumps.
The contention that the fatty meso-appendix will
cover the appendiceal stump is not tenable. It is
impossible to cover the stump by tying the meso-
appendix to it because the two structures will
tend to be side by side. It is necessary to suture-
ligate to accomplish a covering protection. If
suture-ligature covering of the stump by the
meso-appendix is performed then a similar pro-
cedure to a cecal pursestring is being employed.
To have the least possible local reaction burying
should be employed.
The analysis of temperature reactions post-
operatively reveals that the unburied stumps
cause a higher postoperative fever. Inasmuch as
all of the acute non-perforated appendicitis for
ten years are included, this is important evi-
dence. It can be stated that the intr a- abdominal
reaction is greater from an open stump than from
the buried type. This is particularly true for
the first two days after the operation. On the
third postoperative day there is less than .2°
difference.
In spite of improved technique and the better-
ment of the anesthesia plus the antibiotics,
chemotherapy etc., the mortality from operated
acute non-perforated appendicitis remains .5
per cent. Approximately one-half of these deaths
are due to what may be considered as un-
avoidable complications as cerebral hemorrhage,
pulmonary embolism, etc. However, fully one-
half of the deaths are possibly avoidable. In some
instances the fluid intake and output were not
accurately controlled and pulmonary complica-
tions were not sufficiently guarded against. In
others the amount of antibiotics and/or sulfona-
mides were not accurately calculated. In many
other instances the omission of drainage after
soiling of the peritoneum or in the presence of
pus, blood or necrotic tissue eventuated in wound
abscess and prolonged drainage.
Proper therapy of peritonitis of appendiceal
origin is the means by which mortality in ap-
pendicitis can be significantly lowered. Prophy-
laxis is the best treatment and the aim of all
good technique is to prevent soiling of the
peritoneum. This is most easily accomplished by
the prompt removal of the acutely inflamed, in-
tact appendix. A McBurney type of incision
should be used and care must be taken to not
dissect back the layers of the wound inasmuch
as this predisposes to a higher incidence of
hematomas, serum pockets and wound infections.
The appendiceal stump should be buried by
nonabsorbable cecal pursestring with plain catgut
ligature to the base. A refinement of this is the
for February , 1950
123
actual inversion of the remnant of the appendix.
This may be done by amputation through a
crushed portion and inversion of this by a
pursestring, or by two layers of over and over
Cushing stitch inverting the stump as a hemo-
stat is removed. In each instance care must be
observed to include the appendiceal wall at the
junction with the meso-appendix to prevent
possible later hemorrhage from the small in-
tramuscular artery which is located there in
some cases. If omentum is nearby it should be
used to cover the cecum. The wound should be
closed in layers by oo and ooo chromicized gut.
Ordinarily the muscles are not sutured. However,
if the internal oblique and/or the transversalis
muscles are torn at their fascial attachments,
then suturing them at this level is necessary.
Early ambulation decreases postoperative dis-
tention and ileus.
If peritonitis is present on entrance into the
abdomen, the procedure used depends somewhat
on the type of fluid and the serosal reaction. If
the fluid is thin and there is very little thicken-
ing of, or exudate on, the serosa, then appen-
dectomy with burying of the stump should be
accomplished with aspiration of all fluid and
with no drainage. In the presence of peritonitis
as little manipulation as possible should be done.
The peritoneum should be developed to cover
the walls of the wound to protect them during
the operation.
When the peritoneal fluid encountered is thick,
grey with necrosis and much exudate, appen-
dectomy without burying of the stump should be
performed. The stump should be tied with
nonabsorbable ligature. All fluid should be as-
pirated with drainage placed to the site of
origin of the infection, i.e., to and about the
cecum. The drain should not be in contact with
the open stump nor with any important ligature.
In every case of peritonitis an immediate smear
should be made to determine the type of or-
ganism (s) present. Culture should also be taken.
If the infection is found to be monomicrobic the
prognosis is better than if more than one type
of bacterium is discovered. The anti-biotics and
sulfonamides should be used according to the
causative organism present. In the most severe
types and in acute peritonitis of unknown
etiology (as in unoperated cases) strep-
tomycin 21/2 grams, penicillin IV2 million units
and sulfadiazine 5 grams should be given
daily. Intraperitoneal instillations of these
medicines are of no appreciable value and often
cause complications. Further treatment should be
by the use of a decompression tube and the
many supportive measures that are now avail-
able.
The various extra-abdominal complications that
cause deaths in appendicitis patients must be
dealt with by early ambulation, proper assay
and therapy of cardiovascular disease, choice of
proper anesthetic and the interruption of veins
or the use of anti-coagulants as needed.
CONCLUSIONS
1. The great majority of acute appendicitis
cases are seen and treated in the first attack.
The likelihood of a chronic recurrent appendicitis
becoming involved in an acute process is not
great.
2. During the past five years the mortality
following appendectomy in the non-perforated
cases has been lowered to .5 per cent. To lower
this further it is necessary to improve care
against peritonitis because almost all of the
deaths due to intra-abdominal pathology are the
result of peritonitis. Maximum therapy as out-
lined should be available to every peritonitis
patient.
3. In spite of the help of improved techniques,
antibiotics and chemotherapy the mortality from
acute appendicitis with perforation continues to
be over 10 per cent. Part of this is traceable to
the fact that 65 per cent of these cases entered
the hospital more than 48 hours after the onset
of definite symptoms. This would indicate the
public must be educated to the advisability of
obtaining counsel sooner.
4. On the basis of all aspects reviewed it ap-
pears that the stump of the appendix should
be buried in all instances in which no pus nor
thickening is present in the cecal region. Doing
this should help in reducing the morbidity and
mortality from the non-perforated group.
BIBLIOGRAPHY
1. Griffin, W. D., Silverstein, J., Hard, H. D., and Seed,
L. : Prophylactic Chemotherapy in Appendicitis. J. A. M. A.,
133:907-909, 1947.
2. Schullinger, R. N. : Observations on Mortality from
Acute Appendicitis at a University Hospital. Ann. Surg.,
126:448-471, 1947.
3. Meyer, K. A., Requarth, W. H., and Kozoll, D. D. : —
Progress in Treatment of Acute Appendicitis, Am. J. Surg.,
72:830-840, 1946.
4. Tashiro, S., and Zinninger, M. M. : Appendicitis : A
Review of 936 Cases at Cincinnati General Hospital. Arch.
Surg., 53:545-564, 1946.
5. Bower, J. O., and Freed, C. R. : Report of the Third
State-Wide Survey of Acute Appendicitis Mortality. Penn.
Med. J., 51:58, 1947.
Epigastric Pain
With regard to the reflex causes of dyspepsia,
when one cannot find an organic lesion in the
stomach to account for the epigastric distress,
one should make a thorough survey of the other
abdominal viscera. In this connection, in pa-
tients, particularly more than 40 years of age,
one should take an electrocardiogram because
not infrequently cardiac pain, or pain due to
coronary insufficiency, is referred to the region
of the epigastrium.
Finally, if no organic lesion can be found, one
is then in a position to begin to think that the
patient may be affected with a gastric neurosis
or a gastroneurotic functional type of dyspepsia.
— A. C. Ivy, M. D., Chicago, Jour, of Missouri
State Med. Assn., Vol. 47, No. 1, Jan., 1950.
124
The Ohio State Medical Journal
Sudden Death During Surgical Operations, With Report of
Efforts To Revive the Heart
HAROLD FEIL, M. D., and HERMAN K. HELLERSTEIN, M. D.
SUDDEN deaths during surgical operations
are sufficiently frequent to warrant consider-
ing this problem as a major one in surgery.
Sudden death may occur at any time during the
anesthesia and the operation. A watchful anes-
thetist will do much to guide the surgeon when
he should permit rest periods or desist from
undue trauma or traction. In surgical operations
on the heart these warnings are especially im-
portant and the surgeon should be aware of
any serious deviations from the base line of
pulse and respiratory rate, blood pressure, and
cardiac rhythm. There are cases — especially
young patients, when the induction of anesthesia
or the start of an operation will cause sudden
cessation of the heart beat and of respiration.
The operation may be minor as to trauma or
shock, but these cases are the most important
ones because the patients are usually otherwise
in excellent health.
What is the nature of the cardiac mechanism
in sudden death? Experimentally, Harris1 re-
ported that dogs dying of general anoxia had
electrocardiograms showing failure of the pace-
maker and slow ventricular rhythm in most in-
stances. Following occlusion of the anterior
descending coronary artery, ventricular fibril-
lation occurred in half of the experiments, cardiac
standstill and death occurred in the remaining
fifty per cent. In hemorrhagic shock likewise,
pacemaker stoppage usually followed, without
ventricular fibrillation. Experimental coronary
occlusion predisposes to trains of ventricular ex-
trasystoles followed by ventricular fibrillation.
Human electrocardiographic observations made
during the final minutes and seconds of life2
show that half of the patients actually die
with gradual slowing of the heart and final
standstill. The remaining patients have tachy-
cardia, ventricular flutter, and finally ventri-
cular fibrillation. The electrocardiographic rec-
ognition of these two modes of death makes ap-
propriate therapy possible.
The operating room should be properly equipped
to evaluate the nature of the disturbance of
heart action. A direct writing electrocardiograph
should be immediately available and suitable
drugs should be ready for immediate use (ad-
renalin, caffeine, ephedrine, procaine hydro-
chloride (2 per cent solution), injectable quinidine,
Part IV of a Symposium on “Acute Cardiorespiratory
Failure: Requirements for Successful Resuscitation,” pre-
sented at the Annual Meeting of the Ohio State Medical
Association, Columbus, April 20, 1949.
The Authors
• Dr. Feil, Cleveland, Ohio, is a graduate of
University of Wooster, Medical Department,
1911; fellow, American CoUege of Physicians;
diplomate, American Board of Internal Medi-
cine; chief, div. of medicine, Mt. Sinai Hos-
pital; and clinical professor of medicine,
School of Medicine, Western Reserve Univer-
sity.
• Dr. Hellerstein, Cleveland, Ohio, is a grad-
uate of Western Reserve University School of
Medicine, 1941; fellow of cardiology, Univer-
sity Hospitals; fellow of medicine. School of
Medicine, Western Reserve University.
calcium gluconate, atropine sulfate in ampoules,
and an injectable digitalis preparation).
In thirteen cases of cardiac standstill dur-
ing operation at Lakeside Hospital, the chest
was rapidly opened and the heart massaged.
In seven cases ventricular fibrillation was present.
The fibrillation was stopped by electric shock
and the heart was massaged until good vigorous
heart action was observed. When the heart
was in complete standstill, the heart was mas-
saged until spontaneous contraction occurred.
The cerebral and coronary circulations were
maintained by rhythmic cardiac massage.
RESULTS
Three patients recovered completely, eight
patients recovered good cardiac action with a
well-sustained blood pressure but did not recover
consciousness and died in twenty-four hours, one
died in forty-eight hours, and one died on the
operating table. The deaths were due to cere-
bral failure rather than cardiac failure.
CASE REPORTS
The following are the case summaries of il-
lustrative cases :
Case 1.* Depressed Sternum. The patient, a
boy of 14, was being operated upon to relieve
extreme sternal depression. While the wound
was being closed the heart suddenly stopped.
The patient was apparently dead. The wound
was reopened and cardiac massage started.
Digitalis (Lanatoside C) and epinephrine were
given without any effect. The mechanical re-
—
* This case was reported previously. Ref. 3.
/
I
U!
125
for February, 1950
spirator was attached to the intratracheal tube
and cardiac massage was continued for thirty-
five minutes, at the end of which time the elec-
trocardiogram showed ventricular fibrillation.
Another record taken ten minutes later likewise
showed ventricular fibrillation. The first electric
shock did not cause any change in mechansim.
Procaine hydrochloride (2 per cent) was injected
into the right auricle and the heart was mass-
aged. A second series of electric shock was
given, producing complete cardiac standstill. Al-
most immediately, however, feeble cardiac con-
tractions were observed, and the massage was
continued for five minutes more, at which time
it was obvious that contractions were coordinated
and fairly vigorous, though still fast. An electro-
cardiogram then showed a supraventricular
tachycardia with a rate of 175. From this point
on, the heart gradually increased in vigor and
brachial sounds were heard at a pressure of
50 mm. of mercury. At no time was cyanosis
or pupillary dilatation present. This demon-
strated that cardiac massage had maintained an
adequate cerebral circulation. After the coordi-
nated heart beat had been established for twenty
minutes, the wound in the chest was closed.
Within ten minutes after closure of the wound
the intratracheal tube was removed and spon-
taneous respirations were resumed. Within one
and one-half hours the blood pressure rose to 60
systolic and 40 diastolic, and thereafter it showed
a steady, gradual rise to 100 systolic and 70
diastolic. Three hours after defibrillation of the
ventricles, the patient responded rationally to
questioning, and by eight hours . he was fairly
alert in spite of his stormy operative course.
The convalescence for the next few days was
chiefly characterized by signs of digitalis in-
toxication and moderately severe azotemia (non-
protein nitrogen 100 mgm. per 100 cc. of blood
on the second postoperative day.) In eight days,
however, the patient was much improved, and
the BUN was 18 mgm. per 100 cc. of blood.
During the remaining seventeen hospital days,
there were no symptoms or signs indicative of
injury to the brain and he was discharged on
his thirty-first hospital day. In a follow-up
interview three months later, the patient stated
that he had considerable increase in tolerance
of exercise. The electrocardiogram at the time
was within normal limits.
* * *
Case 2. Patent Ductus Arteriosus: A child
of 4 years was anesthetized. As the areolar tis-
sues at the base of the pericardium were being
dissected away the heart stopped suddenly. In-
spection of the electrocardiogram showed auri-
cular activity at a rate of 136 per minute with
long periods of ventricular standstill (8 sec.)
and then complete ventricular standstill for 180
seconds. The heart was massaged after opening
the pericardium and adrenalin, 1-1000 solution
(1/2 cc.), was applied directly to the epicardium.
The auricles continued to beat (at a rate of 100
per minute) and then isolated ventricular beats
occurred at long intervals (1.08 to 10.2 sec.).
Then followed a ventricular tachycardia (rate
125 per minute) and later at a rate of 250 per
minute. Sinus tachycardia followed (214 per
minute) and finally the heart slowed to 166 per
minute. It was decided not to continue the
operation because of the long period of stand-
still. The child made an excellent recovery
with no residual cardiac or cerebral symptoms.
Case 3. Tetralogy of Fallot (with aneurysm
of the pulmonary artery distal to the stenosis):
This patient, aged 5 years, was explored and
the aneurysm exposed. Ventricular tachycardia
with a rate of 170 developed. Cardiac standstill,
lasting 156 seconds, occurred. The heart was
massaged rhythmically and recovery occurred.
The Blalock operation was not performed be-
cause of the aneurysm. Recovery was complete.
* * *
Case 4. Patent Ductus Arteriosus: A female
(aged 27 years) recovered from subacute bac-
terial endarteritis. During the initial stage of
the operation for ligation and section of the
ductus arteriosus, the heart suddenly stopped.
The electrocardiogram revealed ventricular fibril-
lation. Cardiac massage and electric defibrilla-
tion were instituted. Normal cardiac action
with sinus rhythm followed. The patient died
twenty-four hours later without regaining con-
sciousness. The postmortem examination re-
vealed cerebral embolism.
* * *
Case 5. Chronic Cardiac Compression (Pick’s
Disease) : Male, aged 26 years. During resection
of the pericardium ventricular fibrillation oc-
curred. Cardiac massage, electric defibrillation,
and massage were instituted. The patient re-
covered, was conscious, but died the following
day of a communicating pneumothorax.
DISCUSSION
In 1936, Wiggers showed, and Beck emphasized'
the importance of proper cardiac massage in
defibrillation technics. Wiggers showed that
failure to recover from ventricular fibrillation
depended not so much on the inability to de-
fibrillate the heart as on the incapacity of the
myocardium subsequently to resume vigorous
beating and because of prolonged cardiac anoxia,
apparently, the fibrillating ventricles, deprived
of their coronary blood supply for even a short
time, lose their capacity for normal excitation
and contraction. He suggested, therefore, that
cardiac massage (which sustains coronary flow)
be started as soon as possible after the onset
of fibrillation and be continued until the elec-
trodes are ready for application to the heart.
Sudden death during operations is far from
rare. It is imperative that operating rooms be
equipped to care for emergencies. The cardiac
mechanism must be determined, cardiac massage
started promptly, and electric defibrillation must
be done when ventricular fibrillation is present.
If the heart action is weak, adrenalin, calcium,
and continued massage are indicated.
Many lives will be saved, especially in the
cases of young patients, who have no intrinsic
heart disease, by cooperation of surgeons and
internists.
BIBLIOGRAPHY
1. Harris, A. S. : Terminal Electrocardiographic Patterns
in Experimental Anoxia, Coronary Occlusion, and Hemor-
rhagic Shock. Am. Heart J., 35:895, 1948.
2. Stroud, M. W., and Feil, H. S. : The Terminal Elec-
trocardiogram : Twenty-three Case Reports and a Review
of the Literature. Am. Heart J., 35:910, 1948.
3. Beck, C. S., Pritchard, W. H., and Feil, H. S. : Ventri-
cular Fibrillation of Long Duration Abolished by Electric
Shock. J. A. M. A., 135 :985, 1947.
126
The Ohio State Medical Journal
Propyl and Methyl Thiouracil and Radioactive Iodine
In the Treatment of Hyperthyroidism*
E. PERRY McCULLAGH, M. D.
The Author
• Dr. McCullagh, Cleveland, Ohio, is a gradu-
ate of . the University of Manitoba Faculty of
Medicine, 1924; member. Central Society of
Clinical Research, American Assn, for the
Study of Internal Secretions, American Feder-
ation for Clinical Research, and American Col-
lege of Physicians.
THE three modern methods of treatment of
hyperthyroidism are all so good that it is
frequently a matter of difficulty to decide
which is the method of choice in a given patient.
THYROIDECTOMY: ADVANTAGES AND
DISADVANTAGES
Thyroidectomy remains the standard means
of treatment in many centers and forms a basis
for comparison in estimating the value of the
thiourea derivatives and radioactive iodine.
In considering the place of surgery it is well
to keep clearly in mind that it must be viewed
from two angles. First the goiter itself, and
secondly the hyperthyroidism. Surgery is the
treatment of choice and is most clearly indicated
in patients in whom malignancy is suspected,
or when a solitary adenoma exists because of the
tendency to malignancy in it, or where the goiter
is large and unsightly or causing pressure symp-
toms. Surgery has the advantage of a quicker
complete control of hyperthyroidism than can be
accomplished by other methods.
After surgery for hyperthyroidism in adeno-
matous goiter, not only is the goiter gone, it
almost never returns, nor does the hyper-
thyroidism.1 In Graves’ disease, however, this
is not true. It is commonly overlooked that
there is a recurrence rate in postoperative Graves’
disease which is relatively high. Recurrence
rates have been calculated as low as 5 per cent
for all types of goiter2 and as high as nearly
20 per cent in Graves’ disease.3
Surgery for hyperthyroidism has become very
safe. This is due chiefly to the complete pre-
operative control of the disease with propyl or
methyl thiouracil and to the fact that other
methods of treatment are available to patients
who for one reason or another are never good
surgical risks. The mortality rate of surgery is
a small fraction of 1 per cent1’ 4 but even this
is higher than the mortality rate of other
methods. Surgery has the disadvantages of the
need for hospitalization, the discomfort and the
cost of the operation, as well as certain com-
plications the chief of which are laryngeal
paralysis, tetany and hypothyroidism.
Postoperative laryngeal paralysis varies from
about 0.5 per cent in good hands in once oper-
* From the Cleveland Clinic and the Frank E. Bunts Edu-
cational Institute.
Presented before the Section on Medicine at the Annual
Meeting of the Ohio State Medical Association, Columbus,
April 19-22, 1949.
ated patients to as high as 7 per cent or more in
less expert hands and especially in patients oper-
ated upon a second or third time. The frequency
of tetany follows a similar pattern and postoper-
ative hypothyroidism rises in frequency from 10
per cent to nearly 20 per cent where the cure rate
of Graves’ disease is very high. During preg-*
nancy thyroidectomy after proper preparation
is well tolerated but surgery is never indicated
in hyperthyroid crisis.
PROPYL AND METHYL THIOURACIL
Propyl thiouracil has been adequately shown
to be safe and effective as a means of controlling
any hyperthyroidism.6 Its action like other
thiourea compounds is to block the production
of thyroid hormone within the thyroid thus pro-
ducing a physiologic thyroidectomy.
The dose required varies with the individual.
A higher dose is needed in nodular goiter than
in diffuse, and a higher dose in severe hyper-
thyroidism and in large goiters than in mild
hyperthyroidism associated with small glands.
In general 300 mg. per day is effective in 96
per cent of patients.8 In severe cases 400 mg.
may be needed. Since each dose lasts only a
few hours the doses should be spaced at intervals
of about six hours. Methyl thiouracil, though
dangerous in the large doses originally used
in Denmark and Sweden, has a safety closely
comparable to propyl thiouracil in similar doses
and has a somewhat more powerful and quicker
effect.
If iodine has been used in treatment before
propyl thiouracil is begun it should not be with-
drawn abruptly, for if it is, a sharp exacerbation
of the disease will occur before the full effect of
the thiouracil is present. A small dose of iodine
can be given concurrently, it is practical to use
approximately 10 mg. of iodine per day as 1 drop
of Lugol’s solution or a tablet. This prevents
for February , 1950
127
the increased vascularity of the thyroid which
otherwise commonly occurs. In these doses iodine
does not prevent the effect of the propyl
thiouracil.
Propyl or methyl thiouracil are most clearly
indicated for preoperative preparation especially
in severely ill patients. It may be used as con-
tinuous therapy where necessary in patients
whose operative risk never becomes good. It
is the treatment of choice for postoperative
recurrent hyperthyroidism when radioactive
'iodine is not available. It may be used in
an attempt to produce a permanent cure and
although final statistics are not available the
chances of cure seem best in patients who have
relatively small goiters and in whom the hyper-
thyroidism is not very severe.
It is less promising in those instances in
which the goiter tends to enlarge under treat-
ment, or when the patient is less than twenty
years of age. In spite of these generalizations,
11 of the first 50 of our patients now in remis-
sion had metabolic rates over -f50 per cent and
some had large nodular goiters. In our first
218 patients treated, the dose was sometimes in-
adequate by present standards and the patients
•unselected. Remissions known to have lasted
over six months occurred in approximately 50
per cent. It seems reasonable to believe that
in properly selected cases cures will be pro-
duced in more than 60 per cent. This is ap-
proximately the same estimate as that made
by Williams7 for thiouracil.
The plan of treatment now in use involves
maintenance of complete control of the hyper-
thyroidism for one year before withdrawal of
the drug. If hypothyroidism occurs it is often
better to treat it with thyroid than to run the
risk of lowering the dose of antithyroid drug
to an ineffective level.
Propyl or methyl thiouracil can be used to
control hyperthyroidism throughout pregnancy
but there is a risk of producing goiter in the
infant. This risk is obviously greater if rela-
tive hypothyroidism is produced in the mother.
Therefore if surgery seems ill advised and it
is too late in pregnancy to avoid uptake of l131
by the fetal thyroid, the dose of antithyroid
drug should be manipulated in such a way as
to allow a normal rise of metabolic rate in the
mother toward the end of pregnancy or even to
allow a mild hyperthyroidism to exist.
Disadvantages of propyl or methyl thiouracil
include the following:
1. The goiter is not removed.
2. The goiter sometimes enlarges, though it is
usually smaller at the end of prolonged therapy.
3. The recurrence rate is higher than that
following the other methods of treatment.
4. Toxic symptoms necessitate discontinuance
of treatment in about 2 per cent.
5. Agranulocytosis has been reported as a
cause of death in rare instances.
6. It should never be depended upon as ther-
apy in a crisis.
In over 400 patients I have seen severe toxic
symptoms in only two. These were exfoliative
dermatitis and a drug eruption. It is unneces-
sary to do routine blood counts but the patient
should be warned that a fever or sore throat
(which may indicate agranulocytosis) should be
reported promptly.
If the white cell count falls to 2000 or the
granulocytes to below 25 per cent the drug
should be stopped. Death due to agranulocytosis
can probably only properly be ascribed to propyl
thiouracil in four patients. Of the many thou-
sands treated, this is a mortality rate of a frac-
tion of a tenth of 1 per cent.
The great advantages of propyl or methyl
thiouracil therapy are that they allow avoidance
of hospitalization, cost of surgery and apart from
occasional toxic effects there are no complications
and none which are lasting. A patient receiving
a cure from these drugs has a completely physi-
ologic cure.
RADIOACTIVE IODINE
I131 is peculiarly adapted for the treatment of
hyperthyroidism by a happy group of circum-
stances. (1) Because of the avidity of hyper-
active thyroid epithelium for iodine, I131 can be
concentrated in the thyroid about 10,000 times
more than elsewhere in the body. (2) Because
of its short half-life of eight days most of the
administered dose remains within the thyroid
until its energy is largely dissipated. (3) A
high effective dose of irradiation can thus be
applied from within the gland. (4) The Beta
rays it emits penetrate only 1 or 2 mm. thus
rendering no damage to surrounding tissue.
Of the hundreds of patients now treated, no
damage has been known to come to the blood,
the kidneys, bladder, bone marrow, reproductive
organs or the tissue surrounding the thyroid.
Hertz8 has mentioned 16 normal babies born from
parents treated with I131 — 11 mothers and three
fathers. There has been no evidence that it
causes cancer and in about 10 per cent of pa-
tients with cancer of the thyroid I131 in large
and repeated doses has been beneficial.
Although it is now twelve years since Hertz9
began his study of radioactive iodine tracer
doses, no entirely satisfactory method has been
arrived at to estimate the required therapeutic
dose needed by a given patient. In general it
is true that in the diffuse gland of Graves’
disease the effective dose is relatively small.
Here it appears to vary chiefly with the size
of the gland and the severity of the hyperthyroid-
ism. In practice it is very important to sep-
arate the hyperthyroidism of Graves’ disease
128
The Ohio State Medical Journal
from the hyperthyroidism of nodular goiter,
because a curative dose in a large nodular goiter
may be more than ten times as large as that
required for a small diffuse gland.
The required dose can be estimated to some
degree by measuring the ability of the gland
to take up a tracer dose10’ 11 which may be 100
to 400 microcuries. The uptake may be influenced
greatly by factors other than those mentioned,
especially the previous use of iodine, which if
used in large doses will inhibit the uptake of
I131 for three or more weeks after it is stopped
and some blockage may be affected by the in-
advertent use of iodine as in cough mixtures,
iodized salt or iodine-containing contrast media
for X-ray diagnosis. There is also a blockage
produced by the thioureas but this disappears
in three or four days after the drug is stopped.
A very practical method of estimating the
proper dose is to observe the physiologic effects
of a safe initial dose. For example: in Graves’
disease, in a gland estimated to weigh 60 gm.
and with an I131 tracer uptake of over 60 per
cent, 4 me. has proved to be a safe dose (Oak
Ridge standard).* In larger glands 6 or even
8 me. may be used. If no improvement is
evident in two months the dose may be safely
repeated. If on the other hand the basal meta-
bolism has fallen to near normal and improve-
ment continues in two months, more time is al-
lowed before another dose is given.
Other methods of estimation of the required
therapeutic dose of I131 in Graves’ disease have
been published. Haines and his co-workers13 esti-
mate the uptake of a tracer dose, compute
the mass of thyroid tissue present by palpation
and calculate a total dose which will supply
between 200 and 250 microcuries per gram of
thyroid.
In nodular goiter an initial dose of 8 to 15
me. may safely be given and cures may require
doses as high as 58 me. in our experience.
Within the past year we have treated 105
patients with I131. Twenty-eight patients have
been followed long enough to warrant an opinion
as to results. Nineteen of these had Graves’
disease and four to ten months have elapsed
from the time of treatment to the time of this
survey. All were cured. The total doses varied
from 3 to 15 me., an average of 6.7. Twelve
patients had one treatment, 6 had two and 1 three.
The average estimated weight of the gland be-
fore therapy was 61 gm., after therapy 27 gm.
Two developed hypothyroidism. Mild exacerba-
tion of hyperthyroidism and mild irradiation
sickness have been reported immediately follow-
ing treatment. No other complications except
* Present standards are 1.75 times greater than those used
at the time this article was written. Thus, a dose previously
designated as 4 becomes 7 and a dose previously designated
as 8 becomes 14.
hypothyroidism have been seen following this
treatment by us or others.
In nine patients with nodular goiter the hyper-
thyroidism has been controlled and the goiters
are smaller. The total doses required were 12
to 58 me. Two had two treatments, 5 had
three, 1 had four, and 1 had six. The estimated
weight of the goiters averaged 116 gm. before
and 57 gm. after treatment.
I131 can be used safely during pregnancy only
before the fourth month, since Chapman12 has
shown that there is a perceptible uptake by the
fetal thyroid after that time. When I131 is
available it can be used in the treatment of
crisis — not as complete therapy but followed
promptly by iodine medication as usual. There
is some loss of l131 under these circumstances.
The tremendous advantage to the patient with
this type of therapy is evident. It is taken as
a drink of water. Little or no medical super-
vision and no hospitalization or work loss are
necessary. There are no untoward side effects
worthy of mention and apart from hypothyroid-
ism no complications. Hypothyroidism has been
present in about 10 per cent. Disadvantages lie
in the fact that treatment is not available to
all patients and the material to date can only
be handled by groups of men with special skills
acceptable to the Atomic Commission.
The cost is not known since the true cost of
production of the material is not calculated.
This treatment up to the present is reserved
chiefly for those individuals over 40 years of
age until enough time elapses for greater cer-
tainty with respect to possible late complica-
tions which are not expected.
BIBLIOGRAPHY
1. Crile, G., Jr., and McCullagh, E. P. : To be published.
2. Bertelsen, A., Christensen, E., Bruun, E., and Becker-
Christensen P. : Mortality, Operative Complications and Re-
currence Frequency in Surgical Treatment of Thyrotoxicosis.
Acta chir. Scandinav. 96:1 (supp. 133), 1947.
3. Thompson, W. O., Taylor, S. G., and Meyer, K. A. :
Factors Influencing Operative Mortality in Exophthalmic
Goiter. Ann. Int. Med., 8 :350, 1934.
4. Lahey, F. H. : Reduction of Mortality in Hyper-
thyroidism. New England Jr. Med., 213:475, 1935.
5. McCullagh, E. P., Ryan, E. J., and Schneider, R. W. :
Propylthiouracil in Treatment of Hyperthyroidism. Cleve-
land Clin. Quart., 13 :232, 1946.
6. McCullagh, E. P., Hibbs, R., and Schneider, R. W. :
Propylthiouracil in Treatment of Hyperthyroidism. Am.
J. M. Sc. 214:545, 1947.
7. Williams, R. : Thiouracil Treatment of Thyrotoxicosis.
1. Results of Prolonged Treatment. Jr. Clin. Endocrinol,
6:1-22, Jan., 1946.
8. Hertz, S. : Personal Communication.
9. Hertz, S., Roberts, A., and Evans, R. D. : Radioactive
Iodine as Indicator in Study of Thyroid Physiology. Proc.
Soc. Exper. Biol, and Med., 38:510, 1938.
10. Hamilton, J. G. : Use of Radioactive Tracers in
Biology and Medicine. Radiology, 39 :541, 1942.
11. Werner, S. C., Quimby, E. H., and Schmidt, C. :
Clinical Use of Radioactive Iodine. Bull. New York Acad.
Med., 24:549, 1948.
12. Chapman, E. M. : Treatment of Graves’ Disease with
Radioactive Iodine. Tr. Am. A. Study Goiter, p. 74-78,
1942-1946.
13. Haines, S. F., et. al. : Use of Radioiodine in Treat-
ment of Exophthalmic Goiter. J. Clin. Endocrinol., 8 :813,
1948.
for February , 1950
129
The Interpretation of Psychosomatic Complaints
To the Patient
BLAKE CRIDER, Ph.D., and ROBERT SCHOTT, M.D.
PHYSICIANS are aware of the fact that a
considerable portion of their professional
time is being devoted to the practice of
medical psychology, which is the diagnosis and
treatment of patients who have physical com-
plaints arising from emotional upsets. Malamud1
states:
“It may be said without fear of exaggeration
that the number of people whose adjustment is
interfered with because of the various forms of
psychoneurotic disturbances is greater than that
found in any other single type of medical disease
known to the profession. A well-known and re-
liable specialist in internal medicine, who was,
at that time, director of one of the largest gen-
eral hospitals in the country, estimated that of
the entire clientele of the outpatient department
of his institution computed over one year, fully
75 per cent were suffering either from pure psy-
choneurotic syndromes or psychoneurotic super-
impositions upon somatic diseases. Even if this
may be an unusual proportion of the incidence
of these disorders, other men working in the
field and equipped with the training and interest
enabling them to evaluate their material prop-
erly have varied in this estimate from a con-
servative 40 per cent to the high 75 per cent
mentioned above.”
The physician is daily confronted with patients
having a multitude of somatic complaints for
which he can find no organic basis.
If the physician tells the psychosomatic pa-
tient, “It is your nerves,” the patient rightfully
assumes he has some organic disability and ex-
pects to be given medicine. If he tells him he
is neurotic, he is likely to be offended. If he
is told he has a neurosis, the patient may equate
neurosis with psychosis and conclude that he
is insane. To tell the patient there is nothing
wrong with him merely confuses him because
obviously there is something wrong. What the
physician should do is show the patient how his
somatic complaints can arise from emotional
upsets. This explanation is the first step in
therapy.
Physicians who are unable to handle the psy-
chosomatic patient constructively are inclined
to blame the patient for not wanting to get well.
And to a considerable extent they are right
about the patient, for he does seem to resist
treatment. This negative attitude on the part of
the patient was succintly described in a recent
article by Dr. Andrew Hart of the University
of Virginia Medical School, wherein he listed
fifteen ways in which the psychosomatic patient
attempted to sabotage his treatment.2 We are
unable to cover in this article the entire psy-
Submitted April 5, 1949.
The Authors
• Dr. Crider, Cleveland, Ohio, is a graduate
of Western Reserve University, 1934; member,
American Psychological Association and Amer-
ican Association for the Advancement of Psy-
chotherapy; psychologist. Mental Hygiene
Clinic for Children, Department of Pediatrics,
St. Luke’s Hospital, Cleveland; and Chairman,
Department of Psychology, Fenn College,
Cleveland.
• Dr. Schott, Los Angeles, California, is a
graduate of Western Reserve University College
of Medicine, 1947; and is a resident in neuro-
psychiatry, Veterans Administration Center,
Los Angeles, California.
chology of resistance, but we can give the phy-
sician a technique for overcoming the patient’s
resistance to a psychological interpretation of
his somatic distress; one which he can use
beneficially in his daily practice.
The two basic emotions which result in somatic
complaints are anger and fear, with jealousy,
envy, hostility, anxiety, and feelings of guilt
coming under one or the other of these two
major emotions.
When a person has anger or fear, all of the
organs of the body mediated by the autonomic
nervous system are to some extent activated.
Sensations from these organs go to the brain
and are perceived in consciousness as pain or dis-
comfort. The person feels his heart beating
faster, realizes his temperature goes up, that
he is sweating profusely, reports that he has
“butterflies” in his stomach, and so on.
If these visceral sensations occur from an ac-
ceptable and recognizable emotionally arousing
situation, the individual accepts them as normal
and would find no reason to seek medical ad-
vice. For example, if a person is caught in a
falling elevator he is naturally afraid, and thus
receives unpleasant sensations from his viscera;
nevertheless, he makes the best adjustment he
can. However, a person may have these identical
visceral sensations and yet may not be able to
identify in his conscious and perceptual en-
vironment the reason for these peculiar body
sensations. He does not recognize them as fear,
anger, or hostility but thinks of them solely in
terms of their somatic language; he thinks he
130
The Ohio State Medical Journal
lias an illness. This conclusion that he has an
illness makes the patient afraid, and this fear
exaggerates the very symptoms which frightened
him in the first place.
Emotions and their accompanying visceral
sensations, which have no apparent justifica-
tion to the patient, arise from repressed impulses
or mental conflicts. The impulse is repressed be-
cause it is unacceptable to the person’s ideals
and standards, or to his ego and super-ego, if
we wish to be more technical. But once the im-
pulse is repressed, it may continue its arousal
of hostility, guilt, and anxiety just as it did
while in conscious awareness. The distressed in-
dividual has his body sensations, but he does not
know why, i.e., the cause is unconscious. This
unconscious element is the factor which makes
an emotional disturbance a neurosis.
At this point the person may take any one of
several psychological paths. However, the de-
cision most likely to lead him to a physician
would be his belief that he is genuinely ill. Then
the emotionally distressed individual goes to the
physician complaining of indigestion, constipa-
tion, loss of appetite, profuse sweating, difficulty
in getting his breath, and so on. He believes
he has an illness, that the physician will find a
cause for the illness, will prescribe medicine, and
that he will get well.
The physician must explain how these body
sensations are possible without the patient be-
ing genuinely ill, yet make the explanation in
such a way that the patient will accept it. This
should be done even though the patient is to be
referred. In many cases, however, this explana-
tion alone is sufficient therapy.
We have worked out a technique for interpret-
ing to the patient the emotional basis of his
complaints. This technique we wish to pass on
to the general practitioner because we feel it
is something he can use routinely and con-
structively in his practice.
We should point out, however, that this tech-
nique applies primarily to the patient who is
emotionally upset because of situations operating
somewhat currently, and that it is not applicable
to the classic textbook cases of neurasthenia,
hypochondrias, conversion hysteria, and the
obsessive-compulsive reaction patterns. This
leaves those persons suffering from the anxiety
states, constituting the bulk of the physician’s
psychoneurotic patients.
Once the physician decides that the somatic
complaints arise from emotional upsets activated
by unconscious impulses or conflicts, the follow-
ing steps are taken in explaining the diagnosis
to the patient:
1. Have the patient list all of his complaints.
Write these complaints in a column.
2. Go back over the various organs and make
inquiry concerning those organs where the
patient omitted any symptoms. For example,
“Does your heart sometimes beat rapidly?”
This helps complete the list of symptoms.
3. Now ask the patient how he would feel
were he afraid (or angry). List these character-
istics in a second column beside the first column.
You may have to encourage him by saying some-
thing like this: “Wouldn’t you have ‘butterflies’
in your stomach too?”
4. Show the patient that the sensations that
go with emotions of anger and fear are the
same as his complaints. Point to them with a
pencil to show how they match. For example, he
may have come with the complaint that he has
trouble getting his breath, and that when he is
angry he has the same difficulty.
5. Then ask him to tell what is really keeping
him upset or emotionally disturbed and what he
is worried about.
6. Make a final summary and interpretation
for the patient.
This procedure is illustrated in the following
two cases. The interviews were short and were
recorded verbatim. Other patients may require
longer interviews or several interviews before
understanding occurs. But we have selected two
dispensary patients of dull mentality from un-
favorable socio-economic backgrounds to show
how understanding can occur to even the less
favorably endowed psychosomatic patient.
CASE REPORTS
Case 1: The patient was a 37-year-old Negro
male who complained of nervousness. The medi-
cal examination was negative.
1. Get the patient’s complaints.
Therapist: What’s bothering you?
Patient: I’ve got an irritation in the stomach.
I got a funny feeling in my stomach. I get weak
in the legs. I have hot flashes too.
T. Anything else?
P. That’s about all.
2. Make further inquiry.
T. What about your heart? Doesn’t that beat
fast too ?
P. Yeah — like it was scared. Noise gets me
too. I wonder what it could be. I never feel good.
Just sluggish all the time.
T. Doesn’t your bladder bother you too; don’t
you have to go to the toilet pretty often?
P. Sometimes I can’t control it. I just have to
rush to make it.
T. And at night, what happens?
P. It’s O.K. Sometimes I do have to get up
and I have to go quick.
T. And how’s your appetite ?
P. It’s poor.
T. How do you sleep?
P. It was bad until I took some pills.
T. Don’t you have sweats sometimes?
P. I used to have them before I went to the
doctor.
T. I imagine your throat gets dry sometimes
too.
P. Yes, it does. I have to clear it up.
T. Do you ever have trouble getting your
breath ?
P. No, I don’t.
for February, 1950
131
T. I guess you have headaches sometimes.
P. Oh, I do. I had one the other day. But I
thought it was because I got hit in the head
once.
3. Get a list of emotional characteristics.
T. Just how would you feel if I socked you in
the jaw?
P. I’d get upset, it would get me all over.
T. Would your heart beat fast?
P. Yes, it would; like it was scared.
T. Wouldn’t your stomach feel funny?
P. Yeah, a cutting feeling.
T. Wouldn’t you have trouble getting your
breath ?
P. I couldn’t get out what I wanted to say.
T. Don’t you have to urinate when you are
embarassed or talk to a group of people?
P. Yeah, it does irritate me.
4. Show the relationship.
T. You see, all these funny feelings you get
when you are angry or scared are the same as
those you say bother you now.
P. Yeah, I see.
5. Ask patient for explanation of his emotional
state.
T. Can you see what’s bothering you? What’s
really bothering you and making you sick is the
job isn’t it? And we will have to figure out
what is wrong about it that makes it get you
so upset.
P. I don’t know. Maybe they expect too much
of me out there. They hired me as a welder.
Now I am a flunky. I had to clean up the office
the other day. They promised me a raise and
I never got it. They put another man in my job.
They put me to doing janitor work. Everybody
was saying, “Hurry, hurry.” They put me to
driving a truck. I told them I didn’t have a
driver’s license. I didn’t even know how to drive
a truck. They said I didn’t want to work.
6. Final summary and interpretation.
T. So you see you have two things. You were
scared and you were angry. You felt you got a
raw deal. You got upset. You felt it inside
and that’s what you called your nerves. It is
really an emotion. This has been going on now
for a whole year, and it makes you tired and
you can’t sleep. You get all jumpy inside. They
won’t even believe you are sick, and that makes
you even madder. But you are sick, but because
of your emotions. If you got along on the job
better or if you had another job, you would be
in good shape.
P. I can get a better job.
^ ^
Case 2: The patient was a 30-year-old white
woman. Medical examinations were negative.
1. Get the patient’s complaints.
T. What is your trouble?
P. I have a numbness in my head. My hands
sweat and then they get cold. My stomach
bothers me. My eyes get sore. I am weak in the
legs. I am afraid to go places.
T. Is there anything else?
P. I guess that’s about all.
2. Make further inquiry.
T. Does your heart ever beat fast?
P. It sure does.
T. Does your mouth ever get dry?
P. A lot of times when I am nervous.
T. Do you have to go to the toilet often?
P. It does bother my kidneys. My bowels are
awful. I am always constipated. •
T. Do you ever have headaches?
P. I get them frequently. I have a lot of pains
in my neck, too.
T. What about your breathing?
P. I can hardly get my breath sometimes.
3. Get a list of emotional characteristics.
T. What do you think caused this condition?
P. It might be my teeth. I had some of my
teeth out. Perhaps it is change of life. But I
am a little young for that.
T. What if someone walked in suddenly and
threatened to kill you? How would you feel?
P. I’d be scared. I’d tremble and shake.
T. Would your stomach get upset?
P. It sure would.
T. Would you be weak in the legs?
P. Yeah.
T. Would your heart beat fast too?
P. Sure would.
T. Would your mouth get dry?
P. Sure would.
4. Show the relationship.
T. Just what do you make out of what you
have just told me?
P. You are just trying to find out what is
wrong.
T. Here is what it means. You notice that the
complaints you gave to me about your health are
just the ones you would have if someone
threatened to kill you and got you real scared.
P. They are just the same.
T. What you have is just fear. It is not a
sickness, and it is not your nerves.
P. That may be right.
T. Then we have to find the cause of that
fear.
P. I guess we do.
T. What troubles you? What have you worried
about? You just tell me what it is.
P. It’s because there is something wrong with
me physically.
T. Just a fear of being sick.
P. Yeah, just a fear of being sick and going
any place.
T. It is really a fear of a fear.
P. Yeah.
T. You had a fear and it got you upset and
then you got afraid of that upset because you
thought it was an illness.
P. I won’t go to shows or nothing. I was even
afraid to come to the hospital.
T. But we want to know just how it started
the first time. Let’s find out what is really
troubling you.
P. (Here patient relates that two years pre-
viously she had noticed an irritation on the
external labia. She went to a physician who
made a tentative diagnosis of syphilis, with sub-
sequent negative Wassermann. This frightened
the patient. She began to read “Doctor Books.”
The more she read the more frightened she be-
came until she was filled with somatic com-
plaints on an emotional basis).
SUMMARY
We have outlined a technique for interpreting
to the patient the meaning of physiological symp-
toms arising from emotional upsets. We con-
sider this the first step in therapy, regardless of
whether the physician himself does the therapy
or refers the patient to specialists in psy-
chotherapy and medical psychology.
BIBLIOGRAPHY
1. Malamud, W. : The Psychoneuroses. Personality and the
Beha/vior Disorders, edited by J. McV. Hunt. Ronald
Press Company, New York, 1944. Vol. II, p. 835.
2. Hart, Andrew D. : Psychosomatic Diagnosis. J. A. M. A.,
Vol. 136, No. 3, p. 147-152, January 17, 1948.
132
The Ohio State Medical Journal
Treatment of Acute Leukemia of Childhood*
ROBERT W. HEINLE M. D.
THE FOLIC acid antagonists have made it
possible to prolong the lives of certain
patients with acute leukemia beyond any
duration possible before. Their use was inaugu-
rated after it was discovered that acute leukemia
in children1 and chronic myeloid leukemia in
adults2 were aggravated by the administration
of folic (pteroylglutamic) acid.
The folic acid antagonists are compounds
chemically very similar to folic acid. Thus,
aminopterin (4-amino-pteroylglutamic acid) has
an amino-group (NHa) in place of a hydroxyl-
group (OH) of folic acid. A-methopterin (4-
amino-N10-methyl pteroylglutamic acid) has a
similarly substituted amino-group in addition to
which a methyl-group (CH3) replaces one hydro-
gen atom of folic acid. Several other antago-
nists have been synthesized and have varying
degrees of effectiveness.
Folic acid is necessary for the proper growth
of leukocytes, as well as in the metabolism of
many, if not all, other cells of the body. The
antagonists act by competing with folic acid
in the metabolism of the cells. The action is
comparable to that of the sulfonamide drugs in
which para-aminobenzoic acid, necessary for
the growth of certain bacteria, is displaced by
the chemically similar antagonist. Since folic
acid is probably necessary in the metabolism of
most cells, it might be expected that a folic
acid deficiency induced by the use of the antago-
nists would affect all cells equally. That it does
not is probably due to the fact that the abnormal
cells of certain acute leukemias are metabolizing
very much more rapidly than normal cells, their
folic acid requirement is greater, their uptake
of the antagonist is greater, and a folic acid
deficiency is induced in them before it becomes
• apparent in normal cells. Thus, a semi-specific
effect can be obtained, at least for varying
temporary periods of time.
Twenty-six children with acute leukemia, 6
adults with acute monocytic and 2 with acute
lymphoid leukemia have been treated with the
folic acid antagonists at University Hospitals of
Cleveland.f In addition, two adults with chronic
myeloid leukemia have been treated with a
* This study was aided in part by a grant from the National
Vitamin Foundation. The aminopterin, A-methopterin and
crude antagonist were generously supplied by the Lederle
Laboratories Division, American Cyanamid Corp., through
the courtesy of Dr. Thomas H. Jukes.
Presented before the Section on Pediatrics at the Annual
Meeting of the Ohio State Medical Association, Columbus,
April 19-22, 1949.
t All but two of the children reported in this series were
cared for at the Babies’ and Children’s Hospital, Cleveland,
Ohio, Dr. Charles F. McKhann, Director. The diagnosis
and treatment were under the immediate direction of Dr.
Eugene Weber and Felix E. Karpinski, who will report
these cases in more detail in a later publication.
The Author
• Dr. Heinle, Cleveland, Ohio, is a graduate
of Western Reserve University School of Medi-
cine, 1934; member, American Society for
Clinical Research, Society of Experimental
Biology and Medicine and American Institute
of Nutrition; associate physician, Lakeside
Hospital; and associate professor of Medicine,
Western Reserve University.
crude, weak antagonist in association with a
folic acid deficient diet.2
RESULTS OF TREATMENT
Of the 26 children, three died within less than
two weeks after therapy was instituted, and
these are excluded from the series, since the
duration of life was not sufficient for the drug
to be given an adequate trial.
Eleven of the remaining 23 are still alive,
and 12 have died. The longest remission lasted
ten months, in a patient still under observation,
and the shortest one and one-half months. The
latter patient, however, had acute monocytic
leukemia rather than the more common small
cell leukemia of the other cases. All of these cases
had some improvement after antagonist therapy.
In five, symptomatic improvement without ob-
jective blood or bone marrow improvement oc-
curred. These five experienced a sense of well-
being, and an increase in appetite, which lasted
for varying periods of time.
Eighteen of the 23 had both hematologic and
symptomatic improvement. In the most complete
remissions, the peripheral blood and bone marrow
returned to so nearly a normal state that little
evidence of leukemia could be demonstrated.
Spleen and lymph nodes decreased in size or re-
turned to normal. Bone pain, common because of
the marked involvement with leukemia, com-
pletely disappeared and children who had stopped
walking because it was painful walked again
without pain.
This happy state of affairs lasted only three
to four months on the average, however, at which
time relapse ensued. While many of the patients
obtained another remission upon resuming or in-
creasing the dose of antagonist, the remission
did not occur as quickly and was never as com-
plete as with the first course of treatment.
AUTOPSY FINDINGS
Of the 12 children who died after having had
various degrees of remission, autopsy findings
for February, 1950
133
are available in nine. In one case, reticulum cell
sarcoma was found, although blood and bone
marrow findings during life were typical of
acute leukemia. Of considerable interest is the
fact that in the other eight cases, little or no
evidence of leukemia was present at autopsy.
The bone marrow tended to be hypoplastic in
all these cases, but complete aplasia was present
in none. In one patient, marked ulceration was
present in one localized area of the jejunum but
generalized intestinal ulceration was not en-
countered.
The cause of death was doubtful in these
cases. In three, terminal hemorrhage and severe
anemia could certainly have been responsible
for death. In the remainder no obvious cause
was present. The patients usually lost their
appetites, slowly lost weight and strength, be-
came unconscious after varying periods of time,
and died, much as a terminal case of cancer
may die.
ADULT LEUKEMIA
In none of the eight cases of acute leukemia
in adults was there any evidence of clinical or
hematologic improvement. Similar cases have
sometimes shown some improvement in the ex-
perience of others,3 4 however.
Both cases of chronic myeloid leukemia treated
with a crude antagonist and a folic acid deficient
diet, obtained clinical and hematologic remission.
The effectiveness of the antagonists in chronic
myeloid leukemia does not compare with that
of radiation therapy, however, and it seems
safe to state that the folic acid antagonists
have no place in the treatment of chronic myeloid
leukemia. In chronic lymphoid leukemia, there
may be substantial reduction in the number of
circulating lymphocytes but the effects of the
antagonist are manifested predominantly by a
reduction in granulocytes and platelets.5 This
occurrence can probably be explained on the
basis that the more mature lymphocyte of chronic
lymphoid leukemia may not have as rapid a
metabolism as the granulocytes and platelet pre-
cursors, and so are not as susceptible to in-
terference with the folic acid mechanism as
are the normal bone marrow elements.
DOSAGE
The dose schedule of the folic acid antagonists
probably cannot be computed on a patient-weight
basis. In children, the dose of aminopterin is
0.5 to 1.0 mg. daily and the author believes that
larger doses are more toxic without being more
effective. In adults, similarly, doses larger than
1.0 mg. daily have led to rapid production of
toxicity. A-methopterin can be given in doses
three to five times as great as that of aminop-
terin. Other antagonists can be given in larger
doses.1 Thus far, however, toxicity and effective-
ness have run parallel, and an effective dose of
any of the antagonists may be associated with
toxicity.
Our cases were treated with daily intra-
muscular doses until a desirable effect was mani-
fest, usually within two to three weeks, or until
toxic manifestations occurred. When a remission
was induced, the patients were given an intra-
muscular dose three times a week unless toxic
manifestations occurred, in which event treat-
ment was temporarily interrupted. When relapse
occurred, daily injections were resumed. It has
been our experience that when relapse occurs,
response to increased dosage of the antagonists
is not as good as with tihe first course of treat-
ment.
TOXICITY
Toxicity is manifested principally by ulcera-
tion of the mucous membranes of the gastro-
intestinal tract. Ulcers develop on the lips and
in the mouth, and, with the exception of the
stomach, throughout the gastro-intestinal tract.
This is usually associated with bloody diarrhea.
Alopecia has been reported by others9 but has
not occurred in our series.
The folic acid antagonists can produce com-
plete aplasia of the marrow if the dose is not
controlled. It is probable that some hypoplasia
always precedes the hematologic improvement
even in those patients deriving the most benefit.
For this reason, the blood should be examined
three times a week and frequent marrow exam-
inations must be made when the patient is under
active treatment.
As soon as any toxic lesion becomes manifest,
the drug should be discontinued until improve-
ment occurs, usually within seven to ten days.
Folic acid may be administered although it has
not been necessary in our patients and its benefit
is doubtful. Liver extracts, previously given with
the antagonist to prevent toxicity, are no longer
used because they have proved of no value in
our patients or in the experience of others.1’ 3
SUPPORTIVE TREATMENT
It must be emphasized that repeated blood
transfusions and use of the antibiotic drugs, prin-
cipally penicillin, remain a very essential part
of the treatment of acute leukemia. Blood trans-
fusions relieve the symptoms of anemia and, to
a certain extent, control the bleeding. Peni-
cillin certainly has prolonged life by preventing
death from infection to which these patients are
so susceptible.
Hemmorrhage is a common and serious com-
plication of acute leukemia. The use of the
heparin-neutralizing drugs, protamine sulfate and
toluidine blue, have been recommended7 but in
our cases these substances have proven to be of
no value when used in doses of 2 to 3.5 mg. per
kg. of body weight. This does not surprise us,
since hyperheparinemia cannot be demonstrated
134
Tb 9 Ohio State Medical Journal
in these patients, and in all probability the
bleeding is due to the thrombocytopenia and as-
sociated abnormal capillary permeability.
DISCUSSION
The folic acid antagonists have made it pos-
sible to prolong the life of many children with
acute leukemia. In general, the extra months are
comfortable and reasonably happy ones, with
marked clinical and hematologic remission. Re-
lapse invariably ensues, however, and all the
patients eventually die. At autopsy, very little
evidence of leukemia may be found and the
exact cause of death may not be evident. It
seems likely that a general folic acid deficiency
may have occurred in these patients and is the
cause of death.
The folic acid antagonists are not a satis-
factory form of treatment, therefore. In the
opinion of the author, their ultimate failure is
due to the fact that derangement of the folic
acid mechanism is not the primary biochemical
abnormality in leukemia. While it is possible to
interfere with this fundamental cellular bio-
chemical process, the attack is not made on the
primary defect. It can be hoped, however, that
a more fundamental defect can be found, and
an effective means of treatment devised.
SUMMARY
1. Marked remissions with prolongation of life
can be attained by the use of the folic acid
antagonists in acute leukemia of childhood.
2. In our experience, acute leukemia in adults
has been entirely refractory, although others have
reported beneficial effects in some cases.
3. The antagonists are extremely toxic and can
cause death unless administration is carefully
controlled.
4. The use of blood transfusions and penicillin
constitutes an important part of the treatment of
acute leukemia.
5. The anti-heparin compounds, protamine sul-
fate and toluidine blue were ineffective in com-
bating the hemorrhagic tendency in these cases.
bibliography
1. Farber, Sidney: Some Observations on the Effect of
Folic Acid Antagonists on Acute Leukemia and Other Forms
of Incurable Cancer. Blood, 4:160, 1949.
2. Welch, A. D., and Heinle, R. W. : Unpublished data.
3. Damashek, William: The Use of Folic Acid Antagon-
ists in the Treatment of Acute and Subacute Leukemia.
Blood, 4:168, 1949.
4. Stickney, J. M., Hagedorn, A. B., Mells, S. D., and
Talbott C. : Changes in Blood and Bone Marrow in Acute
Leukemias Induced by Aminopterin. J. Lab. Clin. Med.,
33:1481, 1948.
6. Bethell, F. H. : Personal Communication.
6. Farber, S., Diamond, L. K., Mercer, R. D., Sylvester,
R. F., Jr., and Wolff, J. A.: Temporary Remissions in
Acute Leukemia Produced by Folic Acid Antagonist
4-Aminopteroylglutamic Acid (Aminopterin). New Eng.
J. Med., 238: 787, 1948.
7. Allen, J. G., Bogardus, G., Jacobson, L. O., and Spurr,
C. L. : Some Observations on the Bleeding Tendency in
Thrombocytopenic Purpura. An. Int. Med., 27 :382, 1947.
KEEPING UP WITH MEDICINE
• You may well raise the question whether old
age has any diseases of its own.
* * *
• Dentists sometime have to take out teeth
because the supporting structures are inadequate.
Here is where nutrient needs first play an im-
portant role in preventive medicine.
* * *
• The use of arsenic (Fowler’s solution) is a
safe and reliable method of treating polycythemia.
The real objection to its use is the loss of ap-
petite, nausea, and vomiting which so commonly
occur and turn the patient against the drug.
* ❖ *
• In the pregnant diabetic, high fetal mortality,,
pre-eclampsia and obstetrical abnormalities par-
allel an abnormal pattern of sex hormones.
& ^ si:
• Study of the spinal fluid and measurements
of the cerebrospinal fluid pressure during the
first few hours after an injury to the head
almost never provide information of real help.
± ^ ±
• The practice of anesthesiology demands a
thorough grounding in the physiology and
pharmacology of circulation and respiration, com-
bined with proper training in clinical medicine.
The basic training is only “refresher work” but
training in clinical medicine — that is different.
* % &
• They are looking for tuberculosis vaccine
which will produce a high level of allergy and
relatively few complications.
% Sfc
• It has been recognized for nearly twenty
years now that chick eggs, unlike hen eggs, may
actually contain pathogenic organisms of the
Salmonella group.
* * *
• Instances of death from dermatitis and
stomatitis during streptomycin therapy should
keep us on our guard against hypersensitiveness.
^ ^ ^
• Antihistamines are reported as successful
in the treatment of nausea and vomiting of
pregnancy. Wonder if the huckers will seize
upon this.
^ ^
• We should not forget allergy to denture
material when seeking for the cause of angular
stomatitis — especially in those persons who keep
the dentures in all night.
^ ^
• Undulant fever sometimes gives us a
generalized lymphadenopathy which may closely-
simulate glandular fever of Hodgkin’s Disease.
— J. F.
for February , 1950
135
Elective Surgery In Infancy
HENRY W. LEHRER, M. D., HENRY G. LEHRER, M. D., and DAVID R. LEHRER, M. D.
The Authors
• Dr. Henry W. Lehrer, Sandusky, Ohio, is
a graduate of Ohio State University College
of Medicine, 1916; on senior staff, Good
Samaritan and Providence Hospitals.
• Dr. Henry G. Lehrer, Sandusky, Ohio, is
a graduate of Ohio State University College
of Medicine, 1936; on senior staff. Good Sam-
aritan and Providence Hospitals.
• Dr. David R. Lehrer, Sandusky, Ohio, is
a graduate of Ohio State University College
of Medicine, 1943; junior member, American
College of Surgeons; on senior staff, Good
Samaritan and Providence Hospitals.
WITH the present concepts of medicine
and surgery today, it is- time to re-
evaluate surgery in infancy. This sur-
gery is that which cannot be truly termed emer-
gency surgery. Many times it is health-saving
and on some occasions it is actually life-saving,
but it is not truly emergency surgery. So we
will, from the beginning, rule out the acute
appendicitis, intussusception, congenital pyloric
stenosis, and the various congenital anomalies
that produce symptoms so early in life. In this
elective surgery in children we must remember
that there are several important things to con-
sider. First, we must remember that we are
operating upon infants, not upon “yormg adults.”
They are entirely different persons and an en-
tirely different problem and it is upon this basis
that the specialty of pediatrics is founded.
Infants stand surgery surprisingly well. It
is true they do not withstand adult surgery, but
if the surgery is adapted to the child and the
procedure is kept as short as possible, as simple
as possible, and done with the dispatch that
comes with confidence in knowing what you
are doing and with the gentleness that is like-
wise present, the response of children to sur-
gery is most gratifying. This means that in
the actual surgery meticulousness and gentleness
with all tissues must be practiced and instru-
ments used that are designed for infants, not
the big clumsy snaps that we use on adults.
We must realize, however, that in children, their
reactions to trauma are generally more severe.
For instance, their metabolism is much more
active than an adult’s. Their chemistry is more
unstable and the margin of safety is much more
narrow. The surgery should be done as quickly
as is consistent with careful handling of tissues
and complete hemostasis. Speed should never be
secured at the expense of hurried, careless work.
We must remember that children do not stand
shock well because of their narrower water bal-
lance threshold. Fluid shift from the blood-
stream is not at all tolerated. Hemorrhage
is poorly borne. Extreme care in limiting blood
loss must be practiced as a loss of 25 cc. of
blood in an infant is equivalent to the loss of
500 ec. in an adult.
FLUID BALANCE
In the question of fluid balance, it must be
remembered that a child weighing about nine
pounds requires at least 600 cc. of fluid a day
preoperatively. There is no reason why, if the
child cannot take this orally, that he cannot
Presented at Staff Meeting, July 5, 1949, Providence Hos-\
pital, Sandusky, Ohio.
be given fluids subcutaneously or, if necessary,
by continuous intravenous drip. A canula can
be put in one of the arm or leg veins and blood
can be given in this manner also, if it is neces-
sary. The arm is usually better to use as it can
be more easily immobilized than the legs.
The practical importance of this one procedure,
we think, is well emphasized by the following re-
ports on the treatment of congenital pyloric
stenosis. Williams reports in Australia that
from the year 1928 to the year 1938, a 15 per
cent mortality rate was found in operative cases
of congenital pyloric stenosis. However, in the
series from 1938 to 1941, the rate dropped to 2.8
per cent. Gius* 2 reports a mortality of less than
2 per cent. In the last 64 patients operated upon
there was only one death in the series. In
line with this feeling, Dr. Ladd of Harvard
Medical School has said that one thing he does
not think is generally appreciated is that in-
fants in the first 48 hours of life withstand
major surgical procedures far better than they
do a week or two hence.
Indeed, in regard to the fluid balance pre- and
postoperatively on infants as well as on adults,
the biggest advances in surgery in the last 20
years have been not in the actual technique of
surgery but rather in the pre- and postoperative
care of patients, especially with respect to fluid
balance. With these things in mind I think we
can realize that we are perfectly safe in operat-
ing upon infants.
All authorities agree pretty definitely that
open-drop ether is the anesthetic of choice and
they all regard it as one with an extremely
low mortality if it is given by a person who has
had some experience in giving anesthesia to
children. Many times it is better to start anes-
136
The Ohio State Medical Journal
thesia with vinethene, a rapid-acting inhalation
anesthetic with a wide range of safety, switch-
ing over to ether after anesthesia has been in-
duced. Postoperatively respiratory infections
and atelectasis occur very rarely in children.
With the use of antibiotics at present we
can feel more safe than we ever did before.
Postoperatively children never have to be cath-
eterized nor do they need enemas. They are
usually quite ready and eager to take their nour-
ishment and early ambulation is certainly never
a problem.
The operations with which we are most con-
cerned at the present are repair of harelip,
circumcision, inguinal and unbilical hernior-
rhaphies, tonsillectomies and adenoidectomies.
Within the first half year of life repair of hare-
lip is carried out. This is a procedure that
often involves more than one operation. And
yet, there is no question in anyone’s mind but
that this should be done during the very, very
early part of the child’s life. This certainly
cannot be called an emergency procedure. True,
the deformity does interfere greatly with nutri-
tion and undoubtedly puts a great mental strain
on the parents, and for these reasons alone
should be done early.
Circumcision is one procedure that is routinely
practiced by us all within the first week post-
partum if desired by the parents. The patients
may be given Vitamin K preoperatively but
certainly no one is greatly concerned or upset
at the thought of doing this type of surgery in
a child so young, although Dr. Lauterberg in
Germany actually believes circumcision is best
postponed until the child is a year or so old.
INGUINAL HERNIA
With inguinal hernia, a different problem is
seen. We all know and it is generally agreed
by Drs. Ladd and Gross, Larson, Bradford,
Donavan, Bancroft and Humphreys, and others
that inguinal hernias are actually, in an infant,
due to patent processes vaginalis which has not
closed as is the normal case. Within the first
six months of life and even occasionally within
the first year, spontaneous cures may occur
when the neck of the sac becomes adherent and
obliterates the process. After the first six
months or year any spontaneous cures should
be looked upon with askance. Generally, if
these cases are followed long enough the scar
at the internal ring will break down and the
inguinal hernia will return, this occurring dur-
ing puberty and early adult life. With an
inguinal hernia there are three things you can
do. One is nothing; two, surgery; three, truss.
We are sure that most surgeons do not feel that
a policy of doing nothing is justified. Dr. Rosen-
blatt in Northwest Medicine expressed the opinion
that seems to be the general concensus. That
is, that children under one year of age should
not be subjected to surgery for hernia except
where there is a complicating factor such as
marked pain, a very large defect, incarceration,
inability of retention, digestive disturbances, or
other evidence that would indicate harm from
the pathological process present. In the event
that any of these appear, immediate surgery is
indicated. And were it not for the fact that
spontaneous cures do occur within the first six
months, surgery would be advocated, as with
Dr. Larson at Vanderbilt, when the pathological
process is discovered. Dr. Ladd of Boston be-
lieves that a surgeon who only performs sur-
gery on infants upon rare occasions or who
has had no specialty training in this field should,
in many instances, wait until the child is a year
old or until the surgery is a little more easily
performed.
The conservative treatment is that of a truss.
Here again there is pretty general agreement in
the field of pediatric surgery that a yarn truss
is the only one that is adequate. This, too,
has its faults in that as Dr. Ladd has re-
ported, these trusses are rarely curative. They
are a temporary measure and are sometimes in-
effective due to the size of the hernia or the
inaptitude of the parents. Another thing is that
by their very nature, they are quite likely
to become dirty and must be washed or thrown
away and a new or clean one applied. In addition
to this, many parents are extremely alarmed
over the possibility of incarceration of the hernia
and of the apparent genital defect they be-
lieve present. This adds to them and to the child
a greater mental handicap than many of us
realize. Dr. Ladd has been quoted as saying
that if a truss is ineffective in maintaining
reduction of the hernia, operation should be
resorted to regardless of age. He feels that
some surgeons still advocate putting off surgery
until seven or eight years of age for fear of
contamination from the urine. This, Dr. Ladd
feels, is a rather foolish thing.
At Vanderbilt the feeling is that if the oper-
ation is designed for the patient and kept as
simple as compatible with good surgery, hernior-
rhaphy may be performed at the time the diag-
nosis is made. Dr. Larson reports 119 opera-
tions performed on 111 patients and presents
some rather interesting facts that I should like
to repeat.
There were 24 incarcerated hernias in the
119 present, 20 of these being present when first
seen in the hospital. Of the 24 incarcerated
hernias, 21 or 87 per cent occurred under the
age of 37 months and 8 or one-third under 13
months, 6 actually occurring while the patient
was wearing a truss. Repeated incarceration
had occurred in 14 of these patients prior to
being seen. Several of the children had actually
for February, 1950
137
had incarcerated hernias reduced under anes-
thesia prior to the time they were seen and
yet no surgery had been advocated for correction
of the hernia. In the 36 patients who were seen
wearing trusses, 18 of them had actually pro-
gressed increasingly in size in spite of the truss
and in only 4 was the truss actually maintaining
reduction of the hernia.
Of the 119 herniorrhaphies performed, 10
per cent were on patients younger than 6 months,
18 per cent younger than one year, and 50
per cent under the age of 37 months. No recur-
rences have been noted to present. There was
one death.
Another report by Dr. Johnston in The Ohio
State Medical Journal, presents a group of nine
patients, five of whom were between the ages
of 11 weeks to 1 year. All of these were
operated upon for acute strangulation of an
inguinal hernia.
Other surgeons believe as does Dr. Bancroft
that an incarcerated hernia should be reduced,
but that surgery should be deferred. The in-
cidence of gangrene is extremely small and he
feels that it is small enough to accept the risk
of reducing the incarceration, even under anes-
thesia, and then at a period of three to seven
days following this, the hernia is repaired.
This allows the edema at the site of the in-
carceration to subside. The hernia should not,
however, be left unrepaired.
Another consideration in the matter of inguinal
hernia is the reported cases of torsion of an
undescended testicle in the presence of hernia
with resulting gangrene and infarction of the
testicle or ovary in the hernial sac, this neces-
sitating surgical removal. Surgical repair on
an inguinal hernia is certainly simple using
a modified Ferguson repair. No postoperative
complications of residual hydrocele, testicular
atrophy, or recurrence has been found reported.
UMBILICAL HERNIA
Umbilical hernia, in some respects, is like
inguinal hernia. Incarceration is reportedly
less common and yet it is a real danger. We
think the indications for operation are much the
same as those given for inguinal hernia and we
believe that the procedures recommended by Drs.
Ladd and Gross are certainly to be followed for
the first six months. They believe that the
method of treatment under the age of six months
is to strap an umbilical hernia with adhesive
tape. After this time, however, it has a defi-
nitely diminishing value and has practically no
merit for a baby more than a year old. After
the twelfth month of life a hernial opening which
is less than 1 cm. in size should cause little
concern as it will become obliterated as the
child grows. However, those from 1.5 cms. to
4 cms. or more in diameter should always
be repaired.
In the past year we have had two cases of
umbilical hernia, one of them being incarcerated
and one of them not.
Case 1. G. K., six-year-old colored girl seen
on morning of August 15, 1948, with severe in-
termittent abdominal cramps of six hours’ dura-
tion with nausea and vomiting. Physical exami-
nation revealed a mass 2x2 cms. within a
protruding umbilicus. Diagnosis of umbilical
hernia was made and immediate surgery per-
formed. A Richter’s type hernia was found and
repaired in the usual Mayo technique. Post-
operative course was uneventful and result ex-
cellent to date.
Case 2. J. W., two-year-old white girl. His-
tory of asymptomatic umbilical hernia with
hernial ring measuring 2 cms. in diameter. Re-
pair was a Mayo type repair. Postoperative
course was uneventful and result to date is ex-
cellent.
TONSILLECTOMY AND ADEN OIDECTOMY
The next procedure we wish to consider in
this paper is tonsillectomy and adenoidectomy
in infants. In reading through the literature we
have found very few references to this subject.
We believe, however, there are many times defi-
nite indications for tonsillectomies and adenoidec-
tomies being done in children under a year of
age and those in the next two to three years.
We do not believe in waiting until the child is
five or six because we feel this comes under the
same heading as putting off surgery in hernias.
As in hernias there are definite indications for
doing tonsillectomies and adenoidectomies on
infants. We have had many children with re-
current tonsillitis, recurrent otitis media, recur-
rent infection of the adenoids with postnasal drip
and continued cough. These children do not eat
well, they do not feel well and they are always
sick. They get over one episode and within a
week or two are back in another. We have had
in the past year three cases between the ages of
seven and eleven months of age at the time
tonsillectomy was performed. We know that
the adenoid tissue will often grow back and
require subsequent removal but we do not feel
it is fair to risk deafness during adult life be-
cause we are afraid to take out tonsils and
adenoids in a child who is having recurrent
otitis media at the age of ten months, one year,
or older. We have, also, during the past year
seen one child who has developed a recurrent
pyelitis as a result of recurrent tonsillitis. We
have seen another child who has had one kidney
removed due to a perinephritic abscess which
developed following an acute tonsillitis. The
risk of tonsillectomy and adenoidectomy is
negligible but the risk of procrastination is
certainly dramatically illustrated here.
During the acute infection antibiotics and
sulfas will cause the infection to subside. After
they are cleared up and given a week or two to
get on their feet and let some of the edema in
138
The Ohio Stale Medical Journal
the infected tissues subside, infants can be
subjected to tonsillectomy under ether anesthesia
with no greater risk than in a child five or six
years of age. The following illustrative case
reports will further demonstrate our belief in
this.
Case 1. J. W., nine months at time of tonsil-
lectomy and adenoidectomy. Acute tonsillitis
at age of six months, recurred in one week and
one month. Tonsillectomy and adenoidectomy
February 4, 1949, child has been perfectly well
since that time.
Case 2. D. D., eleven months at time of
tonsillectomy and adenoidectomy. First seen at
seven months with tonsillitis and otitis media.
Again seen at eight and nine months of age
with same symptoms. Tonsillectomy and ade-
noidectomy performed February 4, 1949. Child
perfectly well since.
Case 3. J. M., eleven months at time of tonsil-
lectomy and adenoidectomy. First seen at six
months with temperature and cough. Cough
persisted and was more severe when lying down
or nursing. Postnasal drip present but lessened
with AgN03 painting of adenoid tissue. Seen
every two or three weeks since that time with
upper respiratory infection and otitis media.
Tonsillectomy and adenoidectomy performed
March 4, 1949. No recurrence of upper respira-
tory infection or otitis media since that time.
Case 4. M. L., nineteen months at time of
tonsillectomy and adenoidectomy. Recurrent at-
tacks of tonsillitis and otitis media since age
of one year. Temperature would run to 104°
convulsions would follow. Tonsillectomy and
adenoidectomy performed February, 1949. Since
tonsillectomy and adenoidectomy child has been
perfectly well.
Case 5. J. S., twenty months at time of ton-
sillectomy and adenoidectomy. First seen at
eight months of age with tonsillitis. Tempera-
ture would rise to 104° to 105° with each episode
and convulsions would follow. Seen at monthly
intervals until time of tonsillectomy and ade-
noidectomy which was performed November 3,
1948. Child has had one sore throat since that
time.
Case 6. E. V., twenty months at time of ton-
sillectomy and adenoidectomy. First seen at age
of seven months with bilateral otitis media and
tonsillitis. Treated at monthly intervals with
penicillin and sulfa until tonsillectomy and ade-
noidectomy on February 4, 1949. Since that time
child has been seen once with otitis media.
Case 7. J. W., twenty-one months at time
of tonsillectomy and adenoidectomy. First seen
at age of eight months with acute tonsillitis and
bilateral otitis media. Recurrence of this at
regular intervals during next year. No further
trouble since tonsillectomy and adenoidectomy
performed February, 1949.
Case 8. B. L., twenty-two months at time of
tonsillectomy and adenoidectomy. Tonsillitis
and otitis media every two months since one
year of age. Since tonsillectomy and adenoidec-
tomy in February, 1949, there has been no recur-
rence.
BIBLIOGRAPHY
1. Bancroft and Humphreys The Surgical Treatment of
Soft Tissues, pp. 7-23.
2. Gius, John A. : The Surgical Treatment of Congenital
Hypertrophic Pyloric Stenosis. Western Journal of Surgery,
Obstetrics and Gynecology, 52 :209, May, 1944.
3. Ladd, William E. : The Choice of Time and Type of
Operation in Surgery of Early Life. Journal of the Mount
Sinai Hospital, 10 :389, September-October, 1943.
4. Ladd and Gross : Abdominal Surgery of Infancy and
Childhood, Chapters 26 and 29, pp. 354-366, 1947.
5. Larson, Ralph M. : Inguinal Hernia in Infancy and
Early Childhood. Surgery, Vol. 25, No. 2, pp. 307-328,
February, 1949.
6. Williams, Howard : The Surgical Treatment of Con-
genital Pyloric Stenosis of Infancy : A Review of 400
Cases. Medical Journal of Australia, 1:303, March 14, 1942.
Experience and Judgment
What have any of us learned from experience ?
If we are honest with ourselves we must answer,
“Not as much as we should have.” Without a
lifelong and unflinching honesty with ourselves
we can learn nothing. We may dress the shop
window as we like, we may develop a sales per-
sonality that is convincing to others, but unless
our accounts and our stock-taking are entirely
honest we shall finish as cheap jacks. The greatest
of the men before us said, “The art of Medicine
is long and time is fleeting. Experience is falla-
cious and judgment difficult.” But with experi-
ence, carefully recorded and sorted, judgment will
come.
Experience properly used gives us a set of
standards by which fresh experiences can be
judged. We learn to sum up our patients quickly
and fairly accurately as human beings — if they^
are genuine, self-dramatizers, or humbugs, if
they are brave or timid, if they are minimizers
or exaggerators, if they are concealing something
or merely nervous — and in the light of this
assessment we are able to allot a correcting
ratio to the symptoms they relate that gives it
an absolute value in our diagnostic assessment.
We learn to evaluate pain, particularly its se-
verity and its nature, and to construct a scale of
our own by which we associate certain pains
with certain diseases. We learn that too much
pain in too many places is just as much indica-
tion that nothing is seriously wrong as no pain.
We learn to know when a patient is ill, when one
who has been ill is getting better, or when one
who was on the road to recovery has taken a
turn for the worse. We come to say by in-
stinct rather than reason, “That child is too ill
to be suffering from appendicitis.” “That pain
is not severe enough for gall-stone colic.” We
learn what disease to expect at certain ages, in
either sex, and in persons of certain appear-
ance, occupations, or bodily habitus. We become
so familiar with all the characters of common
complaints that one single unfamiliar feature
strikes a warning note without our having had
recourse to the intellectual process of reason-
ing.— Sir Heneage Ogilvie, K.B.E., British Medi-
cal Journal, No. 4629, September 24, 1949.
for February, 1950
139
Transient Diabetes Insipidus Complicating
Bacterial Endocarditis
SALVATORE M. SANCETTA, M.D., and HENRY A. ZIMMERMAN, M.D.
THIS paper deals with the clinical observa-
tions on a patient with acute bacterial
endocarditis due to hemolytic staphylococcus
aureus, whose illness was complicated by tran-
sient diabetes insipidus, an event hitherto not
recorded in the literature as occurring during the
course of bacterial endocarditis. The organism
recovered from the blood demonstrated a low
sensitivity to penicillin, but in spite of this,
massive doses of penicillin over a prolonged
period resulted in a cure. .
REPORT OF CASE
P. L., C. C. H. number 286378, a seventeen-year
old white schoolgirl, was admitted to the Con-
tagious Division of Cleveland City Hospital on
the evening of April 30, 1947, with chills, fever,
stiffness of the neck, and delirium. Except for
an attack of rheumatic fever at age nine and
again a year later, her health had been good
until six days prior to admission when she de-
veloped malaise, a low grade fever, a slight non-
productive cough, and anorexia. These symp-
toms continued until April 27, when the tempera-
ture rose to 40 degrees C. accompanied by a shak-
ing chill, followed by the appearance of a red,
painful purpuric spot on the right ankle. On
April 28 she became drowsy and was admitted to
a local hospital where she remained until April
30. At that time she developed stiffness of the
neck and was transferred to the Contagious Di-
vision, Cleveland City Hospital, with the pro-
visional diagnosis of meningitis.
PHYSICAL EXAMINATION
The patient was a well-developed and well-
nourished girl who was disoriented, and appeared
seriously ill. The temperature was 38.2 degrees
C., the pulse rate 110, and the blood pressure
120/72. There were multiple petechiae and
purpuric areas over the hands, feet and chest.
Subungual splinter hemorrhages were present
in most of the fingers. The conjunctivae were
clear and there were no hemorrhages of the
ocular fundi, but the left optic disc showed
questionable blurring. The tympanic membranes
were intact. There was no discharge from the
nares. Petechiae were noticed in the soft palate
and in the buccal mucous membrane. The neck
was moderately rigid. The left border of cardiac
dullness was percussed in the left anterior axil-
lary line, and there was increased activity over
the left ventricle. The first heart sound at the
apex was followed by a loud, moderately harsh
systolic murmur, heard best at the apex, and
transmitted to the left axilla and along the left
sternal border to the second left parasternal
area. The aortic second sound was clear and
the cardiac mechanism was normal. The per-
ipheral arteries were soft and compressible, and
all peripheral pulses palpable and equal bilater-
ally.
Submitted March 7, 1949.
The Authors
• Dr. Sancetta, Cleveland, Ohio, is a graduate
of Western Reserve University School of Medi-
cine, 1941; and is teaching fellow in medicine.
Western Reserve University, City Hospital
Division.
• Dr. Zimmerman, Cleveland, Ohio, is a
graduate of University of Cincinnati College
of Medicine, 1940; associate member, Ameri-
can College of Physicians; and teaching fellow,
department of medicine, Western Reserve Uni-
versity, City Hospital Division.
The abdomen was not remarkable except for
a questionably palpable spleen and tenderness
in the left upper quadrant. No abnormalities of
the back were noted. The joints of the right arm
and leg were painful on movement but were not
swollen or reddened. The deep tendon reflexes
were all hyperactive, Kernig’s and Brudzinski’s
signs were present, but the Babinski sign was
absent.
LABORATORY DATA
The urine was cloudy, acid, with a specific
gravity of 1016. There were no albumin, sugar
or acetone. No formed elements were noted
other than an occasional white blood cell. The
hemogram revealed the hemoglobin to be 16
grams, the red blood count 4,540,000, white blood
count 18,900, with a differential count of 74
polymorphonuclear leukocytes and 26 lympho-
cytes. Lumbar puncture revealed ground glass
fluid with a cell count of 340 cells, 142 of which
were red blood cells, 164 polymorphonuclear
leukocytes and 34 mononuclear cells. The Pandy
test was 3 plus, the Ross-Jones 3 plus, the spinal
fluid protein was 90 mgm. per cent, and the
chlorides 411 mgm. per cent (678 mgm. per cent
as NaCl). No organisms were seen on direct
smear. The blood cultures on April 30 and
June 1 showed identical hemolytic staphylococcus
aureus. Eighteen subsequent blood cultures dur-
ing her hospital stay were all negative. No
organisms were grown from the spinal fluid.
The skin over several of the petechial and
purpuric areas was denuded and Gram stains
were made of the expressed serum. These
showed clusters of gram positive cocci, several
of which were phagocyted.
Sensitivity tests demonstrated the causative
organism to be inhibited by a concentration of
four units of penicillin (large inoculum), one
unit of penicillin (small inoculum), and 50
micrograms of streptomycin, according to Ram-
melkamp’s tubular dilution method.
The admission electrocardiogram showed a
prolongation of the auriculo-ventricular conduc-
140
The Ohio State Medical Journal
tion time and a slight right axis deviation. Later
records reverted to normal.
HOSPITAL COURSE
After the diagnosis was established the pa-
tient was transferred to the medical service on
June 1st. She was given two grams of sul-
fathiozole, 2 grams of sulfadiazine, and continued
on a dosage of 0.5 grams of each every four
hours. This was continued to a total of 23
grams of each, and stopped on June 9, 1947.
Penicillin was likewise begun, 100,000 units
intramuscularly every hour, and 1,000,000 units
were given intravenously on June 2 and June 3.
On June 4 intravenous penicillin was increased
to 2,000,000 units daily and continued until
June 10. The intramuscular injections of peni-
cillin were increased to 200,000 units every hour
on June 7, and to 400,000 units every hour on
June 8. On June 9 this was reduced to 200,000
units every hour and maintained at that dosage
through the remainder of her active therapy.
The total penicillin dosage was 451,000,000
units given over a period of 108 days; during
the last 97 days of therapy she received 4,800,000
units daily.
From June 11 to June 25 she received Retentin*
(4' carboxyphenylmethanesulfonilide) 1 gram
every 2 hours, to a total dosage of 178 grams.
At no time did she develop signs of toxicity
on this dosage. In addition 3,500 cc. of whole
blood were given by multiple transfusions
through her hospital stay.
Repeated penicillin blood levels throughout
her full course of therapy ranged between three
and eight units. Most of the time steady levels
of eight units were obtained. There was no
evidence that Retentin, in the dosage employed,
significantly elevated the blood penicillin levels.
Her hospital course during the first twenty-
three days was extremely stormy. The temper-
ature remained elevated, with daily variations
of 1.5 degrees C. until it reached a peak of
41 degrees C. on the tenth hospital day.
Acetylsalicylic acid, 1.6 grams, was given, with
a transient drop to 37 degrees C., and was re-
peated on her eleventh hospital day. There-
after the temperature began to decline until
the twentieth hospital day when for the first
time it reached 37 degrees C. The following
day she had a chill, and developed right upper
quadrant pain with severe costovertebral angle
tenderness and muscle spasm. The temperature
rose to 40.5 degrees C. This was interpreted as
a septic embolus to the right kidney or in the
perinephric region, since repeated urine examina-
tions failed to show the presence of red blood
cells. This was the last embolic phenomenon
noted, and thereafter the temperature began
gradually to drop until it stabilized at 37 de-
grees C. or below by the 71st hospital day,
with the exception of one elevation to 37.8
degrees C. on the 76th hospital day, which was
attributed to an intercurrent common cold.
Penicillin therapy was continued unchanged dur-
ing an afebrile period of thirty-nine days, and
she was observed for another twenty-seven days
during which time she gradually resumed activity.
After the first twenty-four hours in the hos-
pital the patient was fully conscious. She never
received more than 3,000 cc. of parenteral
fluids daily, this being given mainly as a
vehicle for intravenous penicillin. Her oral in-
* Supplied through the courtesy of Sharpe and Dohme.
take increased gradually from 800 cc. daily on
the second hospital day, to 5,200 cc. on the
eighth hospital day. On the fourth hospital
day bilateral papilledema of 1 diopter was noted,
although the neck stiffness had subsided; on the
ninth day she developed unbearable thirst and
the oral fluid intake rose to 27,400 cc. or 6.8
gallons; on the tenth day the oral intake was
20,400 cc. or 5.1 gallons; on the eleventh day
10,050 cc., on the twelfth day 8,075 cc., and on
the thirteenth day 4,800 cc. The urinary output
followed the intake of fluids closely, and during
the height of the polyuria the specific gravity
of the urine fell to 1.002 (See Table 1). The
TABLE 1
RECORD OF FLUID INTAKE, OUTPUT, URINARY
SPECIFIC GRAVITY, AND MAXIMAL TEMPERATURE
ELEVATION IN DEGREES CENTIGRADE DURING FIRST
THREE WEEKS OF HOSPITALIZATION.
There is no relation between the temperature elevation
and the oral intake ; during this time of maximal polyuria
and polydipsia the patient exhibited the typical very dry
skin, with a striking absence of hydrosis. Figures in
parentheses indicate parenteral fluids, employed as a vehicle
for penicillin.
Date
Intake in ce.
Output in cc.
Sp. Gravity
Max. Temp.
4/30/47
No record
No record
1016
40.0
5/1/47
800 (1500)
No record
1016
40.0
5/2/47
1700 (3700)
3200
39.5
5/3/47
1500 (3000)
6000
1016
40.2
5/4/47
3200 (3000)
6000
39.8
5/5/47
3800 (3000)
6400
1013
39.5
5/6/47
4000 (3000)
8540
40.2
5/7/47
5200 (2500)
8400
1006
40.0
5/8/47
27400 (1500)
20500
40.2
5/9/47
20400 (1500)
17000
1002
41.0
5/10/47
10050 (1500)
10100
40.6
5/11/47
8075 (750)
7000
39.5
5/12/47
4800
5050
1010
40.0
5/13/47
4200
3200
1015
38.8
5/14/47
5400
3400
1015
39.0
5/15/47
5600
4000
39.3
5/16/47
4200
3400
1012
39.2
5/17/47
3600
3875
1010
39.0
5/18/47
3440
2000
39.0
5/19/47
2400
1000
38.8
5/20/47
2000
1450
1020
40.5
oral fluid intake gradually dropped to 3,400 cc.
by the nineteenth hospital day, and never ex-
ceeded 3,000 cc. thereafter, for the most part
averaging 1,500 cc. to 2,200 cc. daily. By the
tenth hospital day, coincident with the subsidence
of polyuria and polydypsia, the bilateral papil-
ledema had almost disappeared. Spinal punc-
tures were not repeated following the ad-
mission tap since it was felt that she was too
ill, and little was to be gained from the pro-
cedure.
Another interesting feature was the change
in the character of the apical systolic murmur
which gradually became harsher and more widely
transmitted, so that by the time the patient
was discharged, the murmur completely obli-
terated the first heart sound and was heard
over the entire precordium.
The first X-ray examination of the chest
was done on June 15 when the transverse dia-
meter of the heart was found to be 10 per cent
greater than the expected normal for her height
and weight, according to Ungerleider’s scale.
The patient has been seen repeatedly since
discharge and has been found to be in excel-
lent health. At present, ten months following her
release from the hospital, she has maintained
for February , 1950
141
her normal weight and has attended school, able
to participate in all routine activities without
limitations. Her heart, both clinically and
fluoroscopically, has shown no change.
DISCUSSION
Diabetes insipidus is a rather rare clinical
condition. Rowntree7 gives the incidence as 16
in every 100,000 hospital admissions. Fink2 in
reporting a series of 107 autopsied cases col-
lected from the literature, found diabetes insipidus
to occur in 0.01 per cent of all treated hospital
patients. Usually the condition results from
neoplasms involving the supraoptico-hypophysial
system primarily, by direct extension, or by
metastases; syphilis, tuberculosis, actinomycotic
abscess, epidemic encephalitis, certain rare dis-
orders of metabolism, and traumatic lesions ac-
count for the majority of the remaining cases.
A certain number have no known etiology.
Nephrogenic diabetes insipidus has been re-
ported.10 Only nine instances (8.4 per cent) in
Fink’s series2 were due to other inflammatory
lesions, and of these one resulted from a meta-
static abscess originating in a ruptured appen-
dix.6 Jones3 in a series of 42 clinical cases, re-
ports one instance in which diabetes insipidus
may have followed a septic abortion.
Involvement of the water balance system is
likewise rare as a result of direct extension of
a nearby inflammatory process. Although single
case reports occur sporadically in the litera-
ture,8, 11 Yashin did not find a single case of
diabetes insipidus in an analysis of 326 cases
of neurological complications accompanying in-
fections both of the temporal bone and paranasal
sinuses.12
Transient polyuria of levels consistent with
diabetes insipidus is by no means unknown. It
has been recounted in such varied conditions as
hysteria,7 pregnancy,1 treated syphilis, trauma,
and during convalescence from a number of acute
infections, notably typhoid fever.4
A survey of past writings reveals no instance
of diabetes insipidus, either transient or per-
manent, resulting from acute or subacute bac-
terial endocarditis. As these alfections often
cause embolic occlusions of the cerebral vessels,
it is indeed noteworthy that diabetes insipidus
is not more frequently observed.
That the supraoptico-hypophysial system is
responsible for the control of water balance in
the experimental animal was demonstrated by
Fisher, et al.,3 who found that more than fifty
per cent of the system must be ablated bilaterally
to produce permanent diabetes insipidus in the
cat. Although we have no proof that a lesion
in the supraoptico-hypophysial system caused the
disturbance in water balance observed in our
patient, yet favoring this possibility is (1) the
simultaneous appearance of bilateral papil-
ledema which subsided pari passu with the
polyuria and polydipsia, and (2) the clinical
evidence of meningeal irritation associated with
inflammatory cells in the spinal fluid.
It is of interest to note that massive doses
of penicillin arrested an infection caused by an
organism notoriously resistant to therapy.
Wilhelm, et al.,n have summarized the results in
forty published cases of acute bacterial endo-
carditis treated with penicillin, of which 27
were due to staphylococcus aureus, and of these
only six survived, a mortality of 78 per cent.
SUMMARY
1. A case of transient diabetes insipidus com-
plicating the course of acute bacterial endocarditis
of the mitral valve due to hemolytic staphy-
lococcus aureus is presented.
2. The organism recovered from the blood
stream possessed a low sensitivity to penicillin,
but in spite of this, massive doses of penicillin
given hourly by intramuscular injection over a
period of 108 days resulted in a cure.
BIBLIOGRAPHY
1. Eaves, E. C. : Diabetes Insipidus. Brain, 53 :47, 1930.
2. Fink, E. B. : Diabetes Insipidus : Clinical Review and
Analysis. Arch. Path., 6 :102, 1928.
3. Fisher, C., Ingram, W. R., and Ranson, S. W. : Dia-
betes Insipidus and the Neuro-Hormonal Control of Water
Balance. Ann Arbor, Mich., Edwards Brothers, Inc., 1938.
4. Fussell, M. H., Carmany, H. S., and Hudson, H. : Pol-
yuria in Typhoid Fever. Tr. Assn. Am. Phys., 19 :4, 1904.
5. Jones, G. M. : Diabetes Insipidus: Clinical Observations
in 42 Cases. Arbh. Int. Med., 74 :81, 1944.
6. Jungmann: (Untitled: Demonstration of Pathological
specimen). Deutsche Med. Wchnschr., 68:1628, 1922.
7. Rowntree, L. G. : Studies in Diabetes Insipidus.
J. A. M. A., 83 :399, 1924.
8. Weinstein, E. A., and Spingarn, E. L. : Case of Dia-
betes Insipidus of Inflammatory Origin Treated With
Roentgen Rays J. Mt. Sinai Hosp., 7 :90, 1940.
9. Wilhelm, F., Hirsh, H. L., Hussey, H. H., and Dowling,
H. F. : The Treatment of Acute Bacterial Endocarditis with
Penicillin. Ann. Int. Med., 26 :221, 1947.
10. Williams, R. H., and Henry, C. : Nephrogenic Dia-
betes Insipidus Transmitted by Females and Appearing Dur-
ing Infancy in Males. Ann. Int. Med., 27 :84, 1947.
11. Yashin, J. C., Leurey, E. H., and Schwarz, G. H. :
Diabetes Insipidus. Arch. Neurol. & Psychiat, 48:119, 1942.
12. Yashin, J. C. : Neurological Complications of In-
fections of Temporal Bone and Paranasal Sinuses. Arch.
Otolaryng., 30:157, 1939; ibid, 360, 1939.
The Story Behind the Word
Asthma — This word dates back to antiquity
and was employed by the ancient Greek phy-
sicians. Hippocrates referred to asthma nine
times but left no clear cut clinical account. It
is derived from the Greek word “Astma” mean-
ing to pant, but is also given as coming from
the Greek word “aenai” meaning to breathe
hard.
Diabetes — We owe the name of this disease to
Aretaeus of Cappadocia who lived in the Second
Century A.D. He named the disease from the
Greek word for siphon because “the fluid does
not remain in the body but leaves it as by a
siphon.” The word diabetes or siphon comes
from the Greek words “dia” or through and
“baino” I go.
Batty — To go “batty” — literally to be possessed
of the devil in the form of a bat.
Harry Wain, M. D., Mansfield, Ohio.
142
The Ohio State Medical Journal
History of Medicine in Gallia County, Ohio
ELLA G. LUPTON, M. D.
A LITTLE French Colony of 500 over one hun-
dred and sixty years ago was but the foam
blown from the on-rolling waves of an
advancing civilization sired by the fierce tornado
of the French Revolution. The Bastille had fallen
and great unrest wms felt by the government
and people who were just ready to grasp at
anything to relieve their unhappy condition. It
was at this most propitious of times for advanc-
ing schemes designed to swindle distressed, dis-
couraged and peace-loving people that an Ameri-
can land syndicate opened in Paris; and through
them the French Colony was informed that they
owned a vast tract in America that would af-
ford an ideal refuge for them. Upon their ar-
rival at Alexandria, they found that their deeds
did not give a perfect title to the land.
The Scioto Company which was responsible for
their being cheated, patched up their affairs at
Alexandria, Virginia, and arranged to have a
public square cleared and a log block-house and
cabins erected at Gallipolis.
Gallipolis is the highest town bordering on
the Ohio river and the third city founded in Ohio,
Marietta being first; Cincinnati second. Its
name is a combination of Latin and Greek.
Galli, genitive singular of Gallus, and polis,
nominative of the Greek polis meaning city.
Hence the name means City of the Gauls. The
French were proud of their descent from the
ancient race of Gauls.
SOUGHT EASY LIFE
The migration of the French Colony cannot
be attributed to the lofty motives and heroic
determination which animated the rugged New
England pioneers who found firm foot-hold on
bleak Plymouth Rock and offered prayers for
their safety. Rather the French came over
to have peace of mind, easy life, carefree feasts
and balls, for the next evening after their ar-
rival, all of their finery was unpacked to wear
Presented at the Sixty-fourth Annual Meeting of the Ohio
State Archaeological and Historical Society, April 23, 1949.
to a dance wherein much pleasure was indulged.
This same spirit and love for a social life
prevailed for many years. In fact a little of
it still prevails.
Among these French settlers of 1790 was the
first doctor to locate in Gallipolis. Dr. Antoine
Francis Saugrain, physician, chemist and na-
tural philosopher, was an active and plucky
little Frenchman four and a half feet tall, full
of vivacity, vitality and loved by his fellow-
men. He took great pleasure in showing the
curious operations of his blow-pipe and crucible;
tricks with his phosphorous matches; his baro-
meter and thermometer with the scales painted
with a pen.
Dr. Andrew LaCroix, born in Normandy in
1766, was an obstetrician by profession and a
Latin scholar by avocation. He came with or
soon after the arrival of the early settlers and
was there during the cholera epidemic in 1796.
His profession requiring only his occasional at-
tention, and his income from assisting at births
being slender, he was forced to adopt other
means of livelihood. It is said “he had a horse
mill and distilled peach brandy.” An employment
not quite so poetical.
Gallia County was formed from a vast ter-
ritory known as Washington County, April 30,
1803, shortly after Ohio was admitted as a state
just thirteen years after Gallipolis was settled,
June 8, 1790. Gallipolis is the county seat.
“Gallia,” the ancient name of France was given
it in honor of the French settlers. It is situated
in the southeastern part of the hilly country of
the state on the beautiful Ohio River.
Many years ago studying for the profession
of medicine was an entirely different matter
from what it is today. A young man “read”
with a physician and accompanied him on “his
rounds” for a year, then went to Medical Col-
lege for a year, after which he was qualified to
“hang out his shingle.”
Dr. Edward Naret was born in France; grad-
uated in Paris and came to the United States in
for February , 1950
M3
1800. He located in Gallipolis and married Dr.
Antoine Francis Saugrain’s daughter. His home
is now owned by Mr. Howard Neal.
Dr. Jonas Safford was the fourth doctor as
far as is known. He was born at Hardwick,
Massachusetts, 1763, studied with his step-father
at Bennington, Vermont. In 1811, when he was
forty-eight years old, being influenced by his
brother, Col. Robert Safford, who cut down the
first tree in Gallipolis, Dr. Safford removed to
the valley of Ohio, and settled in Gallipolis. He
was everywhere regarded as a very able physi-
cian and was active in organizing the first
Medical Society in Ohio and continued a mem-
ber until his death.
Owing to the burning of the court house in
1877, the records of the early physicians were
destroyed and unless some of the families re-
member (and usually they do not), it is im-
possible to get accurate data. A few names have
been taken from tombstones.
EARLY GALLIA COUNTY DOCTORS
1824 — Dr. Jacob Kittredge died at age of 45,
August 22, 1824.
Dr. James Hamlin died August 5, 1824.
1825 — Dr. Elisha Morgan, Gallipolis, born 1791,
died f870.
1834 — Dr. Perm Gardner, Gallipolis, graduated
from Starling Medical College, Colum-
bus; surgeon; anatomy professor at
Starling.
1846 — Dr. N. B. Sisson, Bidwell, University of
Louisville.
1848 — Dr. J. C. Rathburn, born September 27,
1826; graduated from Starling Medical
College, Columbus, 1848; practiced in
Gallia County until 1868 when he came
to Gallipolis. His acquaintance knew
him as a gentleman, honest, tender and
sympathetic.
Dr. George W. Livesay graduated from
University of Virginia and Columbia
College; located at Gallipolis where, dur-
ing the Civil War, he had charge of the
hospital. In 1873, he moved to Ironton,
Ohio, and engaged in the active pursuit
of his profession until his death Aug-
ust 8, 1900, at the age of 76.
1850 — Dr. John Sanns, born August 1, 1826,
graduated from Starling Medical Col-
lege, Columbus, 1850; practiced in Galli-
polis. He was very brilliant and had a
lucrative practice.
1854 — Dr. W. W. Mills, Gallipolis, graduated
from Starling Medical College, Colum-
bus.
Dr. Clairbourn D. Wall, Gallipolis, Cin-
cinnati Medical College; died 1882.
1857 — Dr. James Johnston graduated from Star-
ling Medical College, Columbus ; prac-
ticed in Kyger 25 years and Gallipolis
until his death. He was the doctor in
charge during the smallpox epidemic.
Dr. Daniel Patterson, Cadmus, graduated
from Starling Medical College, died 1916.
1864 — Dr. David T. Jenkins graduated from
Eclectic Medical College, Cincinnati.
Dr. Eli G. Alcorn graduated from Eclectic
Medical College, Philadelphia; practiced
in Hamlin, West Virginia, then came to
Gallipolis.
Dr. Charles Russell Morgan, Gallipolis,
graduated from Starling Medical College,
died 1874.
Dr. Rufus D. Jacobs, Vinton and Rio
Grande, graduated from Cleveland Medi-
cal College; beloved by his community;
killed by train.
1868 — Dr. William Chauncy Hall Needham was
born in Connecticut, 1845, graduated
from Johns Hopkins Medical 1868;
located at Gallipolis 1868, married, 1870;
entered Civil War when 17 years old;
practiced during Yellow Fever Epidemic;
elected Senator from this district; died
1885.
1869 — Dr. Fred A. Cromley, Gallipolis, graduated
from Cincinnati College of Medicine and
Surgery; member of Board of Health;
assisted Dr. Needham during the yellow
fever epidemic in 1878.
1871 — Dr Jehu Eakins, Patriot and Gallipolis,
graduated from Jefferson Medical Col-
lege, Philadelphia; fastidious, yet pleas-
ant and efficient.
1872 — Dr. Edward W. Parker, Vinton and Galli-
polis, graduated from Cincinnati Medical
College; died May, 1903.
1874 — Dr. J. B. Dustin, Vinton, graduated from
Medical College of Ohio, Cincinnati.
Dr. James T. Hanson, Gallipolis, graduated
from Cincinnati Medical College; jovial,
good fellow, known by his laugh.
1875 — Dr. Thomas Northrup, Gallipolis, grad-
uated from Cincinnati Medical College.
1877 — Dr. Clayton Barton, Addison, graduated
from Kentucky School of Medicine,
Louisville; practiced over large area.
Dr. David A. Howell, Gallipolis, graduated
from Ohio Medical College Cincinnati;
died 1899.
1880 — Dr. Henry P. Gerlack, Crown City, grad-
uated from Medical College of Ohio,
Cincinnati.
Dr. W. J. Fletcher, Chambersburg, grad-
uated from Miami Medical College, Cin-
cinnati.
1881 — Dr. Edwin B. Morrison graduated from
Starling Medical College, Columbus.
Dr. George K. Ewing, Ewington, grad-
uated from College of Physicians and
Surgeons, Baltimore, Maryland.
Dr. S. W. Williams graduated from Miami
Medical College, Cincinnati; practiced
in Mercerville, then in Gallipolis.
1882 — Dr. C. A. Rife, Kyger, graduated from
S-tarling Medical College, Columbus;
surprised everyone by his dexterity; lost
one hand when he was six years old.
Dr. W. W. Miller, Thurman and Vinton,
graduated from Jefferson Medical Col-
lege, Philadelphia.
1883 — Dr. Morris Tipton graduated from Medi-
cal College of Ohio, Cincinnati. In 1913,
he became Probate Judge in Gallipolis.
In 1917, he went to Columbus on staff
of Ohio State Insane Hospital; died 1930.
1884 — Dr. David K. Shaffer, Peniel, graduated
from Starling Medical College, Columbus.
1886 — Dr. L. P. Fletcher, Pine Grove, graduated
from Miami Medical College, Cincinnati.
Dr. George Vanden, Gallipolis, graduated
from Medical College of Ohio, Cincin-
nati; eye specialist.
1887 — Dr. H. Dale Strausbaugh graduated from
Starling Medical College, Columbus.
144
The Ohio State Medical Journal
1888 — Dr. Charles C. Parker, Porter and Galli-
polis, graduated from Medical College of
Ohio, Cincinnati.
Dr. Orin S. Mills, Gallipolis, graduated
from Medical College of Ohio, Cincin-
nati.
1889 — Dr. J. S. Webster, Waterloo and Gallipolis,
graduated from Miami Medical College,
Cincinnati.
Dr. H. M. Hamilton, Vinton, graduated
from Medical College of Ohio, Cincinnati.
1890 — Dr. Chas. W. Ely, Cheshire, graduated
from Starling Medical College, Columbus.
Dr. Edward O. McCall.
1892 — Dr. Louis C. Bean, Gallipolis, graduated
from Starling Medical College, Columbus.
Dr. Luther B. Turner, graduated from
Starling Medical College, Columbus.
Dr. Alexis B. Parker graduated from
Cincinnati College of Medicine and Sur-
gery.
1893 — Dr. John Wm. Bargar graduated from
Medical College of Ohio, Cincinnati.
Dr. Dan J. Webster graduated from Miami
Medical College, Cincinnati.
1894 — Dr. John Winn, Rio Grande, graduated
from Starling Medical College, Columbus.
Dr. John B. Alcorn, Gallipolis and Colum-
bus, graduated from Kentucky School
of Medicine, Louisville; member of Board
of Health; postgraduate course at
Vienna, New York; very successful;
moved to Columbus in 1910; killed June
18, 1942.
Dr. Ella G. Lupton, Gallipolis, graduated
from Woman’s Medical College, Phila-
delphia.
Dr. E. E. Ellsworth, Gallipolis and Iron-
ton, graduated from University of Louis-
ville School of Medicine.
Dr. S. G. Martt, Crown City, graduated
from University of Louisville School of
Medicine.
Dr. Richard F. O’Connell, O. H. E., Cadmus,
University Medical Dept., Washington
D. C.
Dr. Gustave A. Mack, Gallipolis, Bellevue
Hospital Medical College, New York.
1895 — Dr. Claud B. Parker, Gallipolis, graduated
from Medical College of Ohio, Cincinnati.
Dr. Robert Howell, Patriot and Gallipolis,
graduated from Medical College of Ohio,
Cincinnati.
1896 — Dr. Daniel Patterson, Cadmus, graduated
from Starling Medical College, Colum-
bus.
Dr. Edwin E. Martindale, Crown City and
Chesapeake, graduated from Medical Col-
lege of Ohio, Cincinnati.
Dr. A. T. Clark, Vinton, graduated from
Ohio Medical University, Columbus;
died, 1916.
HAD LOGAN HOSPITAL
1897 — Dr. J. S. Cherrington, Bidwell, graduated
from Ohio Medical University, Colum-
bus; later had a private hospital at
Logan, Ohio.
Dr. T. J. Allison, Rio Grande, graduated
from Baltimore Medical College.
Dr. Wm. E. Howell, Rio Grande and Galli-
polis, graduated from Medical College
of Ohio, Cincinnati; Gallia County’s first
health commissioner. He was found
dead in his auto at the side of the road,
after attending a confinement case all
night, January 21, 1939.
Dr. W. H. Wilcox, Vinton and Columbus,
graduated from Ohio Medical University,
Columbus; said to have been in Mexican
War.
1898 — Dr. Elmer E. Clark, graduated from
Barnes Medical College, St. Louis,
Missouri.
20th CENTURY DOCTORS
1900 — Dr. George A. Barton, Gallipolis, grad-
uated from Cincinnati College of Medi-
cine and Surgery.
Dr. Bertie V. Swisher, Addison, graduated
from Cincinnati College of Medicine and
Surgery.
Dr. William Pritchard graduated from
Miami Medical College, Cincinnati. He
became a member of the O. H. E. Medi-
cal Staff in 1903. Two years later he
was made superintendent serving until
1911 when he resigned to take up prac-
tice of his profession in Gallipolis. In
July, 1916, Governor White appointed
him superintendent of Columbus State
Hospital. He served in the Medical
Corps during World War I at Camp
Sherman. He died Nov. 11, 1936.
1903 — Dr. Kromer C. Ice, Rio Grande and Vin-
ton, graduated from College of Physi-
cians and Surgery, St. Louis, Missouri.
1906 — Dr. Homer V. Lusher, Crown City, grad-
uated from Miami Medical College, Cin-
cinnati.
Dr. J. W. Barger graduated from Ohio
Medical University, Columbus.
1907 — Dr. Charles E. Holzer, Sr., Gallipolis,
graduated from Starling Medical College,
Columbus.
1909 — Dr. John S. Biddle, Gallipolis, graduated
from Baltimore Medical College.
Dr. H. L. Crary, Vinton, graduated from
Starling Medical College, Columbus.
1910 — Dr. Everett F. Clouse, Vinton, graduated
from Starling Medical College, Columbus.
Dr. J. C. Strausbaugh, Vinton, graduated
from Starling Medical College, Colum-
bus.
1912 — Dr. S. C. Caldwell, Vinton, graduated from
Starling Medical College, Columbus.
Dr. Fletcher Langdon graduated from
Miami Medical College, Cincinnati.
1915 — Dr. Leo C. Bean, Gallipolis, graduated from
Johns Hopkins University School of
Medicine, Baltimore, Maryland; one of
the originators of the Gallipolis Clinic.
1928 — Dr. Francis W. Shane, Gallipolis, grad-
uated from Ohio State University Col-
lege of Medicine; Gallia County health
physician, 1932.
Dr. Geo. D. C. Thompson, graduated from
Ohio State University College of Medi-
cine; Gallipolis Clinic.
1930 — Dr. W. Lewis Brown, Gallipolis, graduated
from Jefferson Medical College, Phila-
delphia.
Dr. N. A. Martin, Gallipolis, graduated
from Washington University School of
Medicine, St. Louis, Missouri; one of the
originators of Gallipolis Clinic.
1933 — Dr. Homer B. Thomas, Gallipolis, grad-
uated from the State University of Iowa
College of Medicine; one of the origin-
ators of Gallipolis Clinic.
for February, 1950
145
1938 — Dr. N. Howard Foster, Gallipolis, grad-
uated from University of Cincinnati Col-
lege of Medicine; school physician.
Dr. George Mitchell, Centerville, grad-
uated from Ohio State University Col-
lege of Medicine.
1943 — Dr. Floyd M. Beman graduated from Ohio
State University College of Medicine.
Dr. John G. Gibert, Gallipolis, graduated
from University of Cincinnati College
of Medicine; was on the staff of Holzer
Hospital, now a general practitioner.
Dr. John H. Hege, Gallipolis Clinic, grad-
uated from Hahnemann Medical College
and Hospital of Philadelphia.
A CALL TO A CAUSE
“A call to a cause” constitutes life and is
great in its implications. Born in the condi-
tions surrounding us, it demands attention im-
mediately. The call represents a job to be
done. It takes men to do it. We have heard
some of these calls. “Remember tb^ Lusitania.”
“Remember the Maine.” “Remember Pearl Har-
bor.” These were direct calls to which men
and women answered. The following men of
our noble profession went forth to meet the
call in their own time.
MILITARY SERVICE
Dr. W. S. Newton graduated from Medical
College of Ohio, Cincinnati; city councilman;
postmaster eight years; member of pension
board; surgeon in 91st and 193rd Ohio regiment
in Civil War. Pallbearers at his funeral were
his colleagues: Dr. J. C. Rathburn, Dr. John
Sanns, Dr. E. G. Alcorn, Dr. W. W. Mills,
Dr. D. A. Howell and Dr. James Johnston.
Dr. N. B. Sisson: graduated from University of
Louisville School of Medicine, 1846; served with
97th company of Ohio in Civil War; located
at Bidwell.
Dr. James Johnston: enlisted when Civil War
broke out and became the assistant surgeon of
the 116th O.V.I., and was commissioned in
1862. He resigned on account of ill health,
but was again commissioned and assigned to
the 141st 0. V. I. and served to the end of hostil-
ities.
Dr. W. W. Mills: enlisted in the 81st Ohio in
1861, was surgeon for three years; was U. S.
Pension Examiner. During the epidemic of
yellow fever in 1878 he attended many cases.
Dr. Perin Gardner: graduated from Starling
Medical College, Columbus; surgeon in Civil
War for three years; instructor of anatomy at
Starling Medical College, Columbus; physician
and surgeon at Marine Hospital, Gallipolis.
Dr. John B. Alcorn: in 1898, entered the Span-
ish American War; was commissioned, sent to
(Chicamauga) Park, Tennessee, then to Knox-
ville, Tennessee, with the Sixth Ohio Reg. of
Toledo, Ohio, then to Cuba. He belonged to
National Guards.
Dr. J. B. Garrett: at one time ambassador
to Mexico. He was in Civil War in 1862. He
died in 1938 at the age of 93.
Dr. C. E. Holzer: enlisted in the medical corps
in World War I.
Dr. S. L. Bossard: graduated from Loyola
University School of Medicine, Chicago, 1916.
In 1920 he became a staff member of the Ohio
Hospital for Epileptics which he still holds. He
served in World War I, six months as First
Lieutenant, Medical Corps; World War II, six
months Lieutenant Colonel, M. C.: L. M. C. L.:
M. C. R. A.
Dr. N. A. Martin: one of the originators of
our “Gallipolis Clinic” as specialist in Eye, Ear,
Nose and Throat, entered the armed service No-
vember 6, 1940, as Captain in the Medical Corps
Reserve. First called to active duty with the
37th division as Battalion Surgeon of 166th In-
fantry Regiment. In 1942 he was transferred to
Letterman General Hospital, San Francisco, for
overseas training; April, 1942: assigned to 155th
Station Hospital Unit being activated for
overseas duty. In May, 1942, sailed for the
South Pacific combat area; September, 1942, or-
ganized and was commanding officer of the 14th
Portable Hospital 32nd Division for combat duty
in New Guinea and Australia. After returning
to the States in October, 1943, he became chief of
Eye, Ear, Nose and Throat Section and Rehabili-
tation of the Hard of Hearing at Hoff General
Hospital, Santa Barbara, California. This was one
of the three Army hearing centers that were
organized during the war. He was released
April, 1946, as Lieutenant Colonel.
FATHER AND SONS
Dr. Eli G. Alcorn: University Medical College
of Kentucky; graduated from the medical de-
partment Eclectic Medical College of Pennsyl-
vania. Specialized in eye, ear, nose and throat.
He was interested in all civic activities and
moved to Columbus in 1921. He died at the age
of 95 in 1939 at Columbus.
Dr. John B. Alcorn: University of Louisville
School of Medicine, 1894; Gallipolis. He main-
tained offices with his father, Eli G. Alcorn.
In 1900, he built a home with offices therein;
became a very efficient physician; was very
active in lodges. He was Eminent Commander
of Knight Templers; Exalted Ruler of Elks;
president of Board of Education. In 1902 he
bought the first gas automobile in Gallipolis;
moved to Columbus in 1910 becoming a very
popular and prosperous physician.
Dr. James Garfield Alcorn: University of Cin-
cinnati College of Medicine, 1902; Gallipolis
one year; moved to Columbus in 1904 where
he still operates the “Alcorn Eye Hospital.”
ONLY WOMAN DOCTOR
Dr. Ella G. Lupton: graduated from the
Woman’s Medical College, Philadelphia, Pennsyl-
146
The Ohio State Medical Journal
vania, in 1894. In 1896-97 she was on the staff
of Toledo State Hospital. She located in Galli-
polis in 1894, being the only general practicing
“woman physician” in the county. No opposi-
tion to a woman physician was ever manifested
by the men physicians of the county. This was
shown by making her a life member of the
Gallia County Medical Society at its meeting,
December 29, 1947. In 1910, she took a postgrad-
uate course at the Great Ormond St. Hospital for
Children in London, England. She had a large
practice and was active in all civic and church
work. She had the first electric automobile.
Her bicycle was the most used until they went
out of style, then autos followed. She retired in
1946. She is the only living doctor among
those doctors who were practicing in Gallipolis
when she began to practice in 1894.
EPIDEMICS
The first recorded epidemic was in 1793 three
years after the settlement of Gallipolis and no
doubt Dr. Saugrain was the physician at that
time. This was a severe epidemic, resembling
yellow fever. Seventeen persons died. Many
of the settlers left after this to go to more
civilized parts and to the French Grant. In
a clipping taken from our daily paper, The Tri-
bune, of November 15, 1897, appeared a reprint
saying, “the first expidemic of yellow fever that
ever occurred in the United States, was at Galli-
polis, Ohio, in 1793, brought there by a party
of immigrants from Spain who had landed at
Baltimore.”
An epidemic of smallpox in 1872 was not very
severe. Patients were isolated in a pest house
outside of the city. Dr. James Johnson took
charge of it.
In 1878 a steamboat from New Orleans go-
ing to Pittsburg was forced to stop here be-
cause of a broken shaft. Many persons visited
the boat, and in a few days the epidemic of
yellow fever began. Dr. William C. H. Need-
ham, who graduated from Johns Hopkins Uni-
versity School of Medicine and located in Galli-
polis in 1868, was the City Physician who had
charge of the quarantine of the boat and ap-
proaches. Burning pots of tar were used as
disinfection. Asepsis was not in use then as
it is today. Sixty-six people died. Dr. Need-
ham was elected as Senator in 1884 and died
in 1885.
Dr. Samuel Kerr, born 1824, assisted Dr. Need-
ham and Dr. Fred Cromley during Yellow Fever
Epidemic as head of the pest-house, outside of the
city. It is said “he had seven wives.”
The influenza was an epidemic in 1915 and
1917. Many doctors were off duty for a week or
more at a time because of their own illness.
Many deaths occurred especially among the old.
The expidemic of 1917 was not as severe as 1915.
Only sporadic cases of typhoid fever have been
prevalent and the source could almost always be
traced outside of our city. Water in and around
the county has been of the purest. We have
never had a real epidemic of diphtheria.
EPILEPTIC HOSPITAL
In his inaugural address, Governor James E.
Campbell urged the construction of a separate
institution for Ohio’s epileptics and in 1890 the
General Assembly enacted such a law. In
August, 1890, Gallipolis was chosen as the site
for the Ohio Hospital for Epileptics now called
Gallipolis State Institute. The first corner stone
was laid November 12, 1891. It was then the
only one of its kind in the United States on
the cottage plan.
Dr. H. C. Rutter was appointed the first su-
perintendent from 1893 to 1901. The first pa-
tient was admitted November 3, 1893. Dr. W.
K. Coleman followed Dr. Rutter from 1901 to
1902, and was succeeded by Dr. A. P. Ohla-
macher who served from 1902 to 1905. Dr. W.
B. Pritchard served from 1905 to 1911, when Dr.
G. G. Kineon succeeded him from 1911 until
his death, August 21, 1943. Dr. John G.
Schwartz was then superintendent from 1943
to 1944. Dr. George R. Roberts is the present
superintendent, a very capable, tactful and kind
man. This has been a wonderful institution.
Many fine members of the staff served the con-
stantly increasing number of patients, keeping
up with the new treatments being brought forth.
New buildings are still being added as needed
appropriations are allowed. Among the staff
who served many years are the following: Dr.
Mary L. Austin was on the staff of the Hospital
thirty years, graduated from Ohio University
Medical College, 1904, died 1947. She was a
very efficient and useful member. Dr. G. G.
Kineon was on the staff of hospital from 1906
to 1911, when he became superintendent after
Dr. Pritchard resigned to enter general practice
in Gallipolis. He was not only a brilliant physi-
cian and a superb administrator, but he had a
wonderful knowledge about farming, fruit grow-
ing, flora, business, civic and social affairs. His
death was a great loss to the state as well as
to the community in which he lived.
Dr. John G. Schwartz graduated from Medi-
cal College of Ohio, Cincinnati, in 1912. He
was a member of the staff of the Ohio Hospital
for Epileptics from 1912 to 1943, when he be-
came superintendent following the death of Dr.
G. G. Kineon. His death, April 1, 1945, brought
sorrow to his many friends and associates.
Dr. S. L. Bossard has been a loyal and faith-
ful staff member since 1920. He graduated
from the Loyola University School of Medicine,
Chicago.
DR. HOLZER HOSPITAL
After completing a surgical residency at the
Ohio Hospital for Epileptics, Dr. Charles E.
for February, 1950
147
Holzer, Sr., saw the need of a hospital in
Gallipolis. The Holzer Hospital was established
in 1910 by him. Financed on borrowed money,
the first hospital was a remodeled residence,
which accommodated only eight beds. In 1913,
he spent a year in postgraduate study in Europe.
In 1917 the first wing of the present Holzer
Hospital, a four-story brick building, was built.
A few months after this he enlisted in the
Medical Corps of the Army and the hospital was
closed until the end of the World War I. As
it was needed, a unit at a time was built. The
hospital is now air-conditioned and has un-
usually complete equipment. A school of nurs-
ing was established in 1920 with only a few
pupils. Now in 1949, it has graduated 300
nurses. It is fully accredited by the Ohio State
Nurses’ Board. Gallipolis today enjoys recog-
nition as a rapidly growing medical center, the
heart of which is this outstanding hospital. Its
capacity now is seventy-five beds and twelve
bassinets. Six doctors are on the staff and
devote all their time to it and the clinic. All
have had years of training and experience in
their specialities. Gallipolis is fortunate in hav-
ing such excellently trained specialists and gen-
eral practitioners outside of the hospital staff.
Registered medical technologists with radi-
ologist, pharmacist and dietitian are on duty.
The larger part of the work is surgical, owing
to the many surgical cases and limitation of
room. The personnel of the hospital consists
of 120 persons besides the 52 student nurses.
The large proportion of the patients come from
a distance as the reputation of the hospital has
gone far beyond the borders of Gallia County.
Many wished to see the hospital serving the peo-
ple in southern Ohio in perpetuity and with this
thought in mind, The Holzer Hospital Founda-
tion, a non-profit corporation, was founded in
1929, the purpose of which has been to receive
gifts and eventually take over the operation
of the hospital.
Dr. and Mrs. Holzer gave the hospital and
equipment to the Foundation in May, 1948, as
they wished to be able to help the new regime
to get under way rather than wait to turn
over the property after their deaths. Since
January 1, 1949, the Holzer Hospital is no
longer a private institution, but is operated by
the foundation, employing the same personnel,
and giving the same service as in the past.
Dr. Charles E. Holzer, Jr., joined the staff
three years ago and is now head of the surgical
unit.
Following are the members on the staff of
the Holzer Hospital: Dr. Charles E. Holzer, Jr.;
Dr. Otto A. Yornholt; Dr. Paul C. Foster; Dr.
Calvus Elton Richards; Dr. Jacob Weinberger;
and Dr. Marcus J. Magnussen.
GALLIPOLIS CLINIC
Gallipolis Clinic became a reality November
19, 1939, for the purpose of giving better service
to the people by combining the facilities of three
different physicians: Drs. Leo C. Bean, Norvil
A. Martin and Homer B. Thomas. It was or-
ganized as a private enterprise. All modern
equipment was installed even to elevator service.
CANCER CLINIC
Gallia County’s new “cancer detection center”
officially launched its career February 17, 1949,
when the first patient was examined.
A clinic is held once every two weeks in the
Holzer Hospital with Dr. Jacob Weinberger as
head. A complete examination is made by a
staff of competent physicians upon twenty or
more persons, some coming from different cities
and states, who are becoming “cancer-minded.”
This is one of the best educational projects so
far — “early detection of cancer.”
A campaign for funds is now on. It is one
of only a few clinics in the State of Ohio. It
is purely a diagnostic detection cancer clinic.
TRANSPORTATION
The great improvement of roads has made
transportation much easier and time-saving than
when doctors had to make their calls on foot or
horseback. As roads were improved, buggies,
run-abouts, bicycles, and automobiles came in
use. The first automobiles were very crude and
slow running, frightening to horses and amaz-
ing to many people. Fifty years have changed
them into luxurious traveling. In the midst of
this luxury, we are becoming plane-minded. With
the increase of autos, came a decrease of rural
doctors. Patients would pass their rural doc-
tors during the day to go to a city doctor, but
at night, call their rural doctor. Many of these
doctors have had to leave and seek other loca-
tions. There is not one rural practicing physi-
cian now in Gallia County, therefore, Gallipolis
is the medical center.
Because of the increase of drugs (some increas-
ing as much as 200 per cent) instruments and
other supplies, the medical profession, Febru-
ary, 1942, felt justified in formulating a new,
increased fee schedule.
“The remarkable progress of medicine gen-
erally in the course of over one-hundred fifty
years has been reflected in the medical prac-
tice of Gallipolis. In earlier years physicians
then made up their own drugs, while bleeding
by wrist-cutting or leeches was a panacea for
almost any ailment, but now medicine has shifted
from conjecture to science. Our facilities, with
the hospital and clinic, are as good as those
of any county in the state, and our men are as
well trained in postgraduate courses and spe-
cial clinics as can be found anywhere.”
148
The Ohio State Medical Journal
Proceedings of The Council . . .
Machinery Is Set Up for Collection of A. M. A. Dues; 1950 Budget
Is Approved; Other Important Business Transacted at Dec. Meeting
THE Council of the Ohio State Medical Asso-
ciation met in the. State Headquarters Of-
fice, Columbus, on Sunday, December 18,
1949, with the following in attendance: Presi-
dent Lincke, President-Elect Swartz, Treasurer
Worstell; Councilors Heusinkveld, Prugh, Mundy,
Dixon, Davis, Foster, Swett, Clodfelter, and
Hattery; Mr. Charles H. Coghlan, Executive
Vice-President of Ohio Medical Indemnity, Inc.,
and Secretaries Nelson, Saville, Page and Moore.
After calling the meeting to order, Dr. Lincke,
the President, took up with The Council the
question of making some replacements on sev-
eral committees.
Dr. Lincke appointed as a member of the Sub-
committee on Legislation, Dr. Wm. J. Graf, Cin-
cinnati, to succeed Dr. Emil R. Swepston, who has
left Ohio, and Dr. James B. Johnson, Jr., Newark,
to succeed Dr. R. G. Plummer, Newark, resigned.
He announced the appointment of Dr. Charles
F. Good, Cleveland, as a member of the Com-
mittee on School Health, and Dr. Herbert B.
Wright, Cleveland, as a member of the Com-
mittee on National Emergency Medical Service.
TO ANALYZE CHILD HEALTH STUDY
Dr. Lincke stated that he felt the Committee
on Education would be the proper committee to
make an analysis of the recent report on child
health services in Ohio, made by the Ohio branch
of the American Academy of Pediatrics. This
met with the approval of The Council and Dr.
Lincke designated the Committee on Education
to carry on this study. He named Dr. James G.
Kramer, Akron, and Dr. Benjamin Hoyer, Cin-
cinnati, as special consultants to the committee
on this question.
The foregoing appointments were approved by
The Council on motion duly made, seconded,
and unanimously carried.
The minutes of the meetings of The Council
held on September 17-18, 1949, at the Granville
Inn, Granville, were approved on motion duly
made, seconded, and unanimously carried.
MEMBERSHIP AT ALL-TIME HIGH
The Executive Secretary reported membership
statistics as follows: Total membership as of
December 15, 1949, 7,473, an all-time record, in-
cluding 11 military members for whom dues are
waived; compared to a total membership of
7,331 as of December 31, 1948.
On motion duly made, seconded, and unani-
mously carried, The Council authorized con-
tinuance of the policy of waiving State Associa-
tion dues during 1950 for physicians serving
temporarily in the Armed Forces, having been
deferred from military service in order to com-
plete their medical education.
The question of how to assess dues for mem-
bers who leave Ohio to establish a practice in
another state and then return to Ohio and re-
affiliate, was raised by the Executive Secretary
and the advice of The Council requested. On
motion duly made, seconded, and unanimously
carried, the following resolution was adopted:
“When a member of the Ohio State Medi-
cal Association leaves Ohio to establish a
practice in another state and ceases to be a
member of this Association but later re-
turns to Ohio to practice and becomes a
member of a component county medical so-
ciety, he shall be regarded as a new member
of the Ohio State Medical Association and
shall be assessed the current dues being
charged new members.”
Members of The Council then reported on
activities among the county medical societies
in their district.
BUDGET FOR 1950 ADOPTED
The Council then went into executive session
for the purpose of reviewing the finances of the
Association, hearing a report from the Com-
mittee on Auditing and Appropriations and
adopting a budget for the calendar year 1950.
The following recommendations of the Audit-
ing and Appropriations Committee were adopted
on motion duly made, seconded, and carried:
Purchase of a new mimeograph and a postage
meter machine; acceptance of the bid of Stone-
man Press for printing The Journal in 1950 at a
four per cent increase; payment by the State
Association of the base premiums in Blue Cross
and Ohio Medical Indemnity for all employees;
employment of one new full-time clerical em-
ployee; presentation of a Christmas bonus to all
employees.
With respect to the bonuses for employees, the
following resolution was adopted:
“In appreciation of our employees’ sin-
cerity and loyalty, it is moved by Dr. Dixon,
seconded by Dr. Mundy, and carried, that
all permanent employees be paid one month’s
salary as a Christmas bonus, and that all
part-time employees be paid $50.00 each.
The payment of this bonus should not be
construed as the establishment of a bonus
precedent for future years.”
for February, 1950
149
On motion duly made, seconded, and carried,
The Council adopted the following budget for
1950:
The Ohio State Medical Journal ....
Executive Secretary, Salary
Executive Secretary,
Stenographic-Clerical
President’s Expense
Council, Expense
A. M. A. Delegates, Expense
Expense-
Salaries-
.$20
. 10
. 1
_ 16
- 1
_ 2
_ 4
Department of Public Relations (see below)— — 33
Director, Salary $ 8,500.00
,000.00
,000.00
,500.00
,000.00
,000.00
,500.00
,000.00
,100.00
Director, Expense
Asst. Director, Salary
Asst. Director, Expense
Exhibits and Newspaper Publicity-
Literature —
Postage
1,500.00
4,800.00
800.00
2,000.00
10,000.00
2,500.00
500.00
500.00
2,000.00
Committee on Education 1
Committee on Public Relations and Economics
Committee on Scientific Work
Committee on Auditing and Appropriations
Committee on Cancer
Committee on Industrial Health
Supplies
Speakers’ Bureau
Miscellaneous Expense-
Committee on Medical Care of Veterans
Committee on Medical Service Plans
Committee on National Emergency Medical Service
Committee on Rural Health
Rural Medical Scholarship
Committee on School Health _
Miscellaneous Committees
Annual Meeting
Conference County Society Presidents-Secretaries —
Postage —
Telephone and Telegraph
Professional Relations Activities
Rent
Insurance and Bonding
Stationery and Supplies
Employees’ Retirement Fund-
Contingent Unassigned
16
2
1
1
4
7
2
2
11
500.00
500.00
800.00
200.00
500.00
500.00
200.00
200.00
300.00
500.00
000.00
800.00
200.00
,000.00
000.00
500.00
500.00
500.00
350.75
900.00
500.00
550.00
142.58
Total-
—$145,243.33
ACTION OF OHIO MEDICAL APPROVED
Upon re-convening in regular session, The
Council then considered a resolution adopted
by the Board of Directors of Ohio Medical In-
demnity, Inc., on December 14, 1949, reading as
follows:
“Resolved, that Ohio Medical Indemnity, Inc.,
subscribe $25,000 to Associated Medical Care
Plans as a furtherance of its interests in
national enrollment and in accordance with a
Contribution Agreement; that the executive of-
ficers be authorized to execute and deliver said
Contribution Agreement to Associated Medical
Care Plans; that this subscription be subject
to the approval of the shareholders of Ohio
Medical Indemnity, Inc.”
The Council, on behalf of the Ohio State
Medical Association, a shareholder in Ohio
Medical Indemnity, Inc., approved the action of
the Board of Directors of Ohio Medical Indemnity
in authorizing a subscription not to exceed
$25,000 to Associated Medical Care Plans
and authorized the Executive Secretary, on
behalf of the Ohio State Medical Associa-
tion, to sign legal documents which might be
required of shareholders of Ohio Medical for
the purpose of completing this transaction.
Mr. Charles H. Coghlan, Executive Vice-
President of Ohio Medical Indemnity, who had
been invited to participate in the discussion of
this question, reported that Ohio Medical anti-
cipates a total of 700,000 subscribers by the
end of 1949. Mr. Coghlan also reported that the
solicitation by Ohio Medical Indemnity of so-called
“pay direct” subscribers to Blue Cross in the
Cincinnati area had resulted in the addition of
approximately 40,000 new subscribers to Ohio
Medical. Also, he reported that new community
enrollments would be conducted during 1950 and
that considerable progress is being made in
the enrollment of farm groups.
DATES FOR CONFERENCES SELECTED
The Council selected Sunday, March 5, as the
date for the annual conference of county society
presidents, secretaries and committeemen, and
Tuesday, March 14, as the date for a conference
of officers and committeemen of local auxiliaries.
On motion duly made, seconded, and unani-
mously carried, it was decided that these con-
ferences should be held at the Fort Hayes Hotel,
Columbus, and that the Executive Secretary
should proceed to arrange for suitable pro-
grams for such meetings.
DISABILITY INSURANCE DISCUSSED
The Executive Secretary reported to The
Council regarding the activities of a special leg-
islative commission established by the Ohio Gen-
eral Assembly to study the question of setting
up in Ohio a temporary disability insurance
program similar to the unemployment compensa-
tion program. Also, he reported on a conference
he had attended at the A. M. A. Headquarters in
Chicago in November on this question. On
motion duly made, seconded, and unanimously
carried, the President was authorized to desig-
nate the Committee on Industrial Health and
Workmen’s Compensation to handle this question
on behalf of the Ohio State Medical Association
and to appoint special consultants to that com-
mittee, if deemed advisable.
In a second motion, which was carried unani-
mously, the President was authorized to name
one or more representatives from the Ohio State
Medical Association to participate in delibera-
tions of a special committee on temporary dis-
ability insurance being established by the Ohio
Citizens Council for Health and Welfare, 135 East
Gay Street, Columbus.
On behalf of the Committee on Scientific Work,
the Executive Secretary submitted a report on
the progress to date in setting up the 1950
Annual Meeting program. On motion duly made,
seconded, and unanimously carried, the actions
of the committee were approved.
There was a discussion of the argument tak-
ing place in Washington as a result of the action
of the Director of the Budget in disapproving
free medical and hospital care for dependents of
military personnel within the continental limits
of the United States. It was the opinion of
150
The Ohio State Medical Journal
The Council that it should take no action on this
question at this time.
FEDERAL LEGISLATION
Communications from the American Medical
Association, pointing out that the House of
Delegates of the A. M. A., in session in Wash-
ington, D. C., in December, had disapproved the
following Federal bills in their present form,
were read and discussed: S. 1411, the so-called
School Health Services Act; S. 1453, proposing
Federal aid to medical education.
On motion duly made, seconded and unani-
mously carried, the action of the House of Dele-
gates of the A. M. A. was endorsed by The
Council.
It was pointed out that S. 1411 had been dis-
approved because it contained a provision
whereby all school children, regardless of the
financial status of their parents, would be
beneficiaries and that S. 1453 had been disap-
proved because it does not in its present form
guarantee academic freedom of medical schools
which would receive Federal financial aid.
VETERANS ADMINISTRATION
A regulation of the Veterans Administration
prohibiting dual appointments thus preventing
physicians employed on a part-time basis from
participating in the fee-for-service program, was
discussed. This had been discussed at the last
meeting of The Council and left pending. Advice
from the regional offices of the Veterans Ad-
ministration in Ohio indicated that there were
no new developments and that the regulation
is still in effect. On motion duly made, sec-
onded, and unanimously carried the Executive
Secretary was instructed to write the National
Director of the Veterans Administration, Wash-
ington, for the purpose of securing the reasons
for the enactment of the regulation.
Dr. Lincke and others gave reports on the
recent session of the House of Delegates of
the A. M. A. held in Washington, D. C.
COLLECTION OF A. M. A. DUES
The Council, on motion duly made, seconded,
and unanimously carried, endorsed the action of
the House of Delegates in providing for the
collection of $25.00 A. M. A. membership dues
in 1950.
Establishment of the procedure for the col-
lection of the A. M. A. membership dues in
Ohio was then discussed and the following pro-
cedure adopted, on motion duly made, seconded,
and unanimously carried:
1. Notification regarding the A. M. A. mem-
bership dues shall be sent immediately to the
secretaries of all county medical societies.
2. A letter from President Lincke shall be sent
to all members of the Ohio State Medical Asso-
ciation at the time 1950 membership cards are
mailed to members.
3. The letter referred to shall explain in
detail the action of the House of Delegates of
the A. M. A. and the reasons for the dues.
4. The letter from Dr. Lincke shall be ac-
companied by a return, postage-paid envelope
which can be used by the physician in trans-
mitting his check for $25.00 for A. M. A. dues
to the Columbus office.
5. All money collected for A. M. A. dues shall
be banked in the account of the Ohio State
Medical Association.
6. Periodic lump sum payments shall be made
by the Columbus office to the Chicago office of
the A. M. A. and shall be accompanied by a
list of those paying the dues.
7. Lists of physicians paying A. M. A. mem-
bership dues shall be sent periodically to county
society secretaries for their information and
records.
8. After a reasonable time lists of unpaid
members shall be sent to the secretaries of local
medical societies with a request that they contact
physicians who have not paid their A. M. A.
dues and collect such dues for transmissal to
the Columbus office.
The Executive Secretary submitted a statisti-
cal report on the collection of the 1949 special
assessment of $25.00, showing that as of Decem-
ber 1, 4,886 members of the Ohio State Medical
Association had paid the assessment, represent-
ing approximately 65 per cent of the total
membership of the Association as of that date.
50-YEAR AWARDS
Members of The Council reported on the
awarding of the 50-year emblems and certificates,
most of them indicating that the awards had
been made in a majority of the county medical
societies in their districts. All members of The
Council stated that in their opinion this had
resulted in an excellent public relations program
and that the ceremonies in most counties had
received widespread favorable newspaper pub-
licity. On motion duly made, seconded, and
unanimously carried, The Council expressed itself
as believing that this project should be con-
tinued annually as one of the major Fall activities
of the Association.
AMENDMENTS APPROVED
The Council then considered actions taken by
several county medical societies in amending
their constitutions and by-laws.
An amendment adopted by the Darke County
Medical Society at a meeting on November 15,
1949, and a proposed amendment by that so-
ciety to increase local dues, were approved on
motion duly made, seconded, and unanimously
carried
A revised constitution and by-laws adopted
by the Richland County Medical Society on
November 17, 1949, was approved on motion
duly made, seconded, and unanimously carried.
for February, 1950
151
However, the wording of Section 6, Chapter 4 of
the by-laws, particularly the last sentence of
Section 6, was questioned by several members
of The Council as being an unworkable pro-
vision. The matter was referred to Dr. Hattery,
Councilor of the Eleventh District, with a sug-
gestion that he confer with the Richland County
Medical Society on the matter of re-wording
the section.
The Stark County Medical Society had asked
for advice regarding a proposed amendment
which would provide that associate membership
could be extended to physicians who are unable
to pay dues because of illness or misfortune.
The Council could take no official action on
this question as the question had not been sub-
mitted in regular form, but indicated that the
amendment would be approved when properly
submitted.
MISCELLANEOUS BUSINESS
A communication from the chairman of the
Goiter Study Committee of the American Pub-
lic Health Association, asking the Ohio State
Medical Association to endorse, sponsor and
cooperate in the enactment of a bill requiring
that all salt sold in the State of Ohio shall be
iodized, was read and discussed. On motion
duly made, seconded, and unanimously carried,
the matter was tabled pending further study.
On motion duly made, seconded, and unani-
mously carried, the payment of $50.00 in dues
for 1950 to the Conference of Presidents and
Other Officers of State Medical Associations,
was authorized.
A communication from Mr. A. R. Kaiser, Gen-
eral Manager of the Tax Department of Sears,
Roebuck and Company, Chicago, regarding the
activities of the Research Council for Economic
Security, was read and discussed. On motion
duly made, seconded, and unanimously carried,
a contribution of $100.00 to the organization was
authorized.
A communication from the National Tax
Equality Association dated October 27, 1949,
asking for the help of the Ohio State Medical
Association in contacting members of the Con-
gress, was read and discussed. On motion duly
made, seconded, and unanimously carried, The
Council decided that no action should be taken
on this request at this time.
A communication, suggesting that the Ohio
State Medical Association establish a Committee
on Chronic Illness, was read and discussed. On
motion duly made, seconded, and unanimously
carried, the President was authorized to appoint
such a committee.
A proposal from an organization, asking per-
mission to microfilm issues of The Ohio State
Medical Journal for sale to libraries, and propos-
ing a small commission to the Association for
extending such rights, as well as copies of all
microfilms produced, was discussed. On motion
duly made, seconded, and unanimously carried,
the proposition was referred to the Executive
Secretary for final decision after securing ad-
ditional information on the proposal.
There was a discussion of the plan of the
Ohio Commission on Children and Youth to
establish local units in each county. It was
pointed out that several officials of the Ohio
State Medical Association are serving on ad-
visory or executive committees of this com-
mission. The Council expressed itself as be-
lieving that the local units should not be spon-
sored by the county society, but that the county
medical society should have representation on
such local committees in order to properly ad-
vise and guide such local committees in their
activities.
A communication from a Dayton physician
raising a question about the method used by one
Dayton hospital in handling cases involving
recipients of aid for the aged was read and
discussed. On motion duly made, seconded, and
unanimously carried, the Montgomery County
Medical Society was requested to make a thor-
ough investigation of this question and sub-
mit a report to The Council at an early date.
There being no further business, The Council
adjourned to meet at the call of the President.
Attest: Charles S. Nelson,
Executive Secretary.
American College of Allergists
Several Ohio doctors took leading parts in the
Annual Meeting of the American College of Al-
lergists in St. Louis, January 16-18.
Dr. John H. Mitchell, Columbus, assumed of-
fice as president of the College for the coming
year. He also read a paper entitled, “Blood
Eosinophile Fluctuations During Constitutional
Reactions.” This was in cooperation with Dr.
Jesse Gamble of Houston, Tex.
Dr. Jonathan Forman, Columbus, Editor of
The Journal, delivered the presidential address
on January 17. At that time he had the honor
of presenting the Von Piquet medal to Dr. S. S.
Kallos of Sweden. After the presentation, he
relinquished the presidency to Dr. Mitchell.
Dr. Hermann Blatt, Cincinnati, read a paper
entitled, “The Role of Bacterial Allergy in the
Rheumatoid State.”
Dr. Frank A. Nantz, also of Cincinnati, read a
paper entitled, “Hypersensitivity Versus Im-
munity to Streptococci.”
Dr. George E. Rockwell, Milford Center, im-
mediate past-president of the College, took
part in a panel discussion.
Dr. S. William Simon, Dayton, read a paper,
“Hypo-Allergic Penicillin.” Dr. L. E. Seyler, also
of Dayton, opened discussion on Dr. Simon’s
paper.
152
The Ohio State Medical Journal
EXPLANATION OF AMERICAN MEDICAL ASSOCIATION
MEMBERSHIP DUES AND HOW TO PAY THEM
FOLLOWING is the text of a letter over the signature of Dr. Carl A. Lincke,
President of the Ohio State Medical Association, which is being sent to each
member when his 1950 Ohio State Medical Association membership card is mailed
to him from the Columbus Office. State Association membership cards (and the
letter) are mailed after dues are received from the County Society secretary-
treasurer. Cards are mailed as promptly as the checks and lists from local secretaries
can be processed. Checks for A. M. A. membership dues are rolling into the Columbus
Office daily and the dues will be transmitted in lump sum periodically to the A. M. A.
in Chicago.
:jc
Dear Doctor:
Enclosed is your 1950 membership card in the Ohio State Medical Association. Preserve it
carefully, especially for use in registering at the 1950 Annual Meeting, next May 16-18, Cleveland, Ohio.
Also, enclosed is an envelope which you can use in transmitting your check for 1950 American
Medical Association membership dues of $25.00.
For the first time in its history, the American Medical Association will charge membership dues
in 1950. Action calling for the payment of membership dues was taken by the House of Delegates
meeting in Washington, D. C., on December 6, 1949. This was in compliance with a provision of the
Constitution and By-Laws of the A. M. A. but which had never been enforced. Reasons for this
action were enumerated in the following statement, submitted to and endorsed by the House of
Delegates:
“The responsibilities of the American Medical Association are increasing constantly and the
revenues of its publications can no longer meet the costs of its broadening program. The American
Medical Association recognizes the greatly augmented activities of the constituent associations and
of the component medical societies. However, it is aware of its own responsibility in providing aggres-
sive, effective leadership for the medical profession on a national level. This leadership includes con-
structive assistance in building and improving the many splendid voluntary health insurance systems,
so that all who desire or need prepaid medical care may be provided with it, without political
controls or compulsion.
“The American Medical Association, like other great national organizations, must depend on
dues from its membership to support its growing program of service, both to the profession and
to the public.”
A physician delinquent in the payment of A. M. A. membership dues will lose his membership
in the A. M. A. To secure reinstatement he will have to pay accrued indebtedness.
There is no change with respect to A. M. A. Fellowship. To be a Fellow, a physician must first
be a member in good standing. Fellowship dues remain at $12.00 per year. As a Fellow, a physician
receives The A. M. A. Journal ; can participate in the A. M. A. program; and is eligible to be a delegate,
officer or committeeman of the A. M. A. In the future, all members in good standing of the A. M. A.
will be privileged to attend all sessions of the A. M. A. In the past, only Fellows could attend.
Collection of the $25.00 A. M. A. membership dues was delegated to the state and local medical
societies. Our Columbus Office will transmit these dues on your behalf to the Chicago Office of
the A. M. A. You will receive a membership card and membership certificate direct from the
A. M. A. office.
If you will pay your A. M. A. membership dues of $25.00 direct to our Columbus Office, you will
greatly assist and expedite the collection in Ohio. Local Secretary-Treasurers will not be burdened
in the first instance with this job. However, later they will be requested to contact those who may
be delinquent in payment of dues.
The Council of the Ohio State Medical Association, meeting on December 18, endorsed the action
of the A. M. A. House of Delegates and established this procedure for the collection of the A. M. A.
dues. The Council earnestly solicits your prompt cooperation.
Sincerely yours,
S$. £/ync/e, -y///. Q.
President.
jor February , 1950
153
Scene of the 1950 Annual Meeting . . .
The Spacious Cleveland Public Auditorium Will Be the Center of
Activities For Ohio’s Number One Meeting of the Year, May 16-18
cientific Assemblies
Instructional Courses
Medical Topics of the Day
National Affairs
Scientific Exhibits
Technical Exhibits
Auxiliary Annual Meeting
Annual Banquet
DETAILS
SEE FACING PAGE FOR
154
The Ohio State Aiedlcal ]onrnal
• • •
Features of the 1950 Annual Meeting
The Most Comprehensive Scientific Program of the Year Is Planned To
Furnish Postgraduate Work for Doctors in All Branches of Medicine
THREE Red Letter days are on the doctors’ calendar — Tuesday, Wednesday and Thursday, May
16, 17 and 18 — dates of the 1950 Annual Meeting of the Ohio State Medical Association in
Cleveland.
General Sessions — Scientific programs are being sponsored by each of the Specialty Sections
and will be presented before General Sessions to the interest of physicians in all branches of medicine.
This procedure is a change from the previous practice of having Specialty Sections present their
programs before their respective specialty members only. The new procedure is designed to give
all doctors an opportunity to benefit from the experiences of the specialists in their respective fields.
Out-of-state guest speakers as well as Ohio physicians will participate.
Instructional Courses will be conducted in the manner found so effective in the last several
meetings. Eighteen courses will be conducted. They will be scheduled so that each physician can
choose at least three courses in which he is most interested. These courses, conducted on a
question-and-discussion basis, have drawn a great deal of interest in previous meetings. A full list
of subjects to be discussed will be announced in a subsequent issue of The Journal and in a program
resume which will be mailed to all members. Instructional Courses are limited to comparatively
small groups which lend themselves to informality, and admission will be by ticket only. Members
will be advised later on how to obtain tickets.
Medical Topics of the Day — Here again doctors will have a choice of several discussions going on
at the same time. This type of information program was instituted at last year’s meeting where
it proved very effective. These programs are conducted on a slightly more formal basis than the
Instructional Courses, but get away from the scientific paper presentation procedure. Picked au-
thorities carry on an unrehearsed panel discussion for the benefit of attending doctors. Clinical pro-
cedures will be emphasized.
National Affairs — Two out-standing guest speakers will appear on the program for the purpose
of discussing national affairs. One will be United States Senator Robert A. Taft of Ohio who will
talk on pending legislative proposals and vital national problems. The other will be Dr. George
F. Lull, secretary and general manager of the American Medical Association, who will talk about
the National Education Program of the A. M. A. and other activities of the national medical associa-
tion. They will speak at a General Session on Wednesday morning, May 17.
Scientific Exhibits — These exhibits which feature latest developments in medical research and
investigation have become a major feature of the Annual Meetings. This year all exhibits will
be in the spacious Public Auditorium where visitors may take advantage of almost unlimited space
to study exhibits and discuss them with the sponsors.
Technical Exhibits — As usual an interesting feature of the meeting will be the commercial
exhibits of pharmaceutical and other supply houses which have always proved a main educational
feature. These exhibits give doctors an opportunity to observe the latest drugs, surgical instru-
ments, etc., on the market and to discuss their merits with firm representatives.
House of Delegates — The legislative body of the Association will meet twice during the Annual
Meeting to formulate policies and transact other business. These meetings will be held at the Hotel
Cleveland.
Auxiliary The Woman’s Auxiliary of the Ohio State Medical Association will hold its annual
meeting concurrently with the Annual Meeting of the Association. More details will be given as
arrangements are completed.
Annual Banquet — Wednesday evening, May 17, again has been reserved for the main social func-
tion of the Annual Meeting. The banquet will be followed by an evening of entertainment and
dancing. No speeches.
Registration There is no registration fee for any of the scientific programs. Information will
be sent out to members on how to make reservations for Instructional Courses. Since the Banquet
is essentially a social function, a nominal amount will be charged for dinner and entertainment.
for February, 1950
155
/4%e 'tyau /4&ecut?
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for the
1950 Annual Meeting
Ohio State Medical Association
Cleveland, Ohio .
. . May 16,
17, 18
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156
The Ohio State Medical Journal
• • •
On the Congressional Front
Messages of President Indicate He Is Still Pressing for Compulsory
Health Plan; Huge Expenditures for 44 Welfare State” Asked in Budget
IN his recent State-of-the-Union message to
the Congress and in the message which ac-
companied his proposed Federal Budget for
the next fiscal year, President Truman made
it clear that he is not retreating from his stand
in favor of compulsory health insurance and an
inflated “welfare state” program.
Using soft words, but words carrying far-
reaching implications, the President made these
comments regarding social security and health
in his State-of-the-Union message:
“Our social security system should be de-
veloped into the main reliance of our people
for basic protection against the economic
hazards of old-age, unemployment, and ill-
ness. I earnestly hope that the Congress
will complete action at this session on leg-
islation to increase the benefits and extend
the coverage of old-age and survivors in-
surance. The widespread movement to pro-
vide pensions in private industry dramatizes
the need for improvements in the public in-
surance system.
“I also urge that the Congress strengthen
our unemployment compensation law to meet
present-day needs more adequately. The
economic downturn of the past year was the
first real test that our system of unemploy-
ment insurance has had to meet. That test
has proved the wisdom of the system, but
it has also made strikingly apparent the
need for improving its operation and increas-
ing its coverage and its benefits.
“In the field of health, there are immense
opportunities to extend to more of our people
the benefits of the amazing advances in
medical science. We have made a good be-
ginning in expanding our hospitals, but we
must go on to remedy the shortages of doc-
tors, nurses, and public health services, and
to establish a system of medical insurance
which will enable all Americans to afford
good medical care.”
“SKY’S THE LIMIT”
In his Budget Message, Mr. Truman was more
specific, even recommending a definite payroll tax
“to defray initial expenses” of a national health
insurance scheme. Following are certain signi-
ficant passages from the message:
NATIONAL COMPULSORY HEALTH INSURANCE
“I again strongly urge the adoption of legis-
lation providing for a comprehensive system of
prepaid medical care insurance. This should be
geared in with our other social insurance pro-
grams and financed predominantly by employer
and employee contributions.”
OLD-AGE AND SURVIVORS INSURANCE
“I urge that the Congress enact legislation
to expand and improve the old-age and survivors
insurance system . . . Specifically, nearly all
gainfully employed people, including farmers and
the self-employed, should be covered; bene-
fits should be increased sharply; and disability
should be added to the risks covered. It is also
important that the tax base be raised to the
first 4,800 dollars of earned income . . . Only
1,900,000 aged persons received insurance benefits
and 800,000 children and their mothers receive
survivors benefits under the old-age and survivors
insurance system.”
DISABILITY INSURANCE
“Public demand for some form of basic finan-
cial protection against loss of earning power is
evident in the keen interest of wage earners in
industrial pension and insurance plans. What
I wish to emphasize is that the basic approach
should be through a comprehensive public pro-
gram . . . rather than through a multiplicity of
unrelated private plans, which would inevitably
omit large numbers of the working population
and treat others unequally.”
PUBLIC ASSISTANCE
“I therefore renew my recommendation of
last year that the program of Federal grants to
States for public assistance be extended and im-
proved. Approximately 2,700,000 aged people
and 1,500,000 dependent children now receive
public assistance.”
PUBLIC HEALTH AND HOSPITALS
“Federal expenditures for public health are
mainly for grants-in-aid to states and for re-
search. Of the 334 million dollars estimated
for existing programs in the fiscal year 1951,
213 million dollars is for financial assistance to
the states for general public health services
and for a wide variety of special state and local
programs, including hospital construction, mater-
nal and child health, tuberculosis control, and
mental health. The increase of 75 million dol-
lars in expenditures over 1950 for existing pro-
grams is caused largely by a rise in grants to
liquidate prior years’ hospital construction au-
thorizations. This program is helping communi-
ties throughout the Nation to reduce the hospital
shortage.”
LOCAL PUBLIC HEALTH UNITS
“I hope that Congress will soon complete ac-
tion on legislation to increase Federal assistance
to local health services.”
FEDERAL ASSISTANCE TO MEDICAL EDUCATION
“Legislation should be enacted to provide fi-
nancial aid to medical and related schools to
for February, 1950
157
encourage the training of additional medical
personnel. In the case of nurses, tuition scholar-
ships and subsistence aids should be made avail-
able for training graduate nurses, and grants
should be made to States for vocational education
for practical nurses, to encourage more young
women to enter the profession.”
WELFARE DEPARTMENT
“I recommend again that the Federal Security
Agency be given departmental status; its func-
tions are so important to the domestic policies
of the Government that the head of this Agency
should be a member of the President’s Cabinet.”
VOCATIONAL REHABILITATION
“I am also proposing legislation to strengthen
the Federal-State program of vocational rehabil-
itation and to provide additional opportunities
for rehabilitation of the more severely handi-
capped. The Budget includes 4 million dollars
for the first year under the proposed legislation.”
COST OF SOCIAL WELFARE, HEALTH AND
SECURITY PROGRAM
“These items plus increases under existing leg-
islation in these two fields, are expected to cause
Budget expenditures for social welfare, health,
and security to rise in the fiscal year 1951 to
a level of 2.7 billion dollars, an increase of 417
million dollars over the current year.”
NOTE: The figure 2.7 billion dollars is
shown as $2,790,216,652. The inclusion of costs
of security in the above grouping represents only
0
administrative costs — payroll deduction figures
are nowhere represented in this Budget.
VETERANS HOSPITALS
“Construction of hospitals to provide 37,000
new beds and additional domiciliary facilities,
costing 872 million dollars, is now about one-
third completed. When this program is finished,
there will be sufficient beds to provide adequately
for foreseeable needs for all service-connected
cases and a more liberal allowance of beds than
at present for non-service-connected cases.
Obligational authority already available is more
than adequate to meet the needs of the program
now under way. Current expenses for hospital
and medical care are estimated at 590 million
dollars in the fiscal year 1951. About four-fifths
of these expenditures are for the in-patient care
program, and in this program two-thirds of the
cases currently are non-service-connected. A
daily average of 138,000 patients in hospitals
and homes is estimated for 1951, about 9,000 more
than were cared for in 1949 and 4,000 more than
in the current year. The other one-fifth of the
expenditures is largely for the out-patient medi-
cal and dental care programs.”
ALL COSTS NOT INCLUDED
Those who have analyzed the Truman budget
point out that the entire cost of proposed legis-
158
lation to expand the Social Security Program
is not included in the budget. On this point the
budget message comments as follows:
“Under the old-age and survivors insur-
ance, railroad retirement, and Federal em-
ployee retirement programs, benefit dis-
bursements are made from the trust funds
and are not included in Budget expenditures.
On the receipts side, the payroll contribu-
tions for old-age and survivors insurance
are transferred directly to the trust fund
and not included in total Budget receipts.
Receipts and payments under the proposed
health insurance program would also be
handled in this manner.”
In other words the trust funds provided
through payroll taxes for Social Security benefits
are not included in the budget. However, a
trust fund of $250 million through an employer-
employee payroll tax to finance the preliminary
administrative costs of a compulsory insurance
plan is included. The health insurance payroll tax
is one-quarter of one per cent on each employer
and each employee. The budget does include
$30 million to initiate the proposed Federal Aid
to Medical Education plan and $25 million to
initiate the proposed School Health Services
plan.
The President estimated expenditures for the
fiscal year 1951 (July 1, 1950, through June 30,
1951) at $42,438,756,406. During 1951 he esti-
mated that the national debt would rise to
$263,800,000,000. Last year he estimated ex-
penditures for the fiscal year 1951 at $41,857,-
777,869. However, the Treasury statement of
January 5th estimated that expenditures will
run to $43,500,000,000. It is possible that if all
contract and other authorizations are exercised
that expenditures could run as high as 50.9 billion,
dollars according to a study reported by Congres-
sional Quarterly in their publication of the week,
ending December 2, 1949.
Activities of the Editor
Recent speaking engagements of Dr. Jonathan
Forman, Editor of The Journal include the fol-
lowing : Annual Meeting Friends of the Land
in Pittsburgh; Flint (Ohio) P. T. A.; Licking
County Medical Society; Exchange Club of Lan-
caster, and Lancaster Friends of the Land;
Zanesville Rotary and Kiwanis Clubs, and Zanes-
ville School Leaders; Miami County Medical So-
ciety; Oldsters Club of Bexley; Ohio Physical
Educators; Ohio Valley Society of Allergists at
Lexington, Ky. ; Bexley Woman’s Club; Mt. Ster-
ling Rotary Club; Central Ohio Teacher’s Asso-
ciation; National Catholic Rural Life Confer-
ence; Galion Child Conservation League; Shelby
Mother’s Clubs; Adena and Mt. Pleasant Garden
Clubs; Central Ohio Academy of Pharmacy; Co-
lumbus Bar Association; and staff Benjamin
Franklin Hospital.
The Ohio State Medical fourtiaJ
Peril of Welfare State . . .
Noted Publisher Takes Issue With Statement of Historical Writer
That Present ‘Santa Claus’ Theory of Government Is Here to Stay
NOT long1 ago Mr. John S. Knight, owner
and editor of the Chicago Daily News and
the Akron Beacon Journal, who is anything
but a moss-backed reactionary, took his pen in
hand and wrote a little piece in “The Editor’s
Notebook” which appears from time to time in
his Chicago newspaper.
Inasmuch as Mr. Knight’s comments are
especially timely right now, with the Congress
having under consideration a proposal, H. R. 6000,
which would skyrocket the Social Security pro-
gram, The Journal has taken the liberty of re-
printing them, as reproduced by Insurance Eco-
nomics Surveys which we assume presented an
accurate copy of the original. Read what Mr.
Knight has to say and then make up your mind
as to what you had better do about making
known your own views to your own Congressman :
^ ^ ^
The “welfare state,” says historian Arthur
Schlesinger, Jr., “is with us, for better or for
worse.” In fact, Mr. Schlesinger believes it
started when Alexander Hamilton argued that the
nation could not survive and prosper unless
special government favors gave the business com-
munity a large stake in that survival and pros-
perity. According to Mr. Schlesinger, “the
Hamiltonian handout theory remained substan-
tially dominant in Washington” until a veto by
Andrew Jackson forbade the use of national funds
for a Kentucky highway.
Ironically, this is the same Andrew Jackson
whose memory is honored throughout the nation
every year by deserving Democrats who kick
in $100 a plate to further the election of candi-
dates who think President Jackson was the
New Dealer of his day.
UNDERWRITING VS. HANDOUTS
Mr. Schlesinger takes a dim view of men like
Herbert Hoover, who pronounced in his birth-
day address that “the welfare state . . . has
emerged as a disguise for the totalitarian state
by the . . . route of spending” . . . and that
“our pursuit of the welfare state has already
put us on the last mile to collectivism.” He
reminds the Hoovers and other critics of the
welfare state that Alexander Hamilton’s “hand-
out theory” was developed and enlarged by the
Republican party after the Civil War in the form
of protective tariffs and land grants to private
railroad companies.
“Why,” says Mr. Schlesinger; “should Mr.
Hoover and the other enemies of the welfare
state find favors so reprehensible when bestowed
by government upon farmers and workers, and
so beneficial when bestowed upon business?”
The historian then proceeds to answer his own
question by the conclusion that the Hoover case
against the dangers of the welfare state is
based “on the most abominable hyprocrisy.”
Protective tariff differs from handout: It
seems to me that Mr. Schlesinger falls into
loose reasoning when he attempts to make the
protective tariff and government handouts ap-
pear as like peas in the same pod. Nor is there
a true historical resemblance between land
grants to railroads and a public dole. The early
tariff laws were passed when infant American
industries needed protection against foreign com-
petition in order to survive.
In no sense did they constitute a government
“handout” as we think of it today. Industrial
development was essential to America’s progress.
It meant increased employment and the worker
had just as great a stake in protection against
“cheap foreign labor” as did the owners of the
factory.
PROTECTION SERVED ITS PURPOSE
Our thinking is changed today because Ameri-
can industry has achieved a world dominance
which the gradual breaking down of tariff walls
cannot seriously threaten. The protection given
from the post-Civil War era to the Smoot-
Hawley tariff bill in 1930 is no longer needed.
Most people now concede that the free flow of
goods and services from one nation to another
is essential to world economic stability. It was
not so in the days to which Mr. Schlesinger
refers.
Mr. Schlesinger falls into a similar error
when he justifies welfare for all because at one
stage in our history the government gave grants
of land to private railroad companies.
Here again, America was in the early stages
of her development and transcontinental trans-
portation was vital to that development. While
there was no dearth of risk capital for railroad
expansion, no individual or corporate entity
possessed the tremendous financial resources
needed to acquire rights of way from one coast
to another.
INVESTMENT IN TRANSPORTATION
The government wisely shared in this cost be-
cause of the sound belief that America would
prosper in direct proportion to its spreading of
jor February , 1950
159
transportation facilities. Some backward nations,
notably Russia, have never made this discovery.
It is ridiculous to argue that because the
government gave a one-time subsidy to the rail-
roads in their pioneering days, every group
and class is now entitled to special benefits
from Washington. One might as well contend
that since the airlines do not construct and pay
for every airport in the United States, their
passengers should receive free flight insurance
from the government.
^ ^
Historian Schlesinger defines the welfare state
as “a system wherein government agrees to
underwrite certain levels of employment, income,
education, medical aid, social security and hous-
ing for all its citizens.” However, in another
section of his recent article, he says: “Certainly,
if, as the conservatives say, the welfare state
is just a system of government handouts to any
groups politically powerful enough to insist upon
them, then even the most extreme liberal would
be foolish to deny that such a system could harm.
SYSTEM RUNS AMUCK
“Handouts,” he continues, “could easily
create a dependence on the state that might sap
the individual initiatives upon which free society
depends, and, if the handouts were calculated,
not according to economic plan, but according to
political blackmail, they might well result in
a grave weakening of the financial structure.
The old-age pension schemes in California, Ore-
gon, and Washington, for example, seem to be
an example of a handout system running amuck.”
Here, I submit, Mr. Schlesinger’s definition of
the welfare state and the possible abuse of a
handout system reveals a distinction without a
difference.
The extremes to which social welfare has
progressed in the states of California, Oregon
and Washington and the expense it entails
appear mild by comparison with much of the
legislation that has been introduced in the 81st
Congress.
COMMITTEE CHECK VALVES
Fortunately, for the survival of a going eco-
nomy and the ultimate welfare of the country
as a whole, Congress has seen fit to dam up
most of this political swill in committee.
One senator alone, the loquacious Hubert
Humphrey of Minnesota, has introduced enough
appropriation bills in this session of Congress
to bankrupt the country within a few years.
Truman concepts rejected by Taft: Mr. Schles-
inger, like most cultured liberals, evidently be-
lieves in the welfare state if it is not carried
“too far.” “The great issue,” he declares, is
whether the welfare state will become “a matter
of bread and circuses.” He even brings Senator
Taft into his fold by concluding that while Presi-
dent Truman and the senator have bitter dif-
ferences of opinion, “they are not over the wel-
fare state.”
He cites as evidence of Taft’s conversion the
senator’s acceptance of government support for
medical care, provided the care is dispensed as
much as possible through the states and to be
confined to the needy rather than to be avail-
able to all.
TENACIOUS LOCAL AUTONOMY
Here, Mr. Schlesinger does Senator Taft the
same disservice as the hardshells who call Taft
a Socialist because he favors public housing.
Taft is no more committed to Mr. Truman’s
concept of the welfare state than is U. S. Steel
to the philosophies of Phil Murray. Moreover,
it is Taft — not the liberals — who is striving to
prevent the decay of individual initiative, which
is the end result of guaranteed “security” for
all.
The senator correctly recognizes there are
certain areas in which the government has a
continuing obligation to meet proper standards
of education, medical care, and housing. This is
quite different from the “bread and circuses”
concept of social responsibility which Mr. Schles-
inger fears and which Mr. Truman seemingly
approves.
Groups will always compete for benefits: The
trend toward socialism, either of the soft or the
British variety, is a marked departure from tra-
ditional American philosophies. Socialism is a
doctrine of futility; an acceptance of mediocrity;
a shibboleth without substance.
Mr. Schlesinger believes that welfarism can
succeed whenever the politicians of both the
right and the left cease their demands for more
pensions, more tariffs and more handouts . . .
when each of the important special groups,
meaning the business community, the farm bloc
and the trade unions, recognizes that “it cannot
blindly pursue its own narrow interest without
threatening irreparable harm to society as a
whole.”
I am afraid that last statement strains my
credulity too far, Mr. Schlesinger.
CONFLICT OF INTERESTS ALWAYS
You see, in individualistic America, there will
always be a Senator Humphrey matching a
Senator Bricker, an N. A. M. opposing a Walter
Reuther, coal barons tangling with John L.
Lewis, special interests for this and special
interests for that.
The names may change but never will they
lie down in the same pastures.
If, as you say, welfarism is here to stay,
perhaps the Republicans and the Schlesinger
liberals should adopt the slogan suggested by
A. T. Burch, Associate Editor of the Chicago
Daily News.
“You can’t shoot Santa Claus but it’s time to
sober him up.”
160
The Ohio State Medical Journal
MR. TUCKER EXPOSES THE
SUBTLE STRATEGY OF
MEDICAL SOCIALIZERS
Washington Whirligig
Will the Medical Profes-
sion—and the People —
Be Lulled to Sleep and
Outwitted?
READ the accompanying article from
the January 7 issue of The Ohio
State Journal , Columbus morning
newspaper; then draw your own con-
clusions. If you think these measures
add up to "the camel's nose under the
tent,” you should do something about
it, namely: Let your Congressman
know how you feel. The measures
referred to are:
H. R. 5940 (also S. 1453) the
so-called Aid to Medical Schools bill
which has already been passed by the
Senate, approved by the House Com-
mittee on Interstate and Foreign Com-
merce (Congressman Crosser, Cleveland,
chairman), and in the hands of the
House Rules Committee. The latter
committee is being high-pressured to
place the proposal on the calendar for
a vote. Mr. Tucker refers to subsidies
for nurse training schools. The bill,
also would provide U. S. grants to
medical schools.
S. 1411, the so-called National
School Health Services bill, which has
passed the Senate and is now await-
ing hearings by the House Committee
on Interstate and Foreign Commerce.
The Board of Trustees of the Ameri-
can Medical Association and The Coun-
cil of the Ohio State Medical Associa-
tion have adopted resolutions in op-
position to both bills in their present
form. The reasons for such action
are substantially the same as the ob-
jections enumerated in Mr. Tucker's
article.
Specific amendments to both
of these bills have been offered to
Congress by the Board of Trustees
of the A.M.A. to correct undesir-
able features that the measures
contain in their present form. Un-
til proper corrective amendments
are inserted in the bills, they will
be opposed. If you write your
Congressman, call his attention to
the revisions suggested by the
A.M.A.
Seemly Innocuous
Bills May Put Over
Truman Health Plan
By RAY TUCKER
WASHINGTON.— Although White House legislative strategists seem
to have abandoned hope of enacting a compulsory national health
insurance measure during the current session, they aim to achieve a
large part of their federalized medical program through passage of
several seemingly innocuous but
groundwork bills. Thereby they
expect to lull and outwit the op-
position.
In fact, a bill giving the gov-
ernment almost complete finan-
cial control of all schools for edu-
cating and training nurses, fore-
runner of schemes for federal
domination of medical education,
passed the Senate at the last ses-
sion under peculiar circumstances,
and was reported favorably by
the House Interstate and Foreign
Commerce Committee.
It would have been rushed
through the lower chamber and
become law save for a last-min-
ute protest by Miss Dana Hudson
of Atlanta, president of the Geor-
gia Nurses’ Association and super-
intendent of the Georgia' Bap-
tists’ Hospital there.
When she accidentally discov-
ered the far-reaching effect of the
bill, known as the Emergency Pro-
fessional Health Training Act, she
mojsilized a group of resentful
nurses. They persuaded the House
Rules Committee, which was about
‘to place the measure on the legis-
lative calendar, to set it aside for
w‘further study.”
The disputed bill provides for
federal grants of money to nurses’
training schools. Other measures
in the same category propose
Similar governmental advances to
Institutions for education of phy-
sicians through establishment of
federal scholarships. The- under-
ying purpose is to relieve the re-
ported shortage of doctors and
lurses throughout the land.
THE NURSES’ EDUCATION-
AL measure is opposed by Miss
Hudson’s group on the • ground
that it gives politico-economic
power over training schools to the
government.
The Senate-passed bill provides
that, for the purpose of qualify-
ing for federal funds, nurses’
training institutions shall be clas-
sified “in the order of their im-
portance.” They will get large
or small sums, or none at all, on
the basis of their “importance” in
the general medical setup.
But all decisions as to each
school’s status will be made by a
committee named by the Presi-
dent. And the group shall make its
selections on the basis of advice
from the Surgeon General, usually
a personal or political appointee
of the chief executive.
Another measure, which has
also passed the Senate, stands in
the same category, in the opinion
of opponents of compulsory health
insurance. They regard it as part
of the plan to achieve the basis
objective by the “bits and pieces”
tactics — that is, passing meas-
ures quietly and separately.
The second proposal is known
as the National School Services
Act of 1949. It provides for pre-
vention and treatment of “physi-
cal and mental defects and condi-
tions of all children betweeb the
ages of 5 and 17, inclusive, at-
tending school.” That covers pu-
pils from first grade through high
school.
Distribution of the funds for
administering this act would be
in the hands of the Federal Se-
curity Administrator, not the
states or local communities.
At the moment he happens to
be Oscar R. Ewing, President
Truman’s efficient advance man
in the 1948 campaign, ardent ad-
vocate of compulsory national
health insurance and a lively can-
didate* for the Democratic nom-
ination for governor of New York
next year.
* * *
THE LEGISLATIVE HISTORY
of both bills is peculiarly interest-
ing as revealing Administration
strategy in the field of federalized
medicine.
Both measures were called up in
the Senate when only a few mem-
bers were in their seats, and they
were whooped through without a
roll call. Their titles, which ring
with idealistic promises, were read
in a mumble-jumble monotone by
the reading clerk, but their pur-
pose was not explained in detail.
When they reached the House
Interstate and Foreign Commerce
Committee, Chairman Robert
Crosser of Ohio was in Europe.
Again with only h few members
on hand, Acting Chairman J. Percy
Priest of Tennessee rushed them
out with a favorable report. Mr.
Priest is top political aide to Dem-
ocratic Majority Leader John W.
McCormack of Boston.
In view of this background, it
is doubtful if more than a hand-
ful of senators realize that they
passed two of the medical meas-
ures most dear to Administration
advocates of the so-called welfare
state. Ironically, only a few mem-
bers of the American Medical As-
sociation understood the signifi-
cance of these bills
(Ohio State Journal, Columbus, Ohio,
Jan. 7, 1950.)
Licenses Granted . . .
State Medical Board Grants 26 Graduates of Medical Colleges Right
To Practice in Ohio; List of Written Examination Questions Given
WENTY-SIX graduates of Schools of Medi-
cine were granted certificates to practice
medicine and surgery in Ohio by the State
Medical Board which met in Columbus Janu-
ary 16 and 17. The licenses were issued on the
basis of examinations conducted by the Board
December 12-14.
Highest grade in the examinations was made
by Dr. William T. Breesman, Youngstown,
Georgetown University School of Medicine, with
an average of 88.7. Second highest grade was
made by Dr. Enhew Sycz, Cincinnati, University
of Cincinnati College of Medicine, with an aver-
age of 87.8.
In addition, 11 graduates of osteopathic schools
were given certificates to practice osteopathic
medicine and surgery and three applicants who
appeared for additional examinations received
certificates to practice osteopathic medicine and
surgery.
In the limited branches, certificates were
awarded to eight mechanotherapists; nine chiro-
practors; three chiropodists; eight cosmetic ther-
apists, and 30 masseurs.
UNIVERSITY OF CINCINNATI COLLEGE
OF MEDICINE: — Enhew Sycz, Cincinnati.
OHIO STATE UNIVERSITY COLLEGE OF
MEDICINE: — James F. Alexander, Versailles.
GRADUATES OF OTHER SCHOOLS:— Chi-
cago Medical School: — Elliot Migdal, Columbus.
Georgetown University School of Medicine: —
William T. Breesman, Youngstown.
Hahnemann Medical College: — Glenn R. Black,
Akron.
Marquette University School of Medicine: —
Ben Storer, Holyrood, Kansas.
Northwestern University Medical School: —
LeRoy K. Mills, Lyndhurst.
Syracuse University College of Medicine: —
Eaton E. Freeman, Rochester, New York.
University of Illinois College of Medicine: —
Richard W. Deatrick, Cleveland Heights; Mary
M. Johnson, Benton, Illinois.
University of Pennsylvania School of Medicine:
— Louis J. Jindra, Cleveland.
University of Pittsburgh School of Medicine: —
Edward A. Carlin, Jr., William R. Cather, Harry
R. Claypool, William H. Holloway, all of Toledo.
University of Rochester School of Medicine and
Dentistry: — David L. Rodgers, Rochester, New
York.
University of Utah School of Medicine: —
Claude W. Dailey, Ypsilanti, Michigan.
Queens University Faculty of Medicine: —
Murton R. Shaver, Cincinnati.
University of Manitoba Faculty of Medicine: —
Norman C. Chi vers, Cincinnati.
University of Toronto Faculty of Medicine: —
Donald C. Wilson, Toledo.
Pazmany Peter University, Budapest: — Paul
E. Foldes, Cincinnati.
Slovak University, Czechoslovakia: — Gustav
Samak, Forest Hills, L. I., New York.
University of Dublin (Ireland) School of Phy-
sic:— Robert F. Holmes, Youngstown.
University of Kaunes, Lithuania: — Kasimeras
Pautienis, Chicago, Illinois.
University of Prague Faculty of Medicine: —
Valentine Mersol, Cleveland.
University of Iceland: — Frederic V. Kristoff,
Cincinnati.
EXAMINATION QUESTIONS
Following are the written questions asked
those who were examined to practice medicine
and surgery:
ANATOMY
1. Describe the diaphragm in detail.
2. Describe the course and relations of the duodenum.
Give its nerve and blood supply.
3. Give the origin, course and distribution of the left
recurrent laryngeal nerve. What is the result of sever-
ing this nerve ?
4. Name and locate the various cavities draining into the
nasal canal.
5. Explain the anatomy of referred pain from the gall
bladder, the diaphragm and the ureter.
PHYSIOLOGY
1. What is the estimated normal quantity of blood in the
human body ? How is the quantity kept constant ?
What is meant by the term “effective circulating
volume” ?
2. What are the hematopoietic functions of the spleen ?
3. What is the function of the thymus gland ?
4. What are the physiological effects of acromegaly ?
5. Give the physiological properties of cardiac muscle that
peculiarly fits it for the function it performs.
6. What is the function of the synapse?
7. What factors determine the composition of lymph ?
What factors govern the magnitude of pressures built
up within the lymphatic system ?
8. What is the emergency light reflex?
9. What are the physiologic mechanisms that govern the
amount of water a human being ingests ?
10. Discuss the part played by the skin in regulation of
the body temperature during active muscular exercise.
BACTERIOLOGY
1. In order of relative frequency in which they are en-
countered, list four organisms that may be responsible
for bacterial meningitis. Upon what characteristics
would you rely for the identification of each of the
four ?
2. With what disease is trypanosoma gambiense associ-
ated ? How is the disease transmitted ?
3. Cite an instance in which two infective agents act in
conjunction to produce disease, and another in which
one interferes with the action of the other. How are
these results brought about?
4. For each of the following tests, name a disease in
which the test is of outstanding value in the diagnosis ;
(a) non-specific agglutination ; (b) specific agglutina-
tion ; (c) non-specific complement fixation ; (d) spe-
cific complement fixation ; (e) precipitation test.
5. Name two important members of the hemophilus group
of micro-organisms and state the diseases caused by
them.
CHEMISTRY
1. Define: (a) hemolysis, (b) defibrination, (c) plasma,
(d) serum albumin.
2. What are the chief compounds included in the group
162
The Ohio State Medical Journal
of steroids ? What chemical structure is common to
the group ?
3. List the chemical factors that affect the secretion of
gastric juice.
4. Discuss the nature of histamine ; its occurrence and
significance in normal metabolism and disease.
5. Give the norml range of CO2 combining power of blood
plasma.
DIAGNOSIS
1. Give signs and symptoms of hypothyroidism in a young
lady eighteen years of age.
2. Name five anatomical defects of the human heart.
3. Are there any differential findings in nephrosclerosis
and chronic glomerular nephritis.
4. Name five conditions that may produce blood in stools.
5. Give blood and physical findings in infectious mon-
onucleosis.
6. Name some different conditions in which you find club
fingers, spoon fingers and Heberden’s nodes.
7. Give time, after first manifestation of acute rheu-
matic fever that you may expect heart change.
8. Give physical characteristics in anterior pituitary over-
activity ; also in posterior pituitary over-activity.
9. Give two symptoms found in tri-geminal neuralgia, mi-
graine and histaminic cephalalgia that are peculiar to
each condition.
10. Name four conditions that could cause chronic diarrhea.
MATERIA MEDICA AND THERAPEUTICS
1. Define and give example of : (a) acute poisoning ;
(b) cumulative poisoning.
2. In a patient with parathyroid deficiency, give the sig-
nificant changes in the plasma level and urinary ex-
cretion of calcium and phosphate when parathyroid
hormone is administered.
3. Give signs and symptoms of digitalis intoxication.
4. Give five (5) important conditions which modify drug
action.
5. In carbon monoxide poisoning: (a) give manner of
action of the carbon' monoxide ; (b) give treatment of
poisoning from carbon monoxide.
6. By means of a tracing, show the effect of pitoein and
pitressin upon blood pressure and uterine tonus.
7. (a) By what mechanisms may cardiac arrest take place
during anesthesia? (b) Give treatment.
8. Is the RH factor important in choosing a donor
whose blood will be used for a recipient who is RH
negative and who has developed immune bodies to RH
factor ? Why ?
9. Neostigmine (Prostigmine) : (a) Therapeutic uses;
(b) Dosage.
10. Outline the treatment of primary syphilis.
PATHOLOGY
1. In outline form, discuss the etiology and pathological
anatomy of typhus fever.
2. Describe grossly the mitral valve in a case of chronic
rheumatic cardiac disease in a patient about 40 years
of age. Indicate the condition that is likely to be found
in the lungs of the same patient.
3. In outline form, contrast the anatomical changes that
may be found in the following diseases : (a) Malignant
nephrosclerosis ; (b) Chronic diffuse glomerulonephritis.
4. Write a concise definition of each of the following:
(a) teratoma, (b) nasal polyp, (c) rhabdomyoma,
(d) multiple myeloma, (e) hemangioma.
5. List the possible causes of hydrocephalus.
6. Name the three most common sites of formation of
solitary abscesses of the brain and state the usual
mechanism of infection involved in each.
7. Outline the pathogenesis of abscess of the lung. What
are the more common complications ?
8. In outline form, describe the microscopical appearance
of a nodule in multiple myeloma. Name in the order
of frequency the sites of occurrence of this tumor.
9. List the characteristics of the Pasteurella group of
bacteria. Name two members of the group responsible
for disease in man or animals.
10. How may the organism responsible for Asiatic cholera
be identified. Outline the steps that should be taken to
prevent the occurrence of an epidemic of this disease.
PRACTICE
1. Give the etiology and symptoms of small pox.
2. Give signs and symptoms of gout.
3. Give signs and symptoms of infestation with ascarides
(round worms).
4. Give etiology and symptoms of tetanus.
5. Give the signs and symptoms of pulmonary tubercu-
losis.
SURGERY
1. Give the differential diagnosis between the following:
(a) chronic cholecystitis ; (b) recurrent appendicitis ;
(c) duodenal ulcer; (d) renal calculus.
2. Outline the treatment of a compressed fracture of the
twelfth thoracic vertebra with partial paralysis of both
lower extremities.
3. Describe an intertrochanteric fracture of the femur.
Outline the management of this condition.
BETTER HURRY, IF INTERESTED
IN SPECIAL TRAIN TRIP
aS indicated in the OSMAgram,
dated January 13, plans are
^"shaping up well for the Ohio
State Medical Association Special
Train to San Francisco in June when
the American Medical Association
will meet in that city. A three weeks’
tour of the West, including five days
in San Francisco during the conven-
tion, has been planned.
Reservations for the train are now
being accepted at the Columbus Of-
fice. Many members who saw notices
of this project in issues of the
OSMAgram have written in for in-
formation on the itinerary, costs, etc.
Those who are interested in re-
ceiving this information should write
the Columbus Office. It will be sent
to them promptly. This should be
done at once. Accommodations will
be limited to approximately 150 per-
sons. Part of this space already has
been reserved by those who wrote
in for information a month or so ago.
4. Give causes, symptoms, and physical signs of an ab-
scess in the right temporal lobe of the brain.
5. Discuss briefly the etiology of gas gangrene. Describe
the lesion and outline method of prevention and treat-
ment.
OBSTETRICS AND GYNECOLOGY
1. What are the SIGNS which differentiate Abruptio Pla-
centa from Placenta Praevia?
2. What are the conditions to be met for forceps delivery?
3. Outline proper pre-natal care.
4. Give symptoms, causes and treatment of tubal preg-
nancy.
5. Outline diagnosis and treatment of acute salpingitis.
SPECIALTIES
1. Name the three most common causes for a vesiculo,
papular dermatitis associated with pruritus.
2. Name some conditions present in the body which will
give a false positive complement fixation test. (Was-
sermann) .
3. Draw a diagram labeling the important parts of the
right ear drum.
4. True or false: (a) The pupil dilates on distant vision
(true or false?); (b) The opening of the Antrum of
Highmore is underneath the middle turbinate (true or
false?); (c) Frequent colds means that the tonsils
should be removed (true or false?) (d) An oily nose
drop containing a weak ephedrine solution (% per cent)
is the ideal nose drop for babies (true or false?)
5. Outline and give treatment for a stone in the ureter.
PREVENTIVE MEDICINE AND HYGIENE
1. What procedures should be instituted relative to per-
sons who have just been exposed to small-pox ? Under
what circumstances following the application of the
necessary procedures can you declare such persons in-
capable of communicating small-pox to other persons ?
2. Having established the diagnosis of diphtheria in a
child what are your responsibilities as the physician to
(a) the patient; (b) the family; and (c) the com-
munity ?
3. Outline briefly the role of dusts in the production of
diseases of the lungs. What general measures should
be maintained for the prevention of these diseases ?
4. Define: (a) potable water, (b) pasteurization, (c) epi-
demiology, (d) morbidity, (e) carrier-borne epidemic.
5. What are the essential points in public health inspec-
tion of places where food is prepared and served for
public consumption ?
for February, 1950
163
• • •
‘Doctors’ Plan’ Is Expanding
Year’s End Report Shows That Ohio Medical Indemnity Has 650,000
Persons Covered; Plans To Cover Non-Surgical Hospitalized Cases
DURING 1949, nearly 200,000 additional
Ohioans secured Blue Shield protection
through Ohio Medical Indemnity, Inc., the
prepaid medical expense plan sponsored by the
Ohio State Medical Association, bringing to
650,000 the number of persons covered.
At the end of the year, according to Mr. Charles
H. Coghlan, Executive Vice-President of the
company, more than 7,000 Ohio firms and busi-
nesses were cooperating on the payroll deduc-
tion plan. The company has 270,000 contracts
in force, covering, as stated above, 650,000 per-
sons.
The coverage of Ohio Medical Indemnity is now
available in 82 of Ohio’s 88 counties. Enrollment
of subscribers and other administrative details are
carried on by seven Blue Cross Plans in Ohio.
SMALL GROUPS COVERED
Mr. Coghlan pointed out that enrollment in
1949 was most encouraging throughout the
state. He stated that while 3,000 additional
groups were added, the company did not confine
its activities to the enrollment of large industrial
groups. Of the 7,000 groups now covered, over
80 per cent have less than 25 employees. The
minimum number required for group enrollment
in Ohio Medical is five. The “Doctors’ Plan” is
making it possible for the small business firms,
merchants, gas stations and offices to secure ade-
quate protection.
The Ohio Medical enrollment in the Blue Cross
areas as of November 30, 1949, was as follows:
Akron, six counties, 51,136; Canton, five counties,
61,487; Cincinnati, 14 counties, 255,598; Colum-
bus, 29 counties, 133,547; Lima, eight counties,
13,800; Toledo, 12 counties, 86,973; and Youngs-
town, eight counties, 38,411.
Negotiations are now underway with Ports-
mouth Blue Cross for expansion to Scioto
County in early 1950.
During 1949, $2,812,400 was paid in bene-
fits to subscribers. This amount brings the total
benefit payments, since the company started in
January of 1946, to $5,405,500, representing
94,124 claims. Currently, over a quarter million
dollars is paid monthly to subscribers.
During the year over-all administrative ex-
pense was reduced. Now less than 14 cents of
every premium dollar is spent for operating the
company, the balance of 86 cents being spent in
benefits to subscribers and additions to reserves.
An important development during 1949 was
the experiments conducted by Ohio Medical to
make the plan available to non-group individuals.
In conjunction with the Blue Cross plans, “com-
munity enrollments” were conducted in a number
of areas in the state. In these campaigns, the
individuals who were not eligible under the group
plan were offered Blue Cross — Blue Shield for a
limited time.
“We learned a great deal from these cam-
paigns,” Mr. Coghlan stated. “The interested
county medical societies gave us whole hearted
support and the doctors’ recommendation was of
great help in the enrollment,” he said.
Experience figures on this type of enrollment
are now being accumulated and studied and the
company plans an extension of “commtmity en-
rollments” in 1950.
Another step in providing Blue Shield cover-
age to more people occurred in the last quarter
of 1949 when Blue Shield was offered to the
non-group “billed-at-home” Blue Cross subscri-
bers. This program was first offered through
Blue Cross in the Cincinnati area and resulted
in 38,000 members being enrolled. The program
is now to be extended to other Blue Cross plans.
A special committee on medical care has nearly
completed its work and in the next few months
a “rider” contract will be offered by Ohio Medi-
cal. This contract will provide indemnities for
medical illnesses (non-surgical) requiring hospi-
talization.
NATIONAL GROWTH
At a recent meeting of the Board of Directors,
Dr. L. Howard Schriver, President of Ohio Medi-
cal Indemnity and President of the National Bkie
Shield Association, reported on the national
growth of Blue Shield and Blue Cross plans. He
pointed out that during 1949 the Blue Shield
plans, nation-wide, had SV2 million members,
bringing total enrollment in Blue Shield plans to
approximately 14 million. Blue Cross plans,
nation-wide, now cover in excess of 35 million
Americans, three million of whom are enrolled
through the Ohio Blue Cross plans. He further
pointed out that the national association of
Blue Shield plans was now in the process of
organizing a national enrollment agency in order
that firms with employees in two or more areas
would be able to offer these employees uniform
benefits. At the same time, the national enroll-
ment agency will be beneficial to the national
employer as it enables him to deal with one
administrative Blue Shield office for all of his
employees.
164
The Ohio State Medical Journal
CONFERENCE FOR COUNTY OFFICERS AND COMMITTEEMEN
AND MEETING FOR COUNTY AUXILIARY OFFICIALS
TWO important invitational working conferences in Columbus during March
have been set up by The Council, namely :
Sunday, March 5, Annual Conference of County Society Presidents, Secre-
taries, Presidents-Elect, Chairmen of Legislative Committees and Chairmen of
Public Relations Committees and Officers and Committeemen of the Ohio State
Medical Association.
Tuesday, March 14, Conference of Presidents, Secretaries, Legislative
Chairmen and Public Relations Chairmen of the County Woman’s Auxiliaries
under the sponsorship of the Ohio Medical Association.
Both Conferences will be held at the Fort Hayes Hotel, 31 West Spring
Street, Columbus, Ohio.
Attendance will be by invitation. Invitations will be mailed four or five w'eeks
in advance of the conferences. Those invited and planning to attend will be
requested to sign a card so indicating, in order that luncheon reservations can be
made. The luncheons will be complimentary.
The program for each conference will be built around reports on current leg-
islative problems and public relations activities. A number of top-flight guest
speakers have been invited. Programs will be mailed with the invitations.
It is hoped that those receiving .invitations will make a special effort to at-
tend— to find out what’s going on and to discuss plans of action for 1950.
Causes of Accidental Death on
Ohio Farms Analyzed
Nine farm people met with fatal accidents
each week, on an average, for the past three
years in Ohio. This is an annual accidental
death rate of one person per 1,800 farm people.
At this rate, in a lifetime of 60 years there is
a chance of one in 30 that a farm person may
die because of an accident.
The analysis of causes and frequency of deaths
was made by R. B. Schwart and R. H. Baker
and appeared in a bulletin of the O. S. U. De-
partment of Rural Economics & Rural Sociology.
The 1,401 fatal accidents fall into three main
types. The first group — about one-fourth of the
total — occurred on the farm but outside of the
home. More than one-half of these occurred during
the four-month period from June to September.
About 25 to 30 per cent involved farm machinery.
The second group — about 40 per cent of the
total — occurred in the home. About two-thirds
of the victims were over 65 years of age. Most
of the deaths were caused by falls and fires.
The third group occurred off the farm. About
80 per cent were traffic accidents.
Dr. Robert M. Hall is the new secretary of the
Council on National Emergency Medical Service
of the A. M. A.
Name of “Hygeia” Changed To
“Today’s Health”
A change in name to Today's Health, effective
with the March 1950 issue, was announced in
the January Hygeia, health magazine of the
American Medical Association.
The masthead of the January number also
carried for the first time the name of Dr.
W. W. Bauer, Chicago, as editor, succeeding
Dr. Morris Fishbein. Dr. William Bolton, Chi-
cago, is the new associate editor, succeeding Dr.
Bauer. Ellwood Douglass will continue as man-
aging editor.
Hygeia was established by the American Medi-
cal Association in 1923. Written for the layman,
it has come to be one of the most widely quoted
health education periodicals in the United States.
There will be no change in fundamental policy
under the new editorship or new name.
Alpha Chi Omega, national women’s fraternity,
has voted an additional grant of $10,000 to the
National Society for Crippled Children and
Adults, the Easter Seal agency, to continue a
jointly sponsored scholarship program for train-
ing much-needed professional personnel to work
with the cerebral palsied. This is in addition to
a $15,000 previous grant.
for February, 1950
165
T -n i • Comments on Current Economic and Social
IH v^Flll/ "piniOIl • Questions and Professional Problems;
Suggestions Regarding Organized Activities
THINK OVER THIS
ONE, DOCTOR
At a recent Ohio Conference on Citizenship
in Columbus, Prof. Earl L. Shoup of Western
Reserve University “rapped medical colleges for
neglecting political science courses” and blamed
the American Medical Association for failure “to
urge its members to become conscious of civic
and governmental affairs,” according to a re-
port on the meeting published in The Columbus
Citizen.
If the reporter accurately reported the pro-
fessor, Prof. Shoup is fifty per cent correct.
Most medical colleges have neglected to pro-
vide opportunities for their students to become
exposed to civic, community and governmental
affairs. Steps to correct that situation are
being taken but there’s plenty of room for more
speed and improvement.
To blame the A. M. A. (or the Ohio State
Medical Association) for failure on the part of
doctors to take a more active interest in civic
and governmental affairs is silly. Both of these
organizations have been preaching this for years,
as the records will show. Getting physicians
to do something about it is a horse of another
color.
It’s high time for the individual physician to
do something about it. The job can’t be done
out of Chicago or Columbus — or even out of
the county seat. It’s a job which has to be
done by each individual physician out of his
own office, in his own town, in his own neighbor-
hood.
FUZZY THINKING ON
PROBLEM IN ECONOMICS
Speaking at the National Social Welfare As-
sembly recently, Eveline Burns, member of the
faculty of the New York School of Social Work,
is reported to have said that “the question is
not so much what America can afford, but how
much social welfare does America want.”
Sounds like a very simple answer to the
question, doesn’t it? In our opinion, the sen-
tence should be stated in reverse. The question
of what America — the taxpayers — can afford
should come first. In making a budget, income
has to be figured first. Whether or not a busi-
ness or a governmental structure can afford
what the budget calls for certainly has to be
given equal standing with so-called “wants.”
It’s going to be difficult to get our economy on
a sound basis and keep it there as long as this
kind of fuzzy thinking goes on.
LET’S HAVE A REAL
EPIDEMIC OF THIS
We like immensely the following paragraph,
lifted from a recent News Letter of the Okla-
homa State Medical Association:
“Physicians in Shelby County, Indiana, know
actions speak much louder than words in develop-
ing good public relations. When a bad auto-
mobile accident there brought a night emergency
call for doctors, seven rushed to the scene. The
local newspaper commented: ‘Shelby County doc-
tors are providing their own best answer to the
proponents of “free” medicine by providing the
community with honest and skillful service —
without a written order from the government.’ ”
Here’s hoping the “actions speak louder than
words” epidemic spreads and that Ohio gets a
good big dose of it.
QUESTIONS FOR MEDICAL SCHOOL
SURVEY COMMITTEE
The two-year survey of medical education
which is being made by the A. M. A. and the
Association of American Medical Colleges will
certainly be something more than just a routine
inspection if a thorough forward-looking job is
done.
Some of the questions which have to be studied
— and answered — by the joint committee are
pointed up in a recent editorial published by
The Modem Hospital.
Some may not agree with all of the senti-
ments expressed in the editorial, but here it is,
with no punches pulled:
“What is an intern? To the hospital patient,
he is a young man who wears white pants and
asks a lot of questions. To the practicing phy-
sician he is a useful assistant who makes ex-
aminations and takes histories in exchange for
a few critical comments about diagnosis and
other educational courtesies. To the hospital
administrator he is a valuable commodity in short
supply and getting shorter — probably because
of a dark plot hatched by the medical schools
and big teaching hospitals. To the intern him-
self he is something north of a clerkship and
south of a residency, worried and hopeful by
turns.
“Does the internship need redesigning in this
day of residencies rampant, when most medical
graduates are aiming at specialty practices that
only a few will achieve? Is it sensible to con-
tinue approval of nearly 11,000 internships when
there are only half that many interns? If that
isn’t sensible, what is? Should there be stricter
limits on the number of internships approved
for the big teaching centers, so that smaller
hospitals can get a larger share of the avail-
able supply? Would that be fair to the interns?
166
The Ohio State Medical Journal
To hospitals in both groups? To patients in
both kinds of hospitals?
“These are just a few of the many questions
about internships that the joint committee of the
American Medical Association and the Associa-
tion of American Medical Colleges must try to
answer in the medical education survey which is
now under way.
“Related to all these questions are the fund-
amental ones of how much medical service the
nation needs and can pay for and how many facts
can be stuffed into a student in a given period.
According to Dean Hugh Long of Yale Univer-
sity, medical schools must now give thought to
the situation in which ‘nearly half the life of a
man is passed before he can begin to be self-
supporting in his profession.’ Dr. Long proposes
entrance to medical school at an earlier age and
a combination of general education and preclinical
training, a suggestion that will be viewed with
dismay by other observers who see professional
education already so lacking in general cultural
content as to make doctors practically incom-
municado with the rest of the world.
“With so many difficult problems to study, the
medical education committee has a huge task on
its hands. Nevertheless, the answers to two
other questions that aren’t often asked around
medical schools or hospitals might be illuminat-
ing. These are: How many of the nation’s
physicians are discharging their sworn duty to
‘impart a knowledge of the Art to . . . disciples’?
How can those who aren’t be given the oppor-
tunity and the inspiration to do so?”
SHADES OF HOUDINI —
OR IS IT PONZI?
President Truman’s new “prosperity timetable”
for the next half century plunged amateur pencil
experts into some bewildering statistics, the
Washington Bureau of the Cleveland Plain
Dealer reports to its home office. Read what
the P. D. bureau has to say on some of the
hocus-pokus emphasized in Mr. Truman’s vision-
ary message to the Congress in which he sets
up a formula for about everything but how to
wipe out a national deficit which is the greatest
peace-time deficit in the history of the U. S. A.:
“The president told Congress that ‘if our pro-
ductive power continues to increase at the same
rate as it has increased for the past 50 years,’
production in the year 2000 would be nearly four
times today’s rate.
“That would be $1,000,000,000,000 (a trillion)
annual national income as against today’s $255,-
000,000,000 (255 billion).
“He predicted real income of the average
family would increase almost three times — or
$12,000 a year as against today’s $4,200.
“Carrying the president’s formula further:
“If Federal employees show a similar increase
— today’s 2,000,000 civilian employees represent
an eight-fold expansion over the 250,000 civil
servants of 1900 — there will be 16,000,000 Federal
employees by 2000.
“If taxes increase similarly — those of 1950 are
72 times as large as the Federal taxes of 1900 —
the nation’s Federal tax load in 2000 A. D. will be
$2,736,000,000,000.
“That’s almost three times the annual income
foreseen by President Truman for 2000.
“Assuming a population of 200,000,000 by the
year 2000, that would mean a per capital
Federal tax burden of $13,680.
“The average family of three persons would
thus be paying Uncle Sam $41,040 annually in
taxes while earning but $12,000 a year.
“How’s that again, Mr. President?”
BIG DEVILS AND
LITTLE DEVILS
Comments the Saturday Evening Post :
“In announcing himself as a candidate for
governor of California, Jimmy Roosevelt ex-
plained that, while he was against ‘socialized
medicine, with regimentation of doctors and pa-
tients,’ he was in favor of compulsory public-
health insurance based on payroll deductions.
“In other words, Jimmy favors green apples,
but is against bellyache.”
To which we would like to add: Jimmy can
stick his tongue in his cheek when he talks
like others before him. He knows what socialized
medicine is and isn’t. Unfortunately, however,
there are too many folks who don’t. Too many
think socialized medicine is some big he-devil
waiting to pounce on an unsuspecting public.
Could be; but how about the dozens of little
he-devils in the form of seemingly harmless
legislative proposals hiding around the corner
ready to gang up for the kill? Those are the
fellows who need watching.
MERCY SLAYING AND
THE WELFARE STATE
John O’Donnell, Washington columnist for the
Ohio State Journal, Columbus, offers a new slant
to the so-called New Hampshire mercy-slaying
involving Dr. Hermann Sander, which has re-
ceived a big play in the press. O’Donnell con-
tends that the case shall figure in the welfare
state debate now raging in Washington. Read
what he has to say, in part:
“* * * Dr. Sander, so far as he himself is
concerned, rejected the principle by which doc-
tors, ministers of the church and lawyers have
been set aside from the general populace for
centuries and by law and tradition are given
special privileges denied to the average citizen.
The physician gets his privileges by his faith-
ful observance of the Oath of Hippocrates, that
inspiring pledge and declaration of ethics and
duty which has come down through the cen-
turies.
“ ‘The regimen I adopt,’ reads the historic
oath, ‘shall be for the benefit of my patients ac-
cording to my ability and judgment and not
for their hurt or for any wrong. I will give
no deadly drug to any, though it be asked of
me, nor will I counsel such and especially I
will not aid a woman to procure abortion . . .
for February , 1950
167
Whatsoever things I see or hear concerning
the life of men in my attendance on the sick
or even apart therefrom, which ought not to
be noised abroad, I will keep silence thereon,
counting such things to be as sacred secrets.’
“Now this oath of the old Greek naturally is
ignored by the all-powerful state when it takes
over the life and health of its citizens and
makes doctors its civil servants, medical schools
its tax-kept hand-maidens, faculties the stooges
of bureaucrats and hospitals the private domain
of government bureau chiefs.
“Dr. Sander seems to have done it on his
own — and perhaps pointed to the road ahead
for the welfare state.
“This has happened in Russia and Hitler got
pretty far down the road of socialized medicine;
mercy killings were legalized, the euthanasia
(happy death) of the hopelessly insane became
standard procedure except in communities where
the Catholic Church was strong enough to block
the decrees. This line of thought led naturally
enough in the final years of the war to the scien-
tific and thoroughly aseptic mass murder of mil-
lions of Jews. That, of course, was inevitable;
once the individual human being sets up shop
and declares his right to determine the life
and death of one human being, the logical con-
clusion is inevitable: mass murder.”
O’Donnell has a point. Some may think his
reasoning far-fetched. Yet, the dictators abroad
weren’t such bad chaps when they started out,
were they ?
LONG JAUNT BUT
WORTH IT
Probably one of the shortest editorials on rec-
ord against socialized medicine is the following,
published in the January 8, 1950, issue of the
Cleveland Plain Dealer :
“Count Christian Lerchenborg of Copenhagen,
Denmark, came to Johnstown, Pa., when he
wanted to undergo a sinus operation.
“ ‘Medicine,’ said the count at the end of his
3,000-mile trip, ‘is socialized in Denmark.’
“Hmmmmmmmm ! ”
AID OF HEALTH DEPARTMENT
OFFERED DOCTORS
Dr. John D. Porterfield, director of the Ohio
Department of Health, has offered the services of
that Department to physicians of the State in an
effort to trace down the probable cause of “blue
baby” illness. In an article in the December
issue of The Journal, Dr. Porterfield stated that
the personnel of the Department would analyze
the local water supply of any family in which
a physician reported a case of infant “blue baby”
illness.
This is another excellent example of how the
State Department and physicians can cooperate
for the advancement of medicine. Here the work
of the health agency in preventive medicine and
the work in curative medicine of the private
practitioner meet on common ground.
RED CROSS TO STAGE
ANNUAL CAMPAIGN
Every March the American Red Cross goes to
the people for support of its program. This pro-
gram entails responsibilities of national and in-
ternational scope that continue both in war and
in peace.
The Red Cross puts the campaign on a volun-
tary basis — both as to those who take part in the
canvass and those who contribute. However,
balanced against this “voluntary” provision is a
responsibility which removes the opportunity
far from the take-it-or-leave-it class.
The term “Red Cross” has become synonymous
with emergency relief. It is the agency the aver-
age citizen looks to in case of disaster to a family
or to a state.
The American Red Cross has 38,000,000 mem-
bers in 3,746 chapters. It reports that there is a
Red Cross organization in every county in the
United States.
Here is another opportunity about which doc-
tors should deliberate carefully before they pass
it up. The Red Cross is closely associated with
community health and welfare. When the help-
ing hand of the Red Cross is extended, contri-
butors of time or money can take a great deal of
pride in knowing that they contributed toward
extending that hand.
PAMPHLET STRESSES CARE
OF DOGS IN RESEARCH
The Surgery Study Section of the National
Institutes of Health has published a pamphlet,
“Care of the Dog Used in Medical Research.”
Undoubtedly this pamphlet will add materially
to the scientific information of those who are en-
gaged in research involving animals, but perhaps
an even more important point is that it will help
fill a need in an annoying public relations
problem.
The whole field of research involving the use
of animals is under unwarranted and fanatical
attack. Unfortunately many research scientists
have been called upon to defend themselves
against unwarranted charges of abuse of animals.
Scientific care of animals before and during
research will do much to make a favorable im-
pression on legislators and others who are genu-
inely interested in the matter from a humane as
well as from a research point of view.
HALF-HEARD— OR PERHAPS
VERY POORLY TOLD
A favorite pastime of many is that of taking
digs at the newspapers for allegedly getting the
facts mixed in reporting a speech or incident.
Did you ever stop to think — if trained reporters
get the facts confused, how much more con-
fused must the casual observer or listener get
them? A good precept to follow is — Thoughts
for men in terms that children can understand.
168
The Ohio State Medical Journal
The Bettman Archive
The nausea, vomiting and dizziness of motion sickness may
be prevented or relieved, in a high percentage of cases,
with Dramamine* (brand of dimenhydrinate).
DRAMAMINE
for the Prevention and
Treatment of Motion Sickness.
trademark of G. D. Searle & Co., Chicago 80, Illinois
RESEARCH
IN THE SERVICE
OF MEDICINE
SEARLE
for February, 1950
169
Do You Know? . . .
According to the New York Times, one out of
every four persons, aged 65 or over, in the
United States is on public assistance rolls.
* * *
The articles by Hon. Harold E. Stassen on the
British health program, which appeared in the
January and February issues of The Reader's
Digest, are being reprinted for national distri-
bution. Whitaker & Baxter, directors of the
National Education Campaign, American Medical
Association, will mail 15 copies of each article
to every physician in the United States for use
in his reception room.
❖ ❖ ❖
Dr. Jonathan Forman, Columbus, has been
selected to serve his fourth term on the Board
of Directors of the Ohio Chamber of Commerce
and his second term as Chairman of the Board
of Trustees of the Franklin County Historical
Society.
:|c ^ >.
Twenty health and hygiene officials from Co-
lumbus and Dayton have organized the Ohio
Family Foundation as a state-wide group to
fight venereal disease. Officers are: Dr. H. H.
Williams, Dayton, city health commissioner, presi-
dent; Dr. Charles Freebie, Columbus, chief of
the communicable disease division, Ohio Depart-
ment of Health, vice-president; Earl Wright, Co-
lumbus, secretary; Miss Florence Fogle, Colum-
bus, treasurer.
% JjC 5*C
“Keep Your Health,” the health education
radio program sponsored by the Ohio State
University College of Medicine under the direc-
tion of Dr. Jonathan Forman, was resumed over
WOSU, Tuesday evening, January 17, at 6:30
p. m. It will continue for 42 weeks.
^
The National Blood Program of the American
Red Cross is now supplying blood to 1,550 hos-
pitals in 35 states. More than 500,000 pints of
blood were provided last year through 30 regional
blood centers.
❖ ❖ ❖
The National Foundation for Infantile Paralysis
has granted $25,480 to Western Reserve Univer-
sity School of Medicine for the continuation of a
research project begun in 1947 to find some
chemical means to protect nerve cells from polio
virus.
❖ ❖ ❖
Dr. Paul R. Hawley resigned as chief, execu-
tive officer of the Blue Cross and Blue Shield
Commissions to become director of the American
College of Surgeons, effective March 1. He
succeeds Dr. Malcolm T. Mac Eachern.
“They Also Serve,” a 16 mm black and white
sound motion picture depicting the physician’s
role in disasters is now available for presenta-
tion at medical society or hospital staff meetings.
It was prepared by the American Medical Asso-
ciation in collaboration with technical advisors
representing the United States Army, American
Red Cross and the U. S. Public Health Service.
The showing time is 17 minutes. The film is pro-
curable on loan (service charge $2) or purchase
from the Committee on Medical Motion Pictures,
A. M. A., 535 N. Dearborn St., Chicago 10.
^ ^ ^
The American Association of Blood Banks
has named Dr. Paul I. Hoxworth, Cincinnati,
president-elect.
^ ^ ^
General Motors Corporation has appropriated
$1,215,000 for contributions to the building cam-
paigns of hospitals in Dayton.
^ ^ ^
Dr. William C. Woodward, first director of the
Bureau of Legal Medicine of the American Medi-
cal Association and Legislation, died at his
home in Washington, D. C., Dec. 22, aged 82.
He was director of the Bureau from 1922 until
his retirement on Jan. 1, 1940.
% % %
New officers of the Ohio State Veterinary Medi-
cal Association include: Dr. H. K. Bailey, Wil-
mington, president; Dr. S. W. Stout, Hamilton,
president-elect, and Dr. W. H. Pavey, Xenia,
member of the executive committee.
* * *
According to a recent press dispatch from
Washington, only one-third of the patients in
veterans’ hospitals are there for treatment of
illnesses which resulted from their military serv-
ice. The figures showed 36,432 beds occupied by
service-connected cases and 71,165 by non-service
connected cases. The report for the veterans’
hospitals in Ohio showed 1,450 service-connected
cases and 2,912 non-service connected cases.
* * *
One hundred and ninety senior medical stu-
dents have been appointed to Army internships
beginning next July 1, Major General R. W.
Bliss, the Army Surgeon General, has announced.
They represent the Army’s selections out of the
1014 candidates who applied for both Army and
Air Force internships.
* * *
The total number of American women who are
employed or seeking employment has fallen off
since the end of World War II but still ex-
ceeds the 1940 figure by some 4.8 millions. The
estimated total is 18.6 millions, or about 30 per
cent of the country’s entire labor force, according
to Metropolitan Life.
170
The Ohio State Medical Journal
I
It was spring in Marietta and the Ohio River
was on its seasonal rampage. In fact, its swollen
waters were even licking at doorsteps in the busy down-
town section — eagerly reaching higher and higher.
Is it any wonder, then, that one of the town’s leading
x-ray technicians should be alarmed for the safety of
her charge — vital, valuable x-ray equipment in the
flood-threatened office of her employer, a well-known
Marietta doctor. Quite naturally she telephoned
GE’s Columbus, Ohio office — told of her plight.
GE Service went into immediate aciton. Checked
State Highway Department — found roads to Marietta
water-blocked. Then, chartered a plane which landed
across the river from Marietta at Williamsburg,
W. Va., about an hour later. After reaching downtown
Marietta by flatboat and walking a few blocks, the GE
serviceman arrived across the street from the doctor's
office. However, flood waters blocked the way. This
problem was neatly solved when a stalwart dentist
friend happened along and volunteered to carry him
and his equipment across the street piggy back.
The x-ray equipment was speedily dismantled,
loaded on a high wheeled truck and taken to the
doctor’s home which was located on higher ground.
Even a flood ...
failed to stop GE Service!
Don’t wait for a flood to call for GE Service . . .
its available always at —
Cleveland - - 1783 East 11th Street
This story is typical of the hundreds of documented
GE Service reports in our files. A service which
proudly lends a new, broader conception to the
guarantee that stands back of every GE installation.
Cincinnati
Columbus
Toledo
215 West Third Street
40 South Third Street
1 South St. Clair Street
GENERAL^ ELECTRIC
X-RAY CORPORATION
for February, 1950
171
• • •
On the Firing Line
Shots at Truman-Ewing Compulsory Sickness Insurance Scheme;
Ammunition For Doctors in Speeches Against Federalized Medicine
“What thd American must understand, how-
ever, is that while each of these proposals —
Federal invasion of banking, Federal invasion
of power, and socialized medicine — is promoted
as if it were just a single reform unrelated to
all others, the simple fact is that each is intended
to liquidate some sector of the private enter-
prise system and expand the area of socialism.”
— John T. Flynn, The Road Ahead.
* * ❖
“The greatest fear in Britain today is not
the fear of war, nor of Russia’s Atomic
bombs. It is the fear hounding Britain’s
middle class — traditional backbone of the
nation — that it is being possessively wiped
out by skyrocketing living costs and taxes
under Britain’s Socialist regime.” — Seymour
Berkson, General Manager, International
News Service.
5*5 ❖ 5fc
“In the days ahead of us, there will be a
struggle between those who believe in individual
freedom and those who would subordinate the
individual to the dictates of the government.
There will be a struggle, too, between those who
would transfer even greater powers to the Fed-
eral government, and those who would stand by
the Constitution in its reservation of powers to
the States.” — James F. Byrnes, former Secretary
of State, in Readers Digest, September, 19 1+9.
5}: 5*5 5^
“The National Health Service is about 11 per
cent of the national budget, or approximately
£3,250,000,000.” — The National Health Service
of Great Britain, by Williard C. Rappleye, M.D.,
Dean and Professor of Medical Economics, Fac-
ulty of Medicine, and Vice-President in Charge
of Medical Affairs, Columbia University .
“Can it be that the country, that Ameri-
cans have come to accept the idea that a free
economy cannot walk without a perpetual
government crutch?” — Arthur Capper.
5*5 5fc 5*C
“For the- state to usurp the responsibility for
medical care of its citizens . . . constitutes
an infringement of human responsibility and
individual freedom which God has not given to
the state . . . The state has no right to require
by law, force or other method the submission
of the body to its paternal care . . . The battle
(against compulsory health insurance) is not
for the doctor alone but it belongs to all Chris-
tian people who cherish their own freedom . . .” —
American Council of Christian Churches.
5*5 5*C 5}5
“This is no time for us to throw out our
system of government and follow England.”
— Sen. Robert A. Taft.
:*5 5*: 5*:
“What has happened in England could happen
here. Secretary of Agriculture Brannan himself
told me he wasn’t interested in politics. He is
a sincere man. Yet I saw his plan introduced
at a Democratic National Committee session last
June in Des Moines. I then knew the proposal
would take its place with socialized medicine, a
vastly expanded social security program, and
other Fair Deal movements.” — Bill Zipf, Colum-
bus Dispatch farm columnist.
5*i 5*C 5^
“Not only the practice of medicine, but our
entire economy is being pushed into a Socialistic
state under the guise of ‘welfare.’ The welfare
state may well be the farewell to our American
way of life.” — Dr. Herman Kretschmer, Chicago,
former president of the A. M. A.
5*: 5 k sjc
“Beware of the Greeks bearing gifts. Be-
ware of those who promise you something
which does not belong to them and which
can be given to you only at your own ex-
pense.”— James F. Byrnes, former Secre-
tary of State, in the Readers Digest, Sep-
tember, 191+9.
* * *
“The Fair Deal must be judged by its deeds.
These deeds have been a persistent, enlarging
assaut on free-enterprise in the United States
aimed at the creation of a welfare-state social-
ism.”— The Columbus Disjjatch.
5j5 5}5 5j-
“ ‘The Welfare State’ is a government device
for the socialization of man. It is a movement
in the direction of Socialism, that is, government
ownership of the means of production, distribu-
tion and exchange, because if man is socialized,
whatever he possesses must, in due course, be
socialized.” — George E. Sokolskif, .
CLIP THIS MATERIAL FOR REFERENCE
172
The Ohio State Medical Journal
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for February, 1950
173
In Memoriam . . .
William Jamieson Abbott, M. D., Cleveland;
University of Toronto Faculty of Medicine, 1905;
aged 75; died Nov. 15; former member of the
Ohio State Medical Association and a Fellow
of the American Medical Association through
1947 ; diplomate of the American Board of
Otolaryngology; member of the American Laryn-
gological, Rhinological and Otolaryngological
Society; past-president of the Cleveland
Ophthalmology Society. Dr. Abbott began his
practice in Cleveland in 1905 and continued until
his retirement about two years ago. Surviving
are his widow, a daughter and two sons, one of
whom is Dr. William E. Abbott of Detroit.
Clinton John Altmaier, M. D., Marion; Ohio
Medical University, Columbus, 1905; aged 67;
died Jan. 10; member of the Ohio State Medi-
cal Association and a Fellow of the American
Medical Association. Dr. Altmaier began his
practice in Marion in 1915 when he went there
as surgeon for the Marion Steam Shovel Co.
In addition to his practice, he was active in
civic and political affairs. He was a member of
the Ohio State Democratic Committee and served
as central committeeman of the Eighth Con-
gressional District and as chairman of the Marion
County Democratic Committee. He served a
time as medical examiner for the Ohio State In-
dustrial Commission. He held memberships in
the American Legion, the Masonic Lodge, the
Elks, Odd Fellows, Knights of Pythias, Eagles
and Moose. Surviving are his widow, one son,
Dr. Clovis Altmaier, also of Marion, and a
brother.
Samuel Vincent Burley, M. D., Lorain; Medical
College of Ohio, Cincinnati, 1897; aged 74; died
Dec. 23; member of the Ohio State Medical
Association and a Fellow
of the American Medical
Association. Upon crea-
tion of the Eleventh Dis-
trict in 1939, Dr. Burley
was elected to represent
that district on the
Council of the Ohio
State Medical Associa-
tion and served as Coun-
cilor until 1942. He was
vice-president of the
Lorain County Medical
Society in 1919 and its
president in 1928; served
a s Legislative Com-
mittee chairman, 1922, 1931-36 and 1938; and
delegate to the 0. S. M. A., 1926-27, 1930-39
and 1946. Dr. Burley had practiced medicine
for more than 52 years, most of which time
was served in Lorain. Recently he was presented
the 50-Year Pin and Certificate of the State
Association. He served for 15 years on the
Lorain School Board, 13 years as its president.
He was a member of the Masonic Lodge. Sur-
viving are his widow, a son, a daughter and three
brothers.
Oscar S. Brown, M. D., Oceanside, Calif.; Star-
ling Medical College, Columbus, 1886; aged 91;
died Dec. 6. Dr. Brown practiced only for a
short time in Ohio before going to California.
Surviving are his widow, a daughter and two
sons.
James Jefferson Carter, M. D., Columbus;
Meharry Medical College, Nashville, Tenn., 1921;
aged 61; died Jan. 3 as the result of a traffic
accident; member of the Ohio State Medical
Association and the American Medical Associa-
tion. Dr. Carter moved his practice to Colum-
bus from Kansas City in 1935. Organizations
with which he was affiliated included the Elks
Lodge, Alpha Phi Alpha fraternity, Stewards’
Board No. 1 of the A. M. E. Church, O. B. G.
Men’s Charity Club, Masonic Lodge, American
Woodmen’s Lodge, and the Columbus Chamber of
Commerce. He was one of the founders of the
Frontiers Clubs of America, and was on the
board of directors of the Urban League of Co-
lumbus. He was past-president of the Buckeye
State Medical, Dental and Pharmaceutical Asso-
ciation and of the Franklin County Medical,
Dental and Pharmaceutical Association, and was
secretary of the National Medical Association.
Surviving are his widow, a daughter, his mother
and four brothers.
Robert Stanley Coppess, M. D., Springfield;
Ohio State University College of Homeopathic
Medicine, 1919; aged 59; died Jan. 6; former
member of the Ohio State Medical Association
and the American Medical Association through
1946.
Charles Larmon Dolle, M. D., Westerville; Co-
lumbus Medical College, 1892; aged 83; died
Jan. 8. Dr. Dolle had practiced in the vicinity
of Westerville most of his life. He was founder
and owner of the Westerville Sanitarium. Sur-
viving are his widow, four sons, a daughter, two
brothers and three sisters.
Edwin Fauver, M. D., formerly of Oberlin;
Columbia University College of Physicians and
Surgeons, 1909; aged 74; died Dec. 17 while in
Florida. Dr. Fauver for a number of years had
been director of the department of physical edu-
cation and health at the University of Rochester,
N. Y., and had been active in organized college
athletic activities in New York State. Surviving
are his widow, one son and a sister.
Bert Edward Goodman, M. D., Warren; Jef-
ferson Medical College of Philadelphia, 1903;
174
The Ohio State Medical Journal
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for February, 1950
175
aged 73; died Dec. 19; member of the Ohio
State Medical Association and the American
Medical Association through 1948; vice-president
of the Trumbull County Medical Society in 1922
and its president in 1923; delegate to the
0. S. M. A. in 1923. Dr. Goodman had practiced
in Warren and vicinity from 1914 until his re-
tirement about a year ago. He served as local
school physician for 12 years, was a charter
member of Alpha Omega Alpha fraternity; was
a member of the Methodist Church and several
Masonic orders. Surviving are his widow, three
sons, one of whom is Dr. William E. Goodman,
also of Warren, and two sisters.
Leslie Mac Lisle, Sr., M. D., Columbus; Starling
Medical College, Columbus, 1902; aged 72; died
Dec. 12; member of the Ohio State Medical
Association and a Fellow of the American
Medical Association. Dr. Lisle had practiced in
Columbus for approximately 45 years until his
retirement two years ago. Surviving are his
widow, a son, Dr. Leslie M. Lisle, Jr., also of
Columbus, a daughter and a sister.
William Hacker McKibben, M. D., Los Angeles,
Calif.; Medical College of Ohio, Cincinnati, 1891;
aged 80; died Jan. 4; former member of the
Ohio State Medical Association and the Ameri-
can Medical Association through 1933. Dr. Mc-
Kibben had practiced in Cincinnati and Moscow
before moving to Reynoldsburg where he prac-
ticed until his retirement a number of years ago.
Surviving are his widow and a brother, Dr.
James T. McKibben of Cincinnati.
John Orpheus Newton, M. D., Cleveland; Van-
derbilt University School of Medicine, Nashville,
1930; aged 44; died Dec. 16; member of the
Ohio State Medical Association and a Fellow
of the American Medical Association; diplomate
of the American Board of Radiology; member of
the Radiological Society of North America, Inc.,
and the American College of Radiology; past-
president of the Cleveland Radiological Society.
Dr. Newton had been chief of the Radiological
Department at Huron Road Hospital. He was a
member of the State Power Squadron since
before World War II, was a member of Alpha
Tau Omega and Alpha Kappa Kappa and the
Methodist Church. Surviving are his widow, two
sons and his mother.
Joseph Price, M. D., Columbus; Starling Medi-
cal College, Columbus, 1904; aged 73; died Jan. 8;
member of the Ohio State Medical Association
and a Fellow of the American Medical Associa-
tion; member- of the American College of Sur-
geons; president of the Columbus Academy of
Medicine in 1931. Dr. Price served his entire
medical career in Columbus where he founded
and headed the Mercy Hospital. During World
War I he served as a major in the Army
Medical Corps. He was affiliated with several
Masonic orders, the Kiwanis Club and the Colum-
bus Athletic Club. Surviving are his widow, and
two sisters.
James Corey Riffe, M. D., Covington, Ky.; Uni-
versity of Cincinnati College of Medicine, 1930;
aged 46; died Dec. 23; member of the Kentucky
State Medical Association and a Fellow of the
American Medical Association. His widow
survives.
Scott Clark Runnels, M. D., Claremont, Calif.;
Indiana Medical College, School of Medicine of
Purdue University, 1907, and University of
Michigan Homeopathic Medical School, 1908;
aged 67; died Jan. 2; former member of the
Ohio State Medical Association through 1946
and a Fellow of the American Medical Associa-
tion; diplomate of the American Board of Ob-
stetrics and Gynecology. For 17 years Dr.
Runnels had been head of the Department of
Pediatrics and Gynecology at Huron Road Hos-
pital. From 1941 until 1945 he had been with
the Army Medical Corps where he held the rank
of Colonel. Surviving are his widow and a
daughter.
John Augustus Toomey, M. D., Cleveland;
Western Reserve University School of Medicine,
1919; aged 60; died Jan. 1; member of the Ohio
State Medical Association and a Fellow of the
American Medical Association; diplomate of the
American Board of Pediatrics; member of the
American Pediatrics Society, the American Acad-
emy of Pediatrics, the American College of
Physicians and the Society of American Bacteri-
ologists. In charge of City Hospital’s Con-
tagious Diseases and Pediatrics Divisions
and professor of clinical pediatrics and con-
tagious diseases at Western Reserve Univer-
sity School of Medicine, Dr. Toomey’s death
brought to a close 37 years at City Hospital and
29 on the medical faculty. While a graduate
student he was in charge of the hospital store-
room and some time after his graduation from
medical school he returned to the hospital in a
professional capacity, becoming head of the
Contagious Diseases Division in 1922. Dr.
Toomey, recognized as an authority on the
treatment of poliomyelitis, pioneered in a method
said to be one of the most effective to aid in
the recovery of polio patients. His contributions
to medical literature give testimony of his great
interest in clinical investigation and laboratory
research. During his medical career more than
350 of his scientific papers were published. In
1948 he served as president of the American
Academy of Pediatrics. In 1949 he received the
honorary degree of Doctor of Laws from John
Carroll University. He was president of the
Western Reserve Medical Alumni Association for
the year 1947-48. Colleagues last September
presented Dr. Toomey with a portrait by Rolf
Stoll. He was a member of the Catholic Church.
176
The Ohio State Medical Journal
AUR EOMVC IN HYDROCHLORIDE LEDERLE
in resistant
staphylococcal infections
Aureomycin has been shown
to be highly useful in the con-
trol of staphylococcal infec-
tions, many of which exhibit
a high degree of resistance to
other antibiotics and chemo-
therapeutic agents. The prognosis in systemic
staphylococcal infections is sufficiently serious so
that the optimum treatment should be admin-
istered immediately, and continued for one or
several days after the temperature has subsided
to normal.
Aureomycin has been found effective for the
control of the following infections: bacteroides
septicemia, brucellosis,
Gram-negative infections —
including those caused by the
coli-aerogenes group, Gram-
positive infections — includ-
ing those caused by strepto-
cocci and pneumococci, granuloma inguinale,
lymphogranuloma venereum, Hemophilus influ-
enzae infections, primary atypical pneumonia,
psittacosis, Q fever, rickettsialpox, Rocky Moun-
tain spotted fever, penicillin-resistant subacute
bacterial endocarditis, sinusitis caused by suscep-
tible organisms, tularemia, typhus, bacterial and
viral-like infections of the eye.
Capsules: Bottles of 25, 50 mg. each capsule. Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper; solution prepared by adding 5 cc. of distilled water.
LEDERLE LABORATORIES DIVISION American Gyammid company 30 Rockefeller Plaza, New York 20, N. Y.
lor February, 1950
177
Dr. Toomey’s first wife, the former Miss Mary
L. Bagot, died in 1947. His second wife, the
former Miss Helen K. Toomey, survives. Also
surviving are four children, including Dr. Charles
H. Toomey of New York City and Miss Frances
Toomey, a student at Marquette University School
of Medicine; also three brothers and three sisters.
Raoul Lazaar Yioran, M. D., Akron; Jenner
Medical College, Chicago, 1910; aged 66; died
Dec. 7; member of the Ohio State Medical As-
sociation and the American Medical Association.
Dr. Vioran had practiced in Akron for approxi-
mately 32 years and since 1942 was surgeon
for the local police and fire departments.
Joseph Gilbert Whitacre, M. D., Lodi; Ohio State
University College of Homeopathic Medicine,
1917; aged 62; died Jan. 7; member of the Ohio
State Medical Association and a Fellow of the
American Medical Association. Dr. Whitacre
had practiced in Medina County and the sur-
rounding areas for approximately 33 years con-
tinuously except for the time he and his wife
spent studying abroad. He held memberships
in a number of professional organizations. Sur-
viving are his widow, Dr. Clarice E. Whitacre,
and two daughters.
Barnett Edgar Winters, M. D., Columbus;
Starling Medical College, Columbus, 1896; aged
82; died Jan. 6; member of the Ohio State Medi-
cal Association and the American Medical As-
sociation. Dr. Winters had been in practice for
approximately 53 years. He moved to Columbus
from New Straitsville, Perry County, about 31
years ago. He was a member of the Methodist
Church. Surviving are his widow, a daughter, a
brother and two sisters.
Workers’ Welfare To Be Subject Of
Industrial Health Congress
The health and welfare of workers in in-
dustry and business will be the subject of the
10th annual Congress on Industrial Health at
the Hotel Roosevelt, New York, February 20-21.
The meeting, sponsored jointly by the Council on
Industrial Health of the American Medical Asso-
ciation and the Medical Society of the State of
New York, will be participated in by the medical
profession, labor, management and others in-
terested in health care programs.
Most of the discussions during the congress
will be directed toward clarifying the objectives
of industrial health services and bringing these
benefits to more workers.
One phase of the congress will be a symposium
on voluntary health insurance plans. The dis-
cussion will cover union, management, private
insurance, medical society and Blue Cross plans
for industrial workers. This will be conducted
by the A. M. A. Council on Medical Service.
Low Level of Soviet Medicine Laid
To Shackling of Doctors
The low level of medical care in the Soviet
Union results from restraints on doctors, says
an editorial in the December 24 Journal of the
American Medical Association.
“Unfortunately for Soviet citizens, Soviet medi-
cine does not appear to be as good as Soviet
propaganda/’ the editorial points out.
“In fact, few factual data may be found pub-
blished concerning the quality of Soviet medi-
cine. Most evaluations outside the U. S. S. R. are
based on observations of foreigners who have
been in the country and on the reports of Soviet
refugees.
“However, on rare occasions frank articles
have appeared in Soviet periodicals. When the
boasting is discounted and the facts critically
examined these articles reveal a disturbing state
of affairs.
“Official statements said to be attributed to
a Minister of Public Health revealed shortages
of equipment in every medical field. Drugs were
claimed to be often of poor quality, and their
faulty distribution is said to have caused serious
shortages. Medical clinics and institutions have
increased in recent years, but rural areas, it is
said, still are lacking even minimum medical
care and large areas are practically without
facilities for surgery.
“Physicians and nurses are reported to be
poorly trained and to have few opportunities to
specialize. Even the former Minister of Health
admitted in some instances 50 to 75 per cent
error in diagnosis, which, if true, is a sad
reflection of the care available to the Soviet
citizen.
“Apparently opportunities for advanced train-
ing and for personal advancement are hampered
also by a shortage and the inadequate quality
of medical publications and a limited circulation
of those that are published. The ministry prob-
ably publishes fewer than thirty journals and
only one, Soviet Medicine, is suited to the
majority of practitioners. However, even the
Minister of Health once admitted that few ar-
ticles in Soviet Medicine were of interest to
doctors.”
The Clinical center being built for the National
Institutes of Health, chief research branch of the
Public Health Service, is at Bethesda, Md. A
combined hospital and research institution, it will
house one of the best-equipped medical and basic
science laboratories, together with hospital facil-
ities for 500 patients. The $40,000,000, 14-story,
air-conditioned building is scheduled to be com-
pleted by July, 1952.
178
The Ohio State Medical Journal
The sound and wholesome nutritious
diet is an integral part of modern day
preventive and definitive therapy. A
steady stream of adequate amounts of all
the essential nutritional elements is vital
for good growth, maintenance of tissue
structure and functioning, healing after
trauma, and resistance to infection. For
maintaining this daily, steady stream of
nutrients, however, conditions both in
health and illness often make imperative
the use of an efficient food supplement
along with the diet.
The multiple dietary food supplement
Ovaltine in milk has wide usefulness for
enhancing to full adequacy even nutri-
tionally poor diets. Its rich store of vita-
mins and minerals includes vitamins A
and D, ascorbic acid, thiamine, ribo-
flavin and niacin, and calcium, iron and
phosphorus. Its nutritionally complete
protein has excellent biologic rating,
Since these vital nutritional values
along with carbohydrate and easily emul-
sifiable milk fat are incorporated in liquid
suspension or solution, Ovaltine in milk
is also especially adapted to liquid diets.
The highly satisfying flavor makes for its
ready acceptability when foods are often
distasteful.
The important overall nutrient con-
tribution of three glassfuls of Ovaltine
mixed with milk is presented in the
accompanying table.
THE WANDER COMPANY, 360 N. MICHIGAN AVE.f CHICAGO 1, ILL.
Three servings of Ovaltine, each made of Vi oz. of
Ovaltine and 8 oz. of whole milk,* provide:
VITAMIN A 3000 I.U.
VITAMIN Bi 1.16 mg.
RIBOFLAVIN 2.0 mg.
NIACIN 6.8 mg.
VITAMIN C 30.0 mg.
VITAMIN D 417 I.U.
COPPER 0.5 mg.
*Based on average reported values for milk.
Two kinds. Plain and Chocolate Flavored. Serving for
serving, they are virtually identical in nutritional content.
CALORIES
PROTEIN
FAT
CARBOHYDRATE
CALCIUM
PHOSPHORUS...
IRON
\
%
for February, 1950
179
Birth-Death Registration Test Is On . . .
Census Takers Will Test Completeness of Registry in Ohio and Other
States During Period January-Mareh; Ohio Ranked Low in Last Test
THE completeness with which births and
deaths in Ohio and other states are reg-
istered will be determined on the basis of
such registrations during the period January,
February and March, 1950. The last time such
a test was made, Ohio ranked lowest in per-
centage of registrations of any of the Midwestern
States.
The test will be made in conjunction with
the decennial census which begins April 1, but
will be a distinct report in itself. Each family
will be asked if a birth or death occurred in the
family during the period between January 1 and
March 31, 1950. If the answer is affirmative, the
enumerator will fill out a special form which
will show information similar to that on a
birth or death certificate. These special enumer-
ators’ reports will be sent to the National Office
of Vital Statistics. During the same period the
Division of Vital Statistics of the Ohio Depart-
ment of Health will send in reports of each birth
and death certificate filed with it for the same
period. The census enumerators’ reports will
be matched with the reports from the Division
of Vital Statistics and the number of un-
registered births and deaths determined.
The unmatched reports will be returned to
the Ohio Division of Vital Statistics to determine
whether or not: (1) A delayed certificate has
been received; (2) the birth or death occurred
in Ohio; (3) the birth or death occurred during
the test period; (4) the names on birth certi-
ficates had been legally changed.
From the unmatched returns the National
office will determine the percentage of complete-
ness of birth and death registrations for each
city, county and state in the Nation.
OHIO LOW IN 1940
The same procedure was followed during the
last census in 1940, except that the test was
restricted to birth registrations. During that
test it was determined that birth registrations in
Ohio were only 95.6 per cent complete — the
lowest percentage of any of the Midwestern
States. That means that at that time approxi-
mately 5,000 births in Ohio had not been
registered.
Health Department officials report that the
percentage of unregistered births is much lower
than it was ten years ago, but it is still far
from 100 per cent. The war did much to stimu-
late more careful registration of births. In-
creasing demands for registered information have
added to this stimulus. Here are some of the
occasions for which birth certificates are re-
quired: Entrance to school, work permit, right
to vote, right to marry, right to enter civil serv-
ice, right to enter or be exempt from military
service, settlement of pensions, determining
eligibility of social security benefits to aged or
dependent children, inheritance of property, legal
dependency, etc., etc. Death certificates also
play an important role in the lives of descendents
and heirs.
Besides these considerations on the part of in-
dividuals, birth and death certificates play an
all-important part in the establishment of medi-
cal information from vital statistics.
Death certificates do not give Vital Statistics
personnel so much trouble. One reason for this
is that funeral directors cannot obtain burial
permits until deaths are registered. As a re-
sult in most areas morticians and physicians have
worked out a routine for registration.
Most of the difficulty with birth certificates
arises in home delivery cases. Most hospitals
follow a routine in reporting births. However,
in some instances hospital personnel have had
excessive delays in getting doctors to sign birth
certificates, health officials reported.
ONLY A FEW
The chief of Vital Statistics eagerly pointed
out that the great majority of doctors cooperate
100 per cent in the prompt signing of certificates.
This is borne out by the fact that approxi-
mately 6,500 death certificates and more than
15,000 birth certificates, each signed by a phy-
sician, come into the Vital Statistics office in
Columbus every month.
On the other hand, if a thousand or so certi-
ficates fail to come in during the test period,
Ohio may again rank low in registrations among
comparable states.
While a period of grace is allowed during
which delinquent certificates will be checked,
health officials are urging that all who have any
connection with the filing of certificates see that
they are filed promptly.
Opinion of Attorney General
The syllabus of Opinion No. 1071, rendered by
Attorney General Herbert S. Duffy, reads as fol-
lows:
“An X-ray technician appointed by a county
coroner under authority of Section 2855-17 of the
General Code, is not entitled to compensation for
his services under Section 2855-18 of the General
Code.”
180
The Uhio State Medical journal
''The . . . estrogen
preferred by us is
f Premarin,’* a mixture
of conjugated estrogens,
the principal one
of which is
5?
estrone sulfate.
Hamblen, E. C.: North Carolina M.J. 7:533 (Oct.) 1946.
®
In treating the menopausal syndrome
with “Premarin” Perloff* reports that
“Ninety-five and eight tenths per cent
of patients treated with 3.75 mg.
or less daily obtained complete relief
of symptoms”; also, “General tonic
effects were noteworthy and the greatest
percentage of patients who expressed
clear-cut preferences for any drug
designated ‘Premarin! ”
Thus, the sense of “well-being”
usually imparted represents a “plus” in
“Premarin” therapy which not only
gratifies the patient but is conducive to
a highly satisfactory patient-doctor
relationship.
Four potencies of “Premarin”
permit flexibility of dosage : 2.5 mg.,
1.25 mg., 0.625 mg. and 0.3 mg. tablets;
also in liquid form, 0.625 mg. in
each 4 cc. (1 teaspoonful).
♦Perloff, W. H.: Am. J. Obst. & Gynec. 58:684 (Oct.) 1949.
While sodium estrone sulfate is the principal estrogen in
“Premarin” other equine estrogens... estradiol, equilin,
equilenin, hippulin...are probably also present in varying
amounts as water-soluble conjugates.
Estrogenic Substances ( water-soluble) also known as Conjugated Estrogens ( equine)
5003
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, N. Y.
for February, 1950
181
Feeling the Public’s Pulse on
Federal Health Plan
“The New Jersey Poll” conducted by the
Princeton Research Service reported on Decem-
ber 22, 1949, that 46.6 per cent of New Jersey’s
adult population feel that the U. S Congress
should pass the Truman compulsory health in-
surance plan. It was found, however, that 43.4
per cent of the people oppose this program and
that 10 per cent are undecided.
“The New Jersey Poll” characterizes the mar-
gin of 3.2 per cent as “very narrow” and notes
that all New Jersey poll survey findings are
subject to an average error of four percentage
points because of sampling variations.
Most emphatic support for the Truman plan
is found in the biggest cities and among regular
Democratic voters. Independent voters are op-
posed to compulsory health insurance by approxi-
mately the same margin as regular Republican
voters.
URBAN, RURAL DIFFERENCES
In rural communities and in the medium sized
towns, a clear majority appears to oppose com-
pulsory insurance whereas in cities of 100,000
population or more, the vote runs nearly two to
one in favor of this plan.
Younger people are much more likely to favor
compulsory health insurance than those 45 years
of age or more and, in general, the more edu-
cation a person has the more likely he is to be
opposed to compulsory health insurance.
White collar workers are opposed to the plan
by a fairly appreciable margin, whereas manual
workers favor it by a ratio of five to four.
Perhaps most surprising in view of the exten-
sive union propaganda for compulsory health in-
surance is the finding that 51 per cent of labor
union members favor it, 37 per cent do not,
and 12 per cent are of no opinion.
OPINIONS ON HOSPITALS
An interesting correlation — in reverse — is
found between the Poll report on compulsory
health insurance and a similar report by the
same organization issued on November 17 re-
lating to the public attitude in New Jersey to-
ward their community hospitals.
Statewide, the Poll found that 58 per cent of
the people think that their local hospitals are
good enough, 28 per cent are dissatisfied with
them, and 14 per cent have no opinion. Least
satisfaction is found in the rural areas and the
greatest satisfaction in the larger cities.
The principal suggestions offered by dissatis-
fied voters concerned the alleged need for more
personnel, for enlarged facilities, for building re-
pairs, and for new hospitals generally. A num-
ber commented on the high cost of hospitalization
and the “money on the line” attitude of some of
the hospitals with which they have come in
contact.
The New Jersey Poll has a remarkable record
for accuracy whenever its findings have been
tested by actual vote. It was uncannily ac-
curate in the recent gubernatorial election even
having made a daring advance prediction that
Jersey City might go Republican! — New Jersey
Medical Society Membership News Letter.
New Members of O. S. M. A.
Following are the names of new members
of the Ohio State Medical Association, since
December 1, 1949. The list shows the county
in which they are affiliated, city in which they
are practicing, or temporary addresses in cases
where physicians are taking postgraduate work.
CUYAHOGA COUNTY
Herschel L. Browns,
Lakewood
Frederick A. Rose, Cleve-
land
Elmer R. Swanson, Cleve-
land
Edward C. Weiford, Cleve-
land
STARK COUNTY
Edward P. Schneider,
Canton
SUMMIT COUNTY
Devitt L. Gordon, Akron
Walter A. Hoyt, Jr.,
Akron
Edward Kope, Akron
Kazuo Tashiro, Mogadore
Procedure Outlined on X-rays
Sent Industrial Commission
Each year the State Industrial Commission
receives between 600 and 700 sets of X-ray films
which cannot be processed for payment. In
a majority of cases no claims have been
filed. If no claims are filed within a reasonable
time, the films are returned to the senders. A
number of films cannot be identified because
they are not properly marked.
In the 30-day period, between November 19
and December 19, 1949, over 100 sets of such
films were filed with the Commission. If this
average continues, the loss to Ohio physicians
will total many thousands of dollars.
In order to remedy this situation and expedite
the payment of fee bills, the Commission recom-
mends the following procedure in the submission
of X-ray films :
No films should be filed unless the fee bill
and interpretation, personally signed by the
roentgenologist, accompany the film. Each in-
dividual film should be plainly marked, show-
ing the claim number, claimant’s name, doctor’s
name, and date of film.
Claim numbers can be secured from em-
ployers, who are promptly notified of numbers
assigned as soon as claims are filed with the
Commission. In cases where the employer has
no record of a claim number, it is apparent no
claim has been filed and the contact of the em-
ployer by the physician should expedite the
filing of such claims.
182
The' Ohio Stale Medical Journal
salt without sodium
NEOCURTASAE
Hypertensives often do better on palatable low sodium diets.
They will faithfully follow your directions if you
let them have salt without sodium.
Neocurtasal, completely sodium free salt, palatably
seasons all foods. Neocurtasal looks and is used
like ordinary table salt.
Constituents: Potassium chloride, ammonium chloride,
potassium formate, calcium formate, magnesium
citrate and starch. Potassium content 36%; chloride 39.3%;
for February, 1950
183
Activities of County
First District
(COUNCILOR: D. W. HEU SINKVELD, M. D.,
CINCINNATI)
ADAMS
Officers of the Adams County Medical Society
for 1950 are the following: Dr. Samuel R. Gen-
delman, Manchester, reelected pres.; Dr. Robert
B. Ellison, Peebles, vice-pres.; and Dr. Hazel L.
Sproull, West Union, reelected secy.-treas. Dele-
gate is Dr. S. J. Ellison, West Union, and the
alternate is Dr. R. L. Lawwill, Seaman.
BROWN
Three Brown County physicians were presented
the Ohio State Medical Association’s 50-Year Pin
and Certificate at a special meeting of the Brown
County Medical Society. The three are Dr.
George P. Tyler, Sr., Ripley; Dr. H. P. Shelton,
Georgetown; and Dr. S. A. Laughlin, Aberdeen.
Dr. William L. Faul of Georgetown, president,
presided at the meeting while Dr. David W.
Heusinkveld, Cincinnati, Councilor of the First
District, made the presentations.
BUTLER
Officers of the Butler County Medical Society
for the year are Dr. Louis H. Skimming, Middle-
town, pres.; Dr. Paul C. Schumacher, Hamilton,
pres.-elect; and Dr. John A. Carter, Middletown,
secy.-treas. Delegates are Dr. Neil Millikin,
Hamilton, and Dr. Charles Atkinson, Middletown;
alternates, Dr. John F. Borelli, Hamilton, and
Dr. William U. Neel, Middletown.
CLERMONT
The following officers of the Clermont County
Medical Society took office on Nov. 16: Dr. A.
A. Gruber, Bethel, pres.; Dr. Charles B. Arm-
strong, Loveland, vice-pres.; Dr. J. M. Coleman,
Loveland, secy.-treas. Dr. Coleman also was
elected delegate and Dr. Gruber, alternate.
CLINTON
The following officers of the Clinton County
Medical Society were elected or reelected at the
Dec. 6 meeting: Dr. R. H. Vance, pres.; Dr. H.
R. Bath, vice-pres.; and Dr. R. W. DeCrow,
secy.-treas. Dr. E. K. Yantes was elected dele-
gate and Dr. R. R. Buchanan, alternate. All
are of Wilmington.
The Jan. 10 meeting of the Society was held
at the General Denver Hotel. A discussion was
held on forming a Tri-County Society with
Fayette and Highland Counties. Dr. Robert G.
Claeys, Lynchburg, secy.-treas. of the Highland
County Society was a visitor.
HAMILTON
Dr. George X. Schwemlein has been named
editor-in-chief of the revamped journal of the
Societies . . .
Academy of Medicine of Cincinnati. Serving
with him as members of the editorial board are:
Dr. William F. Ashe, Dr. Lester J. Bossert, Dr.
Robert W. Boyle, Dr. Robert W. Buckley, Dr.
Roy L. Kile, Dr. Elmer Maurer, Dr. Kurt
Tchiassney, Dr. Carl F. Vilter and Dr. F. William
Vockell. The historical Journal of the Academy
of Medicine of Cincinnati was discontinued in
its old form after the December issue.
At the Jan. 3 meeting of the Academy, Dr.
Jacob E. Finesinger, University of Maryland,
Baltimore, spoke on “The Psychiatric Aspects
of Fatigue.”
HIGHLAND
Highland County Medical Society officers for
the year 1950 are the following: Dr. John G.
Anderson, Lynchburg, pres.; Dr. Walter Felson,
Greenfield, vice-pres.; Dr. Robert G. Claeys,
Lynchburg, secy.-treas. Dr. J. Martin Byers
Greenfield, is delegate and Dr. Leland D. Mc-
Bride, Hillsboro, is alternate.
WARREN
The following officers of the Warren County
Medical Society were elected for 1950: Dr. Frank
L. H. Batsche, Mason, pres.; Dr. A. G. Steele,
Loveland, vice-pres.; Dr. John DeBold, Morrow,
secy.; and Dr. Mary Cook, Waynesville, treas.
Dr. Orville L. Layman, Franklin, was elected
delegate and Dr. Alfred E. Stout, Waynesville,
alternate.
Dr. Leonard Mounts of Morrow was honored
at a banquet meeting of the Warren County Medi-
cal Society on Dec. 18 at the Golden Lamb. He
was presented the Ohio State Medical Associa-
tion’s 50-Year Pin and Certificate by Dr. 0. L.
Layman, president of the Society. Dr. Mounts
has served his entire professional career in
Morrow.
Second District
(COUNCILOR: M. D. PRUGH, M. D., DAYTON)
CHAMPAIGN
Champaign County Medical Society officers
who took office on January 1 are: Dr. Lewis C.
Inskeep, pres.; Dr. Isador Miller, vice-pres.; and
Dr. F. R. Grogan, secy.-treas. Dr. D. C. Houser
again was elected delegate and Dr. E. R. Earle,
alternate. All are of Urbana. Guest speaker at
the December meeting was Mrs. Bernice Price,
county welfare department director.
CLARK
Dr. H. H. Ingling assumed office as president
of the Clark County Medical Society on Jan-
uary 1. Officers elected include Dr. Ray M.
Turner, pres.-elect; Dr. W. K. Lehmann, secy.;
and Dr. George A. Smith, treas. Dr. Turner also
184
Th& Ohio State Medkal Journal
was elected delegate, and Dr. S. C. Yinger, al-
ternate. All are of Springfield.
At the Jan. 16 meeting, Dr. George Crile, Jr.,
Cleveland, spoke on the subject, “Present Trends
in the Diagnosis and Surgical Treatment of
Abdominal Disease.”
DARKE
Darke County Medical Society officers for the
year are: Dr. Paul G. Lenhert, Arcanum, pres.;
Dr. J. W. VanLue, Gettysburg, vice-pres., and
Dr. Maurice M. Kane, Greenville, secy.-treas.
Dr. J. E. Gillette, Versailles, and Dr. Gilbert E.
Sayle, Greenville, are delegate and alternate,
respectively.
GREENE
Five Xenia physicians were elected as officers
and representatives of the Greene County Medi-
cal Society. They are Dr. Ray W. Barry, pres.;
Dr. C. G. McPherson, vice-pres.; and Dr. R. D.
Hendrickson, secy.-treas. Dr. H. C. Messenger
was elected delegate and Dr. Paul D. Espey,
alternate. The society engaged as executive
secretary Mr. Frank Bateman of Springfield
who also will serve as associate editor of a so-
ciety bulletin. Mr. Bateman performs similar
activities for the Clark County and Butler County
Medical Societies.
MIAMI
Dr. W. W. Trostle, Piqua, and Dr. G. A. Wood-
house, Pleasant Hill, were reelected president
and secy.-treas., respectively, of the Miami
County Medical Society at the annual meeting
held on Dec. 2. The new vice-president is Dr.
K. F. Lowry, Troy. Dr. Woodhouse again was
elected delegate and Dr. Harry Schilling, Troy,
was elected alternate.
MONTGOMERY
Dayton physicians who were elected officers of
the Montgomery County Medical Society and took
office Jan. 1 are: Dr. H. D. Cassel, pres.; Dr.
F. H. Miller, vice-pres.; Dr. H. M. James, pres.-
elect; Dr. Paul Troup, secy.; and Dr. W. A.
Reiling, treas. Delegates are Dr. R. S. Binkley,
Dr. A. W. Carley, Dr. R. D. Dooley and Dr. T. L.
Light.
Third District
(COUNCILOR: J. CRAIG BOWMAN, M.D.,
UPPER SANDUSKY)
ALLEN
Dr. H. L. Basinger is the incoming president
of the Allen County Medical Society for the
ensuing year. Other officers are: Dr. Alfred W.
Pinkerton, pres.-elect; Dr. Richard L. Johnson,
secy.; and Dr. J. W. Burke, treas. The delegate
and' alternate respectively are Dr. F. P. Berlin
and Dr. R. L. Tecklinberg. All are of Lima.
Dr. Ezra Burnett of Delphos was presented the
50- Year Pin and Certificate of the Ohio State
Medical Association at a special ceremony held
in December. He has practiced for about seven
years at Wetzel before moving to Delphos in
1900.
AUGLAIZE
Officers of the Auglaize County Medical So-
ciety were reelected for the ensuing year. They
are Dr. Elizabeth Kuffner, St. Marys, pres.; Dr.
W. F. Schmiesing, Minster, secy.-treas. Dr. C.
W. Berry, Wapakoneta, is the new delegate and
Dr. R. S. Oyer, also of Wapakoneta, continues,
as alternate.
CRAWFORD
Officers of the Crawford County Medical So-
ciety for 1950 are: Dr. D. D. Bibler, pres.; Dr.
K. H. Barth, vice-pres.; and Dr. Donald R.
Wenner, secy.-treas. The delegate is Dr. John
S. Kiess and the alternate Dr. Jack W. Arnold.
Dr. Barth is of New Washington; the others of
Bucyrus.
Four Crawford County doctors were honored
at a dinner meeting of the Crawford County
Medical Society in Galion. They are Dr. W. H.
Guiss, Tiro; Dr. H. H. Hartmann, Galion; Dr.
E. R. Schoolfield, Bucyrus; and Dr. C. A. Mar-
quart, Crestline. The 50- Year Pin and Certi-
ficate of the Ohio State Medical Association was
presented* to each by Dr. J. Craig Bowman, Upper
Sandusky, Councilor of the Third District. Dr.
Martin L. Helfrich, Galion, president of the So-
ciety, presided. Guest speaker for the occasion
was Kenneth M. Petri, Galion attorney and for-
mer State representative of Crawford County.
HANCOCK
The following officers were elected by the
Hancock County Medical Society and took office
on Dec. 14: Dr. Harold K. Treece, Arlington,
pres.; Dr. T. R. Shoupe, Findlay, vice-pres.; Dr.
Grant Janes, Findlay, secy.; and Dr. David Gree-
gor, Findlay, treas. Delegate and alternate, re-,
spectively, are Dr. Frank M. Wiseley, Findlay, and
Dr. Treece. Scientific speaker at the December
meeting was Dr. Robert McArthur, Wayne Uni-
versity College of Medicine, Detroit, who spoke
on “Other Diseases of the Body Simulating Kid-
ney Tract Disease.”
HARDIN
Dr. George M. Mason, Mt. Victory, was
presented the 50-Year Pin and Certificate at a
special meeting of the Hardin County Medical
Society and the Auxiliary. Dr. Mason moved
to Mt. Victory about seven years ago. He
formerly practiced also in Washington County
and in Noble County where he was health com-
missioner for a number of years.
LOGAN
The following officers were elected in the
Logan County Medical Society for 1950: Dr. C.
K. Startzman, Belief ontaine, pres.: Dr. Hobart L.
Mikesell, West Liberty, vice-pres.; Dr. F. Blair
for February , 1950
185
Webster, Belief ontaine, secy.-treas. Dr. War-
ren F. Mills, Bellefontaine, was elected alternate
delegate.
Dr. 0. W. Loffer, DeGraff, was honored in
December by being presented the 50- Year Pin
and Certificate of the Ohio State Medical Asso-
ciation.
MARION
At the annual business meeting of the Marion
County Academy of Medicine held on Dec. 13,
Dr. R. T. Gray, Prospect, was elected and in-
stalled as president. Other officers are Dr. F.
T. Merchant, vice-pres., and Dr. William Leffler,
secy.-treas., both of Marion. Included in business
discussed at the meeting was that of opening a
Well-Baby Clinic in Marion County for the ex-
amination of indigent infants and children.
MERCER
Dr. R. G. Schmidt, Celina, was reelected presi-
dent of the Mercer County Medical Society for
1950. Other officers are Dr. E. J. Willke, Maria
Stein, vice-pres.; and Dr. John W. Chrispin,
Lockford, acting secy, and treasurer. Delegate
and alternate, respectively, are Dr. L. M. Otis
and Dr. Ralph J. Beare, both of Celina.
SENECA
The following officers were elected by the
Seneca County Medical Society for 1950: Dr. W.
R. Funderburg, pres.; Dr. Avery D. Powell- vice-
pres.; and Dr. Walter A. Daniel, secy.-treas.
Dr. R. F. Machamer was elected delegate and
Dr. Paul J. Leahy, alternate. All are of Tiffin.
VAN WERT
The following Van Wert physicians were
elected as officers of the Van Wert County Medi-
cal Society and took office Dec. 13: Dr. R. E.
Shell, pres.; Dr. W. C. Scheidt, vice-pres.; and
Dr. T. L. Edwards, secy.-treas. Dr. Shell also
was elected delegate and Dr. Edwards, alternate.
Fourth District
(COUNCILOR: CARLL S. MUNDY, M. D., TOLEDO)
FULTON
Members of the Fulton County Medical So-
ciety elected the following officers who took of-
fice on Dec. 13: Dr. Ralph W. Reynolds, Fayette,
pres.; Dr. C. F. Murbach Archbold, vice-pres.; and
Dr. Paul I. Geer, Metamora, secy.-treas. The
elected delegate is Dr. E. R. Murbach, Archbold,
and the alternate, Dr. R. E. Merrill, Delta.
HENRY
The following Napoleon physicians were elected
to office in the Henry County Medical Society
for the ensuing year: Dr. Thomas Quinn, pres.;
Dr. J. R. Bolles, vice-pres., and Dr. John R.
Schlereth, secy.-treas. Dr. B. L. Johnson,
Deshler, is the society’s delegate, and Dr. Quinn
is alternate.
LUCAS
The following programs were included in the
schedule of the Academy of Medicine of Toledo
and Lucas County for December:
General Meeting, Dec. 2 — “Legal and Prac-
tical Aspects of Mal-Practice,” Mr. Charles W.
Peckinpaugh, Jr., Toledo attorney.
Section on Pathology, Experimental Medicine
and Bacteriology, Dec. 9 — “Investigations of
Bone Marrow in the Control of Blood Cells,”
Dr. Bernhard Steinberg, Toledo.
OTTAWA
The following officers of the Ottawa County
Medical Society were elected to serve during
1950: Dr. H. O. Beeman, pres.; Dr. Gordon R.
Ley, vice-pres.; and Dr. James I. Rhiel, secy.-
treas., all of Port Clinton. Elected delegate and
alternate, respectively, are Dr. G. A. Boon, Oak
Harbor, and Dr. C. R. Wood, Port Clinton.
PAULDING
At the regular meeting of the Paulding County
Medical Society in November the following of-
ficers were elected for 1950: Dr. K. C. Evans,
Payne, pres.; Dr. W. H. Caine, Antwerp, vice-
pres.; and Dr. J. M. Poitras, Antwerp, secy.-
treas.
PUTNAM
Members of the Putnam County Medical So-
ciety at their December meeting elected the
following officers: Dr. M. W. Palestrant, Con-
tinental, pres.; Dr. D. B. Lucas, Columbus Grove,
vice-pres.; Dr. C. J. Heitz, Ft. Jennings, secy.;
and Dr. H. N. Trumbull, Columbus Grove, cor-
responding secy.
SANDUSKY
Dr. Harold L. Keiser- Fremont, was elected
president of the Sandusky County Medical So-
ciety at its December meeting. Other officers
named for the current year are Dr. F. A. Vis-
conti, vice-pres., and Dr. Ervin L. Koons, secy.-
treas., both of Fremont. The December meeting
was held in conjunction with a Fourth District
meeting of the Academy of General Practice.
WILLIAMS
Members of the Williams County Medical So-
ciety elected the following officers for the year
which began Dec. 15: Dr. Paul G. Meckstroth,
Bryan, pres.; Dr. William L. Hann, West Unity,
vice-pres.; and Dr. Irving L. Colvin, Edon, secy.-
treas. The elected delegate and alternate are
Dr. H. R. Mayberry, and Dr. R. A. Gilreath,
respectively, both of Bryan.
WOOD
The Wood County Medical Society held its
regular dinner meeting at the Midway Restau-
rant, Dixie Highway, Perrysburg, Dec. 15.
At the short business session the following
officers were installed for the year of 1950. Dr.
Ray Whitehead, Bowling Green, pres.; Dr. James
186
Tbel Ohio State Medical Journal
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for February , 1950
187
R. McAuley, Perrysburg, vice-pres.; and Dr.
Roger Peatee, Bowling Green, secy.-treas.
The paper of the evening was given by Dr.
George P. Hohley, Coroner of Lucas County,
entitled “A Coroner Looks at Life.” This was
a different type of paper from that usually
presented at medical meetings, but with Dr.
Hohley’s long experience in forensic medicine
it was informative and thought provoking.
After reviewing the history of the office and
commenting on routine procedure Dr. Hohley
pointed out some of the hazards not usually
recognized — for instance, death from vitamins,
from barbiturates and alcohol. He commented
on the newer scientific methods of determining
the causes of death and of the very good facili-
ties in Ohio.
Malnutrition, particularly in the aged, came
in for mention as seen in some convalescent
homes.
A rising vote of thanks was tendered Dr.
Hohley.
Fifth District
(COUNCILOR: FRED W. DIXON, M. D., CLEVELAND}
ASHTABULA
Incoming officers of the Ashtabula County
Medical Society for the year which began
Dec. 13 are the following: Dr. C. T. Risley, Con-
neaut, pres.; Dr. William H. Eberle, Ashtabula,
vice-pres.; and Dr. R. C. Irving, Conneaut, secy.-
treas. Dr. M. R. Martin, Geneva, was elected
delegate and Dr. P. J. Collander, Ashtabula, al-
ternate.
GEAUGA
Geauga County Medical Society officers for
the year which began Oct. 27 are: Dr. W. C.
Cory, Chardon, pres.; Dr. G. D. Chirelli, Park-
man, vice-pres.; and Dr. Isa Teed Crampton,
Burton, secy.-treas. Dr. Phillip P. Pease, Char-
don, is delegate, and Dr. Alton W. Behm, also
of Chardon, alternate.
LAKE
Dr. Paul E. Reading, Painesville, was named
president of the Lake County Medical Society.
Dr. Thomas E. Byrne, Mentor, is the vice-pres.,
and Dr. R. Keith Miles, Madison, secy.-treas.
Delegate and alternate, respectively, are Dr.
Morris G. Carmody and Dr. B. S. Park, both of
Painesville.
Sixth District
(COUNCILOR: PAUL A. DAVIS, M. D„ AKRON )
COLUMBIANA
Members of the Columbiana County Medical
Society elected the following Salem physicians
as officers for 1950: Dr. R. J. Starbuck’ pres.;
Dr. R. J. McConnor, vice-pres., and Dr. H. F.
Hoprich, secy.-treas.
MAHONING
Mahoning County Medical Society members
elected the following officers who took office
on Dec. 20: Dr. Gordon C. Nelson, pres.; Dr.
E. J. Wenaas, vice-pres.; Dr. G. E. DeCicco,
secy.; and Dr. L. H. Getty, treas. Delegates
are Dr. V. L. Goodwin and Dr. C. A. Gustafson;
alternates, Dr. R. E. Odom and Dr. J. C. Vance.
Dr. Vance resides in Poland; the others in
Youngstown.
PORTAGE
Members of the Portage County Medical So-
ciety elected the following officers who took of-
fice at the first of the year: Dr. Myron W.
Thomas, Garrettsville, pres.; Dr. Robert M.
Dumm, Kent, vice-pres.; and Dr. Edgar A.
Knowlton, Mantua, secy.-treas. Delegate and
alternate, respectively, are Dr. Dumm and Dr.
R. C. Neely, Ravenna.
Dr. J. H. Krape, practicing physician in Kent
for approximately 56 years, was honored at a
meeting of the Portage County Medical Society
on Jan. 5. Dr. Paul A. Davis, Akron, Councilor
of the Sixth District of the Ohio State Medi-
cal Association, presented the 50-Year Pin and
Certificate.
STARK
Officers of the Stark County Medical Society
who took office on Dec. 8 are the following; Dr.
Ian B. Hamilton, pres.; Dr. L. E. Anderson,
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for February , 1950
189
pres.-elect; Dr. J. L. Yahraus, secy.-treas.
Delegate and alternate, respectively, are Dr.
John E. Dougherty and Dr. A. A. Lichtblau.
All are of Canton except Dr. Anderson who re-
sides in Greentown.
SUMMIT
Dr. John D. Brumbaugh assumed office as
president of the Summit County Medical So-
ciety at the Jan. 3 meeting. Other officers
are Dr. Louis A. Witzeman, pres.-elect; Dr.
Donald I. Minnig, secy.; and Dr. Arthur F.
Dorner, treas. Delegates are the following: Dr.
Kurt Weidenthal, Dr. C. A. Raymond, Dr. E. W.
Burgner and Dr. F. T. Moore. Alternates are
Dr. W. T. Bucher, Dr. J. W. Ewing, Dr. R. G.
McCready and Dr. R. H. Wilson. Except Dr.
Weidenthal, a Hudson resident, the foregoing
are Akron physicians.
TRUMBULL
Dr. E. G. Caskey, Mineral Ridge, is the new
president of the Trumbull County Medical So-
ciety. Dr. J. M. Gledhill, Warren, is vice-pres.
and Dr. C. W. Mathias, Niles, is secy.-treas.
Delegate and alternate, respectively, are Dr.
Densmore Thomas, Niles, and Dr. S. J. Shapiro,
Warren.
Seventh District
(COUNCILOR: R. J. FOSTER. M. D.. NEW
PHILADELPHIA)
BELMONT
Belmont County Mecfical Society officers for
the year beginning January 1 are: Dr. Harvey
H. Murphy, Barnesville, pres.; Dr. David Danen-
berg, Bridgeport, vice-pres.; and Dr. Bertha M.
Joseph, Martins Ferry, secy.-treas. Dr. Murphy
also was elected delegate and Dr. Danenberg,
alternate.
CARROLL
Dr. John H. Murray, Carrollton, was elected
president of the Carroll County Medical Society
for the year beginning Jan. 1. Dr. Joseph D.
Stires, Malvern, is the vice-pres., and Dr. Charles
H. Dowell, Carrollton, secy.-treas. Delegate
and alternate respectively are Dr. W. G. Lyle,
Minerva, and Dr. Glenn C. Dowell, Carrollton.
COSHOCTON
The Coshocton County Medical Society elected
the following officers for 1950: Dr. George D.
Mogil, pres.; Dr. J. C. Briner, vice-pres.; and
Dr. H. W. Lear, secy.-treas. Dr. E. J. Booth
was elected delegate and Dr. F. W. Craig, al-
ternate. All are of Coshocton except Dr. Briner
who is of West Lafayette.
HARRISON
President of the Harrison County Medical So-
ciety for 1950 is Dr. D. L. Tippett, Cadiz. Dr.
G. E. Vorhies, Scio, is vice-president, and Dr.
Richard W. Weiser, Jewett, secy.-treas. Dele-
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gate and alternate are Dr. C. F. Goll, Hopedale,
and Dr. Tippett, respectively.
JEFFERSON
The following Steubenville physicians were
elected to office in the Jefferson County Medical
Society for 1950: Dr. S. L. Burkhardt, pres.;
Dr. Warren G. Snyder, vice-pres.; and Dr. San-
ford Press, secy.-treas. Dr. John F. Gallagher
was named delegate and Dr. Burkhardt, alter-
nate.
TUSCARAWAS
Members of the Tuscarawas County Medical
Society elected the following officers who took
office on Jan. 1: Dr. William E. Hudson, New
Philadelphia, pres.; Dr. Vincent C. Nipple, Mid-
vale, vice-pres.; and Dr. Harold F. Wherley, New
Philadelphia, secy.-treas. Dr. J. S. Adler, Stras-
burg, is delegate, and Dr. E. C. Davis, Jr., Dover,
is alternate.
Eighth District
(COUNCILOR: CHESTER P. SWETT, M. D., LANCASTER)
ATHENS
The new president of the Athens County Medi-
cal Society is Dr. M. H. Mitchell, Albany. Dr.
A. A. Baldwin, Athens, is the new vice-president
and Dr. C. R. Hoskins, Athens, secy.-treas.
Delegate and alternate respectively are Dr.
Beatrice Postle, Athens, and Dr. M. H. Mitchell,
Albany. Officers were elected at a dinner meet-
ing Dec. 13 at which guest speaker was Dr.
Frank W. Lowenstein, medical director of the
Athens County Nutrition and Health Survey.
GUERNSEY
Dr. Reo. M. Swan, Cambridge, took office as
president of the Guernsey County Medical So-
ciety on Jan. 1. Other officers are Dr. J. D.
Knapp, Cambridge, vice-pres., and Dr. F. Gordon
Lawyer, Cambridge, secy.-treas. Dr. Robert A.
Ringer of Cambridge is delegate and Dr. Ben-
jamin S. Gillespie, Senecaville, alternate.
Thirteen members and one guest were present
at the Jan. 5 meeting at the Berwick Hotel. Dr.
Kenneth J. Frakes was the guest. New com-
mittee members were announced. A letter was
read from Dr. E. J. Farrell, Jr., who is taking
residency training at Louisville, Ky.
It was moved by Dr. Denny and seconded
by Dr. Wells that “this society go on record
as requesting an explanation by the A. M. A. as
to why those who contributed their $25 dona-
tion to the A. M. A. last year should not be
given credit for this, against the $25 to be levied
against them this year, so as to put one and all
on a fair and equitable basis.” After discussion
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for February, 1950
191
the motion carried six to two, some members
not voting.
The scientific portion of the program was in
charge of Dr. Lawyer who spoke on “Newer
Developments in Dermatology,” based on dis-
cussions at the recent meeting of the American
Academy of Dermatology and Syphilology in
Chicago.
Members of the Society entertained their wives
and other guests at a holiday program at the
Berwick Hotel, arranged by Dr. Lawyer and Dr.
M. C. McCluskey.
MUSKINGUM
Dr. James E. McCormick was elected presi-
dent of the Muskingum Academy of Medicine
at the annual banquet on Dec. 2. Other officers
named are: Dr. D. K. Matthews, Dresden, vice-
pres.; Dr. W. W. Renner, Zanesville, secy.-
treas. Dr. George C. Malley was named dele-
gate and Dr. Paul A. Jones, alternate, both of
Zanesville.
NOBLE
Dr. Charles F. Thompson was reelected presi-
dent of the Noble County Medical Society for
1950. Other officers are Dr. N. S. Reed, vice-
pres., and Dr. Edward G. Ditch, secy.-treas.
Dr. Ditch also was elected delegate and Dr.
Reed, alternate. All are of Caldwell.
Ninth District
(COUNCILOR: J. PAUL McAFEE, M. D.,
PORTSMOUTH)
GALLIA
The following Gallipolis physicians were elected
to office in the Gallia County Medical Society
for 1950: Dr. Homer B. Thomas, pres., and Dr.
J. Gordon Gibert, secy.-treas. Dr. Charles E.
Holzer, Jr., was chosen delegate and Dr. Jacob
Weinberger, alternate.
Dr. Ella G. Lupton was honored by a banquet
sponsored by tfie Gallia Society on Dec. 28, at
which time she was presented the 50-Year Pin
and Certificate of the Ohio State Medical Asso-
ciation. The presentation was made by Dr.
N. Howard Foster, retiring president. Leading
citizens in addition to members of the Society
joined in the banquet honoring Dr. Lupton who
is 87 years old.
JACKSON
Dr. J. S. Hunter, Jackson, was presented the
50-Year Pin and Certificate of the Ohio State
Medical Association at the meeting of the Jack-
son County Medical Society early in December.
A veteran of World War I, Dr. Hunter is still
practicing at the age of 84.
LAWRENCE
Dr. Anne-Marting Alstott was elected presi-
dent of the Lawrence County Medical Society
with the following other officers: Dr. Charles H.
Ross, vice-pres., and Dr. G. Newton Spears,
secy.-treas. Delegate and alternate are Dr.
Charles Myers, an above knee amputee, wore his
first Hanger Limb over eight years ago. "During
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Canada. In Central America I worked on air route
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192
The Ohio State Medical Journal
Spears and Dr. George G. Hunter, respectively.
All are of Ironton.
SCIOTO
The Hempstead Academy of Medicine elected
the following officers and representatives for the
year .1950: Dr. L. B. Hatch, South Webster,
pres.; Dr. R. L. Wagner, Portsmouth, vice-pres.;
Dr. C. L. Pitcher, Portsmouth, secy.-treas.;
Dr. 0. D. Tatje, Portsmouth, delegate; and Dr.
W. M. Singleton, West Portsmouth, alternate.
VINTON
Dr. Richard E. Bullock and Dr. Herbert D.
Chamberlain of McArthur, were reelected presi-
dent and secy.-treas., respectively, of the Vinton
County Medical Society. Dr. Chamberlain also
was elected delegate and Dr. Bullock alternate.
Tenth District
(COUNCILOR: H. M. CLODFELTER, M. D., COLUMBUS)
DELAWARE
Dr. B. R. Lauer is president of the Delaware
County Medical Society for the ensuing year.
Dr. G. E. Robinson is vice-pres., and Dr. F. M.
Stratton, secy.-treas. Delegate and alternate,
respectively, are Dr. George J. Parker and Dr.
Edward C. Jenkins. Dr. Robinson is of Ostran-
der; the others of Delaware.
PICKAWAY
The following Circleville physicians were
elected officers of the Pickaway County Medical
Society for 1950: Dr. H. D. Jackson, pres.; Dr.
Lloyd Jonnes, vice-pres.; and Dr. Walter F.
Heine, secy.-treas. Dr. E. L. Montgomery is
delegate, and Dr. E. S. Shane, alternate.
ROSS
The following Chillicothe physicians were
elected officers and representatives of the Ross
County Medical Society and took office Dec. 1:
Dr. Edwin H. Artman, pres.; Dr. Francis W.
Nusbaum, pres.-elect; Dr. Richard L. Counts,
secy.-treas.; Dr. Ralph W. Holmes, delegate, and
Dr. Harold M. Crumley, alternate.
UNION
Union County Medical Society officers for the
year which began on Dec. 13 are the following
of Marysville: Dr. J. M. Snider, pres.; Dr. Paul
R. Zaugg, vice-pres.; and Dr. Malcolm Maclvor,
secy.-treas.
Eleventh District
(COUNCILOR: JOHN S. HATTERY, M. D., MANSFIELD)
ERIE
The following Sandusky physicians were elected
officers of the Erie County Medical Society for
the year which began Dec. 15: Dr. Charles J.
Reichenbach, pres.; Dr. Duane D. Love, vice-
pres.; and Dr. Arthur G. Groscost, secy.-treas.
Dr. Ross M. Knoble was designated delegate and
Dr. H. W. Lehrer, alternate.
Cook County
Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technique,
two weeks, starting Feb. 20, Mar. 20. Surgical Tech-
nique, Surgical Anatomy & Clinical Surgery, four
weeks, starting Feb. 6, Mar 6. Basic Principles in
General Surgery, two weeks, starting April 3.
Personal Course in General Surgery, two weeks,
starting April 17. Surgery of Colon & Rectum,
one week, starting Mar. 6, April 10. Esophageal
Surgery, one week, starting June 5. Breast &
Thyroid Surgery, one week, starting June 26.
Thoracic Surgery, one week, starting June 12. Gall-
bladder Surgery, ten hours, starting April 24. Frac-
tures & Traumatic Surgery, two weeks, starting
Mar. 20.
GYNECOLOGY — Intensive Course, two weeks, start-
ing Feb. 20, Mar. 20. Vaginal Approach to Pelvic
Surgery, one week, starting Mar. 6.
OBSTETRICS — Intensive Course, two weeks, starting
Mar. 6, April 3.
PEDIATRICS — Intensive Course, two weeks, starting
April 3. Personal Course in Cerebral Palsy, two
weeks, starting July 31.
MEDICINE — Intensive General Course, two weeks,
starting April 24. Electrocardiography & Heart
Disease, four weeks, starting Mar. 13. Hematology,
one week, starting May 8. Gastro-Enterology, two
weeks, starting May 15. Liver & Biliary Diseases,
one week, starting June 5. Gastroscopy, two weeks,
starting Mar. 6, May 15.
DERMATOLOGY — Formal Course, two weeks, start-
ing May 8. Informal Clinical Course, every two
weeks.
UROLOGY — Intensive Course, two weeks, starting
April 17. Cystoscopy, Ten Day Practical Course,
every two weeks.
General, Intensive and Special Courses in all
Branches of Medicine, Surgery and the Specialties
TEACHING FACULTY — ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address : Registrar, 427 South Honore Street,
CHICAGO 12, ILLINOIS
FOR THE NEW YEAR!
and Your Convenience
OUR SERVICE HAS (SEEN
EXTENDED TO INCLUDE
CORSETS
Individually Designed
As Prescribed
COLUMBUS ORTHOPAEDIC
APPLIANCE COMPANY
337 S. HIGH STREET
COLUMBUS 15,
OHIO
MAin 0990 Pi cert^.e?^
for February, 1950
193
HURON
The fourth quarterly meeting of the Huron
County Medical Society was held at Norwalk
on Dec. 14. Dr. Clyde J. Cranston, Wakeman,
was named for his third consecutive term as
president; Dr. William W. Corwin, Willard,
was voted vice-president; and Dr. George F.
Linn, Norwalk, was reelected for his seventh
consecutive term as secretary-treasurer. Dele-
gate and alternate, respectively, are Dr. Owen
J. Nicholson, Norwalk, and Dr. William H.
Kauffman, Willard. Dr. C. L. Hannum, Ply-
mouth, gave an illustrated lecture on “Regional
Anesthesia.”
LORAIN
Members of the Lorain County Medical So-
ciety elected the following officers who took of-
fice on Dec. 13: Dr. Swen D. Nielsen, Elyria,
pres.; Dr. Henry C. Marsico, Lorain, vice-pres.;
Dr. L. H. Trufant, Oberlin, secy.-treas. Dr.
Leonard Stack, Lorain, and Dr. Russell Arnold,
Avon, were elected delegates, and Dr. Anthony
Piraino, Oberlin, and Dr. George R. Wiseman,
Amherst, alternates.
Also at the Dec. 14 meeting of the Society,
Dr. John S. Hattery, Mansfield, Councilor of
the Eleventh District of the Ohio State Medi-
cal Association, made an official presentation of
50-Year Pins and Certificates to eligible physi-
cians, none of whom was able to be present at
the meeting. The physicians honored are Dr.
H. J. Austin and Dr. George Gill, of Elyria; Dr.
F. B. Gregg, Wellington; Dr. 0. B. Monosmith,
Lorain; and Dr. S. V. Burley, Lorain (since de-
ceased); and posthumously to Dr. Emil Heinig,
late of Vermillion.
MEDINA
Dr. Louis L. Zwick, Wadsworth, is the new
president of the Medina County Medical Society
for the year. Other officers are Dr. T. V. Kolb,
Litchfield, vice-pres.; and Dr. Morris M. Mal-
mud, Sharon Center, secy.-treas. Delegate and
alternate, respectively, are Dr. William Dwyer
and Dr. A. J. Karson, both of Medina.
RICHLAND
The December meeting of the Richland County
Medical Society was held Dec. 22, at which time
the following officers were elected for 1950: Dr.
R. D. Campbell, Mansfield, pres.; Dr. F. M.
Wadsworth, Mansfield, vice-pres.; Dr. Charles
0. Butner, Shiloh, secy.-treas. Delegate and al-
ternate, respectively, are Dr. P. A. Blackstone,
Belleville, and Dr. W. H. Buker, Mansfield.
Dr. John S. Hattery, Councilor of the Eleventh
District of the Ohio State Medical Association,
presented Fifty-Year Pins and Certificates to
Dr. R. R. Black, Dr. J. L. Stevens, Dr. L. A.
Smith, Dr. J. M. Garber and Dr. J. A. Yoder, all
of Mansfield, and Dr. G. J. Searle, Sr., of Ply-
mouth. Dr. Searle and Dr. Yoder were unable
to attend the meeting. The four doctors present
for the awards made a few brief informal re-
The Wendt - Bristol
Company
Two complete ethical stores in
Columbus
51 E. State St. 721 N. High St.
for the convenience of the Physicians and
Surgeons — and the many people they serve
Two Prescription Departments
maintained in a high class manner with
twenty-one registered Pharmacists
Other Complete Departments
OFFICE EQUIPMENT
PHYSIO THERAPY APPARATUS
HOSPITAL SUPPLIES
W-B Pharmaceutical Supplies
JOBBING STOCKS ALL LEADING
MANUFACTURERS
Antitoxins and Vaccines in Special
Refrigeration Plants
Prompt Service on Phone Orders
W. H. MILLER, M. D.
328 East State Street
COLUMBUS 15, OHIO
X-RAY DIAGNOSIS AND THERAPY
FEVER THERAPY
RADIUM
TELEPHONES
Office Residence
MA. 3743 EV. 5644
194
The Ohio State Medical Journal
marks concerning their many years of medical
practice. Four of these men, Drs. Black, Garber,
Smith and Stevens, are still in active practice,
making rounds at the hospital, having regular
office hours, and making house calls, officers of
the Society reported.
WAYNE
The following Wooster physicians were elected
as officers and representatives of the Wayne
County Medical Society: Dr. John B. Beeson,
pres.; Dr. Richard N. Smith, vice-pres.; Dr. R.
C. Paul, secy.-treas.; and Dr. L. L. Moore, assist-
ant secy.; Dr. Layman A. Adair, delegate, and
Dr. Harold G. Beeson, alternate. At the age of
88, Dr. Paul was elected secretary-treasurer for
the 28th consecutive year.
Woman’s Auxiliary . . .
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
ASSOCIATION SPONSORED CONFERENCE
On Tuesday, March 14, a conference of presi-
dents, secretaries, legislative chairmen and public
relations chairmen of county Woman’s Auxil-
iaries, also key state officers of the Auxiliary
will be held in the Fort Hayes Hotel, 31 W.
Spring St., Columbus, under sponsorship of the
Ohio State Medical Association. Attendance
will be by invitation.
BELMONT
CHAS. F. BOWEN, M. D.
332 East State Street
COLUMBUS 15, OHIO
X-RAY DIAGNOSIS
AND
TREATMENT
OF
CANCER
RADIUM
X-RAY
SURGERY
•
Office Home
AD. 8548 EV. 1344
The Belmont Hills Country Club was the scene
on Dec. 20 of the annual Christmas party of
the Auxiliary to the Belmont County Medical
Society. Members brought gifts for distribution
at the coifhty infirmary and donated money for
Christmas treats to be purchased for the pa-
tients at the county tuberculosis sanatorium.
Following the business session, the women joined
their husbands for a dinner-meeting and heard
Representative Wayne T. Hayes, guest speaker,
give an interesting account of a recent trip to
Europe.
CUYAHOGA
The Woman’s Auxiliary to the Cleveland
Academy of Medicine plans to repeat this year,
for the third consecutive time, its $25 merit
award to one outstanding student in the junior
class of each of the eleven Greater Cleveland
schools of nursing.
There was a record gathering of Auxiliary
members in October at Halle’s Auditorium when
Mrs. Paul C. Craig, chairman of public rela-
tions for the Woman’s Auxiliary to the American
Medical Association, spoke on “The Doctor’s
Wife in the Community.” Mrs. D. M. Keating,
president, presided at this meeting. Tea was
served later, with Mrs. Charles A. Obert and
her hospitality committee in charge of arrange-
ments. The Cuyahoga County Auxiliary has
three or four meetings a year of the entire
YOUR PATIENTS . . .
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visceroptosis, nephroptosis, orthopedic condi-
tions, hernia and mammary gland.
MA. 5-7961 23 EAST STATE ST.
COLUMBUS, OHIO
for February , 1950
195
group, with regular and frequent board sessions
at which business matters are handled.
ERIE
The Erie County Auxiliary extended a note
of Christmas cheer to the nurses and personnel
of Good Samaritan and Providence Hospitals
when it entertained with a tea at the Business
Women’s Club on Dec. 12.
A musical program was presented during the
afternoon by Miss Virginia Beuthel, young
pianist, and Miss Darlene Miller, soprano. Mrs.
C. E. Swanbeck, Mrs. C. J. Reichenbach, Mrs.
Ross Knoble and Mrs. E. J. Meckstroth presided
at the tea table. Mrs. Fred Schoepfle was chair-
man of hostesses.
FAIRFIELD
The Auxiliary to the Fairfield County Medical
Society held its annual Christmas party for
members and their husbands on Dec. 15. Dinner
was served at the Lancaster Country Club.
HURON
A luncheon meeting was held on Dec. 9 by the
Huron County Auxiliary in the Maple Room of
the Greenwich Hotel. This was the third meet-
ing of the Huron Auxiliary since its inception
in the fall. Mrs. A. H. Kimmel is president.
The group’s regular meeting date is the second
Friday of each month.
LUCAS
December was a comparatively quiet month
for the Toledo and Lucas County Auxiliary, with
the exception of the study groups which met
during the month. The Legislative Workshop
ended its series- with the Dec. 5 meeting; but
the group on “Child Development” and the group
on “Live Issues of Today” continue their pro-
grams. A new course on Art Appreciation was
scheduled to start Jan. 13.
The “Child Development” group, whose leader
is Mrs. W. W. Green, held its January meeting
at the home of Mrs. Oliver E. Todd. The topics
discussed were “Developing Initiative” and
“Educating for Competence.”
The “Live Issues of Today” group met on
Jan. 4. This group continued its discussion on
how to ward off a Welfare State and also dis-
cussed “Devaluation of the British Pound.”
For Feb. 11 the Academy and the Auxiliary
have scheduled a supper dance at the Com-
modore Perry Hotel. Mrs. James McAuley, social
chairman, is in charge of arrangements.
MONTGOMERY
The Woman’s Auxiliary to the Montgomery
County Medical Society held its Christmas meet-
ing on Dec. 13 at the Dayton Art Institute. This
was a luncheon meeting, with an attendance of
70. Following the luncheon, a skit “Medicine
Marches On” was presented, illustrating the
doctor’s office of yesterday, the present, and what
would take place in a “socialized medicine” of-
fice.
BLOOD
ALLERGY
URINALYSIS
BLOOD CHEMISTRY
THROAT CULTURES
STOMACH CONTENTS
SURGICAL PATHOLOGY
AGGLUTINATION TESTS
ELECTROCARDIOGRAPHY
WASSERMAN & KAHN TESTS
SPUTUM
EFFUSIONS
FECES-VACCINES
X-RAY DIAGNOSIS
PREGNANCY TESTS
BASAL METABOLISM
PNEUMOCOCCIC TYPING
AUTOGENOUS VACCINES
PREMARITAL SEROLOGY
DARK FIELD-SPIROCHETA
Clinical and Pathological
LABORATORY
Established 1904
370 E. Town Street Columbus, Ohio
H. M. BRUNDAGE, M.D., Director
M. D. GODFREY, M.D.
Prompt Service
Telephone: MAin 2490
A SERVICE OF SUPPLY
Bowman
TO THE MEDICAL ARTS
MEDICAL mid SURGICAL
EQUIPMENT and SUPPLIES
PHARMACEUTICALS
BIOLOGICALS
MEDICAL FURNITURE
SURGICAL and DIAGNOSTIC
INSTRUMENTS
The Bowman Brothers Drug Co.
CANTON, OHIO
CANTON at 719 Schroyer Ave., S.W.
AKRON at 370 East Market Street
LIMA at 539 West Market Street
19 6
The Ohio State Medical Journal
OTTAWA
The Ottawa County Woman’s Auxiliary met on
Dec. 15 at the home of Mrs. Gordon Ley. Mrs.
E. D. Schuiteman is a new member. Mrs. George
Boone was named delegate and Mrs. George Poe
alternate to the state auxiliary convention to be
held in May.
After the business meeting, the doctors joined
their wives for a gift exchange and social hour.
feature of the afternoon was the showing by
Mrs. Ralph Lewis of special motion pictures, in
color, of Philippine Island activities taken by
Dr. Lewis when he was stationed there. One
such activity — the planting and harvesting of the
rice — was presented in amazing detail and
against a background of warmth, color and
dramatic effect.
TRUMBULL
SANDUSKY The Auxiliary to the Trumbull County Medical
The annual Christmas party of the Sandusky Society met for its annual Christmas party on
County Auxiliary was held on Dec. 15 at the Dec. 16 at the Trumbull Country Club. Fol-
home of Mrs. F. L. Moore. Preceding the lowing the luncheon, the business session was
festivities, a business meeting was held, with conducted by the president, Mrs. D. R. Mathie,
Mrs. Robert Fox, president, presiding. One of -
the group’s projects was the sending of robes,
aprons and facial tissues to the detention home.
Hose sold to auxiliary members helped finance
this project.
After the business session, cards were played
and later in the evening lunch was served. There
was also a gift exchange. Committee in charge
of arrangements included Mrs. M. M. Riddell,
chairman, Mrs. C. I. Kuntz and Mrs. M. S. Huber.
SCIOTO
The Scioto County Auxiliary had the privilege,
on Dec. 1, of presenting the entertainment fea-
ture at the annual Christmas dinner and meet-
ing of the Hempstead Academy of Medicine.
Produced and acted by auxiliary members, a
“Cavalcade of the Past” was presented in twelve
scenes, depicting actual activities of the local
auxiliary during its nine and a half years of
existence.
The regular meeting of the auxiliary was held
on Dec. 14 at the home of Mrs. Clyde M. Fitch
who, each year, plays hostess to the Christmas
party. Unusual and striking Christmas decora-
tions provided the background for the afternoon’s
festivities. The business meeting, under the di-
rection of Mrs. W. A. Ray, president, preceded
the passing party and special program. Christ-
mas “treats” for the County Home were voted,
as was a special appropriation to purchase needed
replacements for the recreation room at the
Home, an original project of the auxiliary. The
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Immediate delivery — Mail orders to
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THE NERREN COMPANY
2680 N. Moreland Blvd., Cleveland 20, Ohio
RADIUM
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium Laboratories
(Owned and directed by a Physician-
Radiologist)
HAROLD SWANBERG, B.S., M.D., Director
W.C.U. Bldg. Quincy, Illinois
for February, 1950
197
when plans were discussed for a new money-
making project in the form of a “Gardenia
Ball.” The money is to be used for the Nurse's
Scholarship Fund.
Gifts were brought by each member, to be
later distributed to the women of the County
Home and to the children of the Christmas
Stocking Club of the Salvation Army. At the
completion of the business meeting, the Student
Nurses’ Chorus of the Trumbull Memorial Hos-
pital presented a delightful program of Christ-
mas music. Mrs. Kyle, program chairman, in-
troduced the group.
A. M. A. Authorizes Study
Of Physicians* Incomes
The A. M. A. Board of Trustees, meeting in
Chicago Nov. 5, authorized the Bureau of Medi-
cal Economic Research to undertake a study of
physicians’ incomes during 1949. The study will
be undertaken in cooperation with the Office
of Business Economics of the U. S. Department of
Commerce and will begin sometime next spring.
The Bar and Dental Associations previously
have cooperated with the Department of Com-
merce in surveys of their respective professions.
The sample study will be of the mail-
questionnaire type and will be prepared jointly
by the Bureau of Medical Economic Research and
the Department of Commerce. The sample will
be drawn from the Bureau’s complete punch-card
file of physicians. The questionnaires will be
confined principally to questions of income and
those necessary to cross-classify the respondents.
The physician will not sign his questionnaire.
COMING MEETINGS
Ohio State Medical Association, Annual Meet-
ing, Cleveland, May 16-18.
American Medical Association, Annual Session,
San Francisco, June 26-30.
American Academy of General Practice, St.
Louis, Feb. 20-23.
American Association of Industrial Physicians
and Surgeons, 35th Annual Meeting, Sherman
Hotel, Chicago, April 22-29.
American Association for Thoracic Surgery,
Denver, Colo., April 15-19.
American College of Physicians, Boston, April
17-21.
American College of Radiology, San Francisco,
Calif., June 25.
American Goiter Association, Shamrock Hotel,
Houston, Texas, March 9-11.
American Pediatric Society, French Lick, Ind.,
May 8-10.
National Conference on Rural Health, Kansas
City, Mo., Feb. 3-4.
National Tuberculosis Association, Washing-
ton, D. C., April 25-28.
INDEX TO ADVERTISERS
Abbott Laboratories 111
Ayerst, McKenna & Harrison, Ltd 181
Baker Laboratories, Inc. 173
Bell, Kathryn S., Inc. 195
Bowen, Charles F., M. D., 195
Bowman Bros. Drug Company 196
Camp, S. H., Company 110
Cincinnati Sanitarium 115
Clinical and Pathological Laboratory 196
Coca-Cola Company 187
Columbus Orthopaedic Appliance Company 193
Cook County Graduate School of Medicine 193
Davies, Rose & Co., Ltd. 117
Fairfield Nursing Home 190
General Electric X-ray Corp 171
Hanger, J. E., Inc. 192
Harding Sanitarium 116
Ingleside Home, Inc.._ 187
Lederle Laboratories 177
Lilly, Eli & Company Insert Between
Page 120 and 121
McMillen Sanitarium ... 115
Mead Johnson & Company Back Cover
Medical Protective Company 192
Medico Press 191
Mercer Sanitarium 116
Miller, W. H., M. D. 194
Nerren Company, The 197
New York Polyclinic Medical School 189
Num Specialty Company - 199
Oak Ridge Sanatorium 114
Parke, Davis & Company 200 and
Inside Back Cover
Pogue, Mary E., School 188
Quincy X-Ray & Radium Laboratories 197
Resthaven 191
Rupp & Bowman Company 190
Sawyer Sanatorium 105
Schering Corporation 107
Schmid, Julius, Inc 175
Searle, G. D., & Company 169
Special Formula Corporation 119
Squibb, E. R 109
Stoneman Press 189
Upjohn Company 120
Van Wagner Company 197
Wander Company 179
Wendt-Bristol Company 194
Wickhaven Sanitarium 116
Windsor Hospital — 116
Winthrop-Stearns, Inc 183
Wyeth, Incorporated 118
198
The Ohio State Medical Journal
QlaAAiliedl Ad<xefUi^eme>ttt^
Rates: 50 cents per line. Minimum charge of $1.00 for each insertion. Price covers the cost
of remailing answers. Forms close 16th of the month preceding publication.
WANTED : Two residents in anesthesiology. Appointment
immediately — male or female ; two-year organized clinical
anesthesia diagnostic and therapeutic nerve blocks, in-
halation therapy, blood bank. The course is collaborated
with basic science courses at medical school. Full main-
tenance. Salary open. Box 79, Ohio State Medical Journal.
FOR SALE: General Electric Portable F-4 X-Ray unit
with case ; 14x7 and 8x7 cassette holders, 14x7 and 8x7
hangers, 3 gal. developing ’ tank ; total $964 ; 1 % yrs. old. —
Thomas G. Petrick, M. D., Belle Center, Ohio.
WANTED : Resident physician in 150-bed hospital. Must
be graduate of approved medical school in the United
States ; excellent opportunity for future general prac-
titioner to study through rotating residency ; $250 per
month and full maintenance. Apply, Supt., Lake County
Memorial Hospital, Painesville, Ohio.
PRACTICE FOR SALE : Physician’s practice ; office with
complete equipment and Westinghouse X-ray machine. Sud-
den death reason for sale ; excellent opportunity. Address
Mrs. Samuel Rosenfeld, Jr., 2686 Bexley Park Rd., Colum-
bus, Ohio, or Phone DO 9522.
FOR SALE : Six-room home and four-room office com-
bination in midwestem Ohio community of 100,000. Active,
growing general practice grossed $18,000 in 1949. Office
completely furnished. Specializing. Available about July 1.
Box 96, Ohio State Medical Journal.
WANTED : Capable young physician for temporary posi-
tion in Industrial office. 200 Republic Building, Cleveland.
FOR SALE : Furnishings, drugs and equipment. Office
for rent at Spencerville, Ohio. Mrs. I. C. Stayner, Spencer-
ville, O.
FOR SALE : McCarthy, Brown-Buerger cystoscopes ;
urethrascope ; three 12" sterilizers; metal instrument cab-
inet ; Leitz microscope, three lenses. Box 95, Ohio State
Medical Journal.
FOR SALE : Established general practice of 39 years ;
also drugs and equipment. Office available ; small, progres-
sive village on Lake Erie ; physician recently deceased.
Box 114, Vermilion, Ohio.
DOCTOR’S DAUGHTER seeking employment as a phy-
sician’s secretary-receptionist ; pleasant appearance, reliable,
familiar with medicine and medical terms. Can type and
handle light bookkeeping. Must be in Cleveland or suburbs.
Please write or phone Mrs. Betty J. Berger, 13614 Glenside
Ave., Cleveland 10, Ohio ; ULster 1-1521.
FOR RENT : Complete suite of offices consisting of two
operating rooms, laboratory, dark room and waiting room.
K. S. Rowe, 225 W. Center St., Fostoria, Ohio ; Phone 3601.
WANTED : Thoroughly competent physician for Industrial
Office. Must be graduate of Class A School with adequate
hospital training. Salary, $6,000 per year. 200 Republic
Building, Cleveland 15, Ohio.
SITUATION WANTED : Competent physician wishes
Locum Tenens ; industrial position or institutional work ;
full or part time considered ; capable of administrative
work ; graduate of Class A medical school ; American &
single ; association or partnership with busy physician
desirable. Box 85, Ohio State Medical Journal.
BACTERIAL INCUBATOR: Hot Pack Model 808, 115 v.
all electric, wet or dry, completely automatic, brand new,
temp, range 30 to 60 deg. cent. Inside 18x18x19%, 2
shelves adjustable any height. Will sell for $200 f. o. b.
Ashland, crated. M. D. Shiling, M. D., 408 Center St.,
Ashand, Ohio.
FOR SALE : E. E. N. & T. practice and equipment in large
city. More than thirty years in same location. Box 90,
Ohio State Medical Journal.
Observations Are Drawn From
Cleveland X-Ray Survey
Greater Cleveland’s X-Ray Survey which ran
from March 5 through August 21 showed some
results which are of interest to all Ohio doctors.
According to a report in Ohio Public Health,
in that period of time 688,204 70mm. films were
taken — 684,763 by the survey team and the re-
mainder by cooperating agencies.
Of the total number, 95.9 per cent were read
as normal; 02.5 per cent were read as showing
evidence of abnormality. Of the total number,
0.3 of one per cent showed definite evidence of
tuberculosis, and one per cent showred evidence
of suspected tuberculosis.
There were 0.5 of one per cent of the films
which showed evidence of the presence of path-
ological change other than tuberculosis and heart
disease. Conditions found included carcinoma,
acute pneumonia, chronic suppurative lung dis-
ease, pneumonoconiosis, bronchiectasis, em-
physema, mediastinal tumors, sarcoidosis, and
diaphragmatic hernia. Of the total number, 0.7
of one per cent showed evidence of heart disease.
The percentages given show only evidence of
disease following examination of the small film.
Final figures following complete clinical in-
vestigation will not be available for some time.
At the time figures were compiled, 72.8 per
cent of persons recalled for further clinical in-
vestigation had returned to the retake center.
Officials estimate that this percentage will in-
crease to 80.
Of the tuberculosis cases discovered, 64.6 per
cent were in the minimal stage, 33.3 per cent
were in the moderately advanced stage and
only 02.1 per cent were in the far advanced stage.
jor February, 1950
199
*
Hamblen, E. C. : Some Aspects
of Sex Endocrinology
in General Practice,
North Carolina M. J.
7:533 (Oct.) 1946.
"Nowhere in medicine are
more dramatic therapeutic effects
obtained than those which
follow estrogen therapy in the
girl who has failed to develop
sexually. A daily dose of 2.5 to
3.75 mg. of Premarin’ given in a
cyclic fashion for several months
may bring about striking adolescent
changes in these individuals.”*
Estrogenic
Substances
( water-soluble)
also known as
Conjugated
Estrogens
(equine).
“Premarin”— a naturally conjugated estrogen— long a choice
of physicians treating the climacteric— has been earning
further clinical acclaim as replacement therapy
in hypogenitalism.
In the treatment of hypogenitalism, “Premarin” supplies
the estrogenic factors that are missing, and thus tends to
eliminate the manifestation of the hypo-ovarian state. The
aim of therapy is to develop the reproductive and accessory
sex organs to a state compatible with normal function.
Four potencies of “Premarin” permit flexibility of
dosages: 2.5 mg., 1.25 mg., 0.625 mg., and 0.3 mg. tablets;
also in liquid form, 0.625 mg. in each 4 cc. (1 teaspoonful).
While sodium estrone sulfate is the principal estrogen
in “Premarin” other equine estrogens... estradiol, equilin,
equilenin, hippulin . . . are probably also present in
varying amounts as water-soluble conjugates.
Ay erst, McKenna & Harrison Limited
22 East 40th Street, New York 16, New York
5005
for March, 1950
207
*7<4e PUtfAMtianX
By JONATHAN FORMAN, M. D.
Human Breeding and Survival: Population
Roads to Peace and War, by Guy Irving Burch
and Elmer Pendell (35 cents. Penquin Books,
Inc., New York City), has been well received
in both its previous editions, and makes as
strong a case for population limitation as can
be made. There are many misunderstandings
about this problem and many approaches. Even
the strongest opponents of the use of contra-
ceptives have written: “Catholic teaching, if
loyally adopted, cannot possibly lead to an ex-
cessive and haphazard population/’ There is
then no controversy on that score. The ques-
tion is, shall we accept defeat or shall we spend
our energies raising more and better food to
supply our people and then spend some time giv-
ing a thing they have never been offered —
an education for living within the biologic norm?
Rational Medicine, by John W. Todd ($6.50.
Williams & Wilkins Company, Baltmore, Mary-
land), lives up to its title. I have often recom-
mended a book as “a must” for every physician,
but never as wholeheartedly as I do this. It
puts first things first. It shows what is rational
and what is not about the practice of medicine
— diagnosis, analysis of symptoms, physical
signs, assessing the value of treatment, diet
drugs, the role of food injection, psychotherapy,
and the prevention of disease. Then, there is
that brilliant chapter of 27 pages giving the
biography of the child of an inadequate mother
from conception to old age, showing how badly
we all handle the constitutionally and nutri-
tionally inadequate person. — “The Black Chap-
ter of Medicine.” By all means, get this book
and read it for your own soul’s sake and the
good of your patients.
Gynecology and Gynecologic Nursing, by Norman
F. Miller, M. D., and Betty Hyde, R. N., ($4.25.
Second Edition. W. B. Saunders Company, Phila-
delphia) presents the necessary facts of nursing
in this field as presented by the staff at The
University of Michigan Medical School. Dr.
Miller has done a good job of making clearer
and more understandable the disease being cared
for.
Nutrition of the Dog, by Clive M. McCay ($3.50.
Comstock Publishing Co., Inc., Ithaca, New York).
Most physicians are dog lovers and most of us
own one or more. Most dogs grow old and die
before their time because of poor eating habits.
Few dog owners understand how to feed their
dogs to insure health, a good nature, and a
long life. Here is all of the known facts as-
sembled by one of the outstanding nutritionists
and a most successful practical dog feeder —
Professor of Nutrition, Department of Animal
Husbandry in the Cornell University.
Community Health, by Laurence B. Chenoweth,
M. D., and Whitelaw R. Morrison, M. D., ($3.00.
Third Edition. Appleton-Century-Crofts, Inc., New
York City), has been written by these two Ohio
physicians as a college text on the subject. It
has been written with an eye to giving the stu-
dent a grasp not only of the subject but also
of the cultural side — the historical developments
upon which progress rests — so often missing even
in our instruction in medical schools.
The Best Medicine, by Frederic M. Loomis,
M. D., ($2.75. Loomis Book Company, 516 Park
Way, Piedmont, California), is a nicely printed
gift edition of a series of short stories that have
appeared in national magazines in recent years,
by the author of “The Consultation Room,” “The
Bond Between Us,” and “In a Chinese Garden.”
A wise physician and an experienced counselor,
his stories are interesting and truly human.
Health Instruction Yearbook, 1949, compiled
by Oliver E. Byrd, M. D., ($3.50. Stanford Uni-
versity Press, Stanford, California) , is the
seventh annual appearance of this valuable re-
sume of 255 articles chosen from 1,643 read by
the compiler. Your reviewer has come to look
forward to the appearance of this annual as a
check upon his own reading. It is one of the
most valuable surveys of American medical and
health literature that exists.
Ecology of Health, edited by E. H. L. Corwin,
Ph. D., ($2.50. The Commonivealth Fund, New
York City), is the distillate of the papers read,
and the discussions of them, at the 1947 Institute
on Public Health sponsored by the New York
Academy of Medicine: Genetics; Maternal
Health; Animal and Insect Reservoirs of Dis-
ease; Climate, Geography and Disease; Realities
in Preventive Psychiatry; Trends in State and
Local Health Services; Professional and Lay Edu-
cation in Support of the Public Health; and
finally Government and Public Health. Such are
the titles, and the list of essayists and discus-
sants is from the Blue Book. Your reviewer
has been insisting at all times for the last ten
years that both health and disease must be ap-
proached and considered from the ecologic point
of view. Here is the beginning.
Nutrition — A Survey of the Basic Cause of Dis-
ease, by Charles Noyes Kinney, Emeritus Pro-
fessor of Chemistry, Drake University ($3.50.
W allace -Homestead Company, Des Moines, Iowa),
208
The Ohio State Medical Journal
is an elementary treatise prepared for use in
the livestock feed industry. It is a book that
physicians should read because it defends in
elemental terms the thesis that disease is pro-
duced by, or results following, abnormal metab-
olism of the cell and that good health in man
and beast is an ideal state of bodily chemical
balance. The primary cause of all disease is,
therefore, malnutrition. As would be expected,
the author, just as most physicians would do,
favors mineral and vitamin supplemental feed-
ings which in your reviewer’s opinion is proper
until the soil can be restored by deep-rooted
crops, trash mulch and compost as well as com-
plete mineral fertilizers.
%
Beauty After Forty, by Edyth Thornton Mc-
Leod ($3.95. Ziff-Davis Publishing Company,
New York City), presents in a hopeful way the
means by which the woman passing forty can
assert her right to life, love, and happiness. It
is the kind of book which could prevent many
a middle-aged separation and make the life of
many a husband happy by getting his mate’s
mind off her expected troublesome menopause.
It is a helpful volume in every aspect of aging.
Textbook of Physiology, by William D. Zoe-
thout and W. W. Tuttle ($4.75. Tenth Edition.
C. V. Mosby Company, St. Louis, Missouri) , has
been revised extensively. Among the new topics
are: Ferritin, sedimentation rates, globulins,
isotopes, lobotomy, the functions of the hy-
pothalamus, regulation of body temperature and
water content, energy balance and sleep.
Backgrounds of Social Medicine, by a group of
authorities at a round-table conference held by
The Milbank Memorial Fund (1.00 paper.
The Milbank Memorial Fund, New York City),
is an attempt to get sickness on the basis of
human ecology where it belongs. It is not Marx-
ian to insist that environmental factors are of
major importance in the production of sickness
and that medicines must always play a role of
minor significance even when in a crisis they
may save a life for the time being. When our
medical schools get chairs of social pathology
devoted to the environmental factors in diseases,
then the physician will lose his cast and priestly
character and will be in danger of becoming
merely a technician. Such an understanding of
life at the same time will jeopardize the priest-
hood as well. It is a field, therefore, that every
thinking physician should be exploring.
• «
Relation of Soil Content to Human Longevity
(Apply T. J. Brooks, Assistant Commissioner of
Agriculture of Florida, Tallahassee, Florida),
is a report of the discussion of many scientists
from many fields — a sort of scrapbook gathered
together in an effective way by the former
professor of economics in Mississippi State Col-
lege and his son, chief physician of the Florida
State University at Tallahassee. It supports in
the main the contention which I have been de-
fending throughout this country that there is a
relation and a direct one between balanced soils,
balanced foods, and robust health.
Operations of General Surgery, by Thomas G.
Orr, M. D., ($13.50. Second Edition. W. B.
Saunders Company, Philadelphia) , has been
issued in its second edition within five years which
speaks well for a text in this field. While the
arrangement remains the same a considerable
number of new techniques have been added.
Seventeen hundred step-by-step illustrations
serve to clarify adequate and clear descriptions
of operations.
The Salt-Free Diet Cook Book, by Emil G.
Conason and Ella Metz ($3.00. Lear Publishers,
New York City). As more and more physicians
come to recognize the value of a salt-free diet
in some 13 or more clinical conditions, the prob-
lem making such diets appetizing becomes of in-
creasing importance for this is the only way to
encourage fidelity. Here we have a cook book
that tells us just how to do it. Fifty menus
with receipes are presented as are suggestions
for those who eat out and those who are diabetic.
Diagnosis of Syphilis by the General Prac-
titioner, by Joseph Earle Moore (25 cents.
Superintendent of Public Documents, United
States Printing Office, Washington, D. C.), is
the simple statement of current information by
the distinguished teacher at Johns Hopkins writ-
ten for the U. S. Public Health Service.
Nutrition, by Margaret Chaney and Margaret
Ahlborn ($3.90. Fourth Edition. Houghton Mif--
flin Company, Boston, Massachusetts) , is an ex-
cellent text for the alert teacher of this most
important of all subjects.
Physiology of Heat Regulation and the Science
of Clothing, by L. H. Newburgh, M. D., (S7.50.
W. B. Saunders Company, Philadelphia) , is one
of those books that grew out of the wartime
activities of the National Research Council which
can be used so profitably by peoples who are not
at war. The relation of clothing to the weather
and to climate is a much more important topic
than most of us physicians have any idea.
Gynecological Endocrine Disorders, by C. L.
Buxton, M. D., and E. T. Engle, M. D., ($2.00.
C. C. Thomas, Springfield, Illinois), is another of
these efficient volumes written for the internist.
This boils down a great flood of books for you
and me.
Physiology of the Nervous System, by James
F. Fulton, M. D., ($10.00. Third Edition, Re-
vised. Oxford University Press, New York City),
brings us up to date since the second edition
appeared six years ago. It includes the more
significant developments.
for March, 1950
209
Entrance to Grounds
HARDING SANITARIUM WORT^gTON
For Nervous and Mental Disorders
NINE MILES NORTH OF STATE HOUSE— COLUMBUS
HARRISON S. EVANS, M.D., Medical Director
GEORGE T. HARDING, M.D., President ol Board
CHARLES L. ANDERSON, M.D., Clinical Director
L. HAROLD CAVINESS, M.D. J. RUSSELL FRANTZ, M.D. CHARLES W. HARDING. M.D.
THEODORE J. LUKENS, M.D. LESLIE H. GOULD, M.D.
Telephone: Columbus FR. 2-5367
An institution for the study and treatment of NERVOUS and MENTAL DISORDERS
John H. Nichols, M.D., Medical Director Herbert A. Sihler, Director Edmund V. Sihler, Assoc. Director
Roger K. Kalina, M.D., Resident Medical Director Approved by American College of Surgeons
'WINDSOR HOSPITAL. CHAGRIN FALLS, OHIO Phone: Chagrin Falls 7347
28707 EUCLID AVENUE
Located 12 Miles East of
Cleveland Public Square
WICK HAVEN
AN INSTITUTION FOR SELECTED NERVOUS AND MENTAL PATIENTS EMPLOYING
WICKLIFFE, OHIO
Phone Wickliffe 160
RATIONAL METHODS OF TREATMENT
(Member of American Hospital Association; Ohio Hospital Association and National Associaton of
Private Psychiatric Hospitals)
W . W . DANGELEISEN, M, D., M e d i c a I Director
THE MERCER SANITARIUM
MERCER, PA.
(30 Miles East of Youngstown)
For Nervous and Mild Mental Cases — Restful, Quiet, Attractive Surroundings — All Private
Rooms. Psychotherapy, Shock Therapies, Physiotherapy, Hydrotherapy, Occupational Ther-
apy, Special Diets, Excellent Library and Recreational Facilities.
Licensed by State; Member of Pa. Hosp. Assoc.; Member of Amer. Hosp. Assoc.; Member National Associa-
tion of Private Psychiatric Hospitals.
Medical Director, John L. Kelly, M. D., Diplomate in Psychiatry
■
I
210
The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association, a scientific society , non-profit corporation, with a definite
membership, for scientific and educational purposes.
Vol. 46 March, 1950 No. 3
Jonathan Forman, M. D., Editor
Charles S. Nelson, r. Gordon Moore,
Managing Editor — Bus. Mgr. Asst. Managing Editor
The Effect of Vitamin B12 on the Hematologic and
Neurologic Manifestations of Pernicious Anemia
JOHN F. MUELLER, M.D., THOMAS JARROLD, M.D., V. R. HAWKINS, R.N., and
RICHARD W. VILTER, M.D.
FOR many years numerous investigators
have attempted to obtain the active anti-
pernicious anemia substance from liver by
fractionization. It was not until early in 1948
that Rickes, Brink, Koniuszy, Wood and Folkers1
announced the isolation of a crystalline substance
containing cobalt with an as yet unpublished
chemical formula which they named vitamin Bi2.
Ultimate isolation depended upon the selection of
a suitable micro-organism, Lactobacillus lactis
Dorner, which required it for growth. The dis-
covery of this method of assay provided a means
by which its concentration could be determined
during the process of refining liver.
Randolph West2 was the first to use vitamin Bi2
clinically. He administered the material to three
patients with pernicious anemia and obtained very
satisfactory reticulocyte and erythrocyte re-
sponses. Soon thereafter Berk, Denny-Brown,
Finland and Castle3 reported a case of pernicious
anemia with postero-lateral column disease who
was sensitive to various liver extracts and who
responded promptly to vitamin Bi2. There was no
apparent sensitivity to this fraction of liver. The
effectiveness of this new member of the B-com-
plex in nutritional macrocytic anemia and sprue
was demonstrated by Spies4 and co-workers in
Puerto Rico and Cuba.
Various investigators have studied the relation-
ship of vitamin B!2 to the classic extrinsic-
intrinsic factor hypothesis of Castle’s. Bethell,
From the Department of Internal Medicine, College of
Medicine, University of Cincinnati, Cincinnati, Ohio. These
studies were aided by grants from Merck and Co., Inc.,
and the Robert Gould Research Foundation.
The Authors
• Dr. Mueller, Cincinnati, Ohio, is a graduate
of University of Cincinnati College of Medi-
cine, 1946; member, American Federation for
Clinical Research; and senior asst, resident in
medicine, Cincinnati General Hospital.
• Dr. Jarrold, Dayton, Ohio, is a graduate of
University of Cincinnati College of Medicine,
1942; member, American Federation for Clin-
ical Research; chief, medical residents, Brown
General Hospital, V. A. Center, Dayton; and
dean’s committee appointment, Univ. of Cin-
cinnati.
• Miss Hawkins, Cincinnati, Ohio, is a gradu-
ate of University of Cincinnati College of Nurs-
ing and Health, 1940; member, Ohio State
Nurse’s Association; medical head nurse, Cin-
cinnati General Hospital; and research asst, to
Dr. Vilter.
• Dr. Vilter, Cincinnati, Ohio, is a graduate
of Harvard Medical School, 1937; member,
American Society for Clinical Research; fel-
low, American College of Physicians; attend-
ing physician. Dept, of Internal Medicine and
chief clinician, medical clinic, Cincinnati Gen-
eral Hospital; assoc, prof, of medicine and
asst, dean. College of Medicine, University of
Cincinnati.
Meyers and Neligh5 reported that the feces of
patients with pernicious anemia contained more
vitamin B,2 than one would need to administer
parenterally to relieve their disease. They postu-
lated that these patients were unable to absorb or
utilize this material due to the lack of “intrinsic
factor” in the gastric juice. This theory was
225
given further impetus by the work of Berk,
Castle, Welsh, Heinle, Anker and Epstein6 who
showed that the hematopoietic activity of orally
administered vitamin Bi2 in pernicious anemia is
greatly potentiated by the simultaneous adminis-
tration of normal human gastric juice, but that
the parenteral route of administration is much
more effective. It is suggested from this work
that vitamin Bi2 is identical with tbe food (ex-
trinsic) factor which in turn is closely related to,
if not identical with, the antipernicious anemia
principle of liver.
This report deals with observations on seven
patients with pernicious anemia treated with
vitamin Bi2 during the past year, and confirms
the effectiveness of this agent in microgram
doses for the relief of hematologic, neurologic and
glossal abnormalities of pernicious anemia.
MATERIALS AND METHODS
Four patients (Case 1, 2, 3, and 4) were seen
and treated at the Cincinnati General Hospital
and subsequently followed in our outpatient de-
partment. The remaining three patients were
treated at another hospital and follow-up was im-
possible. Patients 2, 6 and 7 were new cases
who were admitted with severe macrocytic
anemia, achylia gastrica and megaloblastic ma-
turation arrest of the bone marrow. Cases 1
and 5 had been diagnosed as having pernicious
anemia three and two years, respectively, before
this admission but had received no treatment in
the interim. In addition, Case 5 presented him-
self with unequivocal evidence of postero-lateral
column disease of at least two years* duration.
Patients 3 and 4 were being treated with folic
acid for investigative purposes at the time they
developed spinal cord degeneration.
The following laboratory examinations were
performed on all patients on admission. Ery-
throcyte count, hemoglobin concentration, leuco-
cyte count, platelet count, reticulocyte count, and
cover slip preparations of the peripheral blood
and bone marrow stained with Wright-Giemsa
stain. Gastric analysis following histamine stimu-
lation, serum bilirubin, serology, stool examina-
tion and urinalysis were done routinely.
Following therapy, reticulocyte counts were
performed daily for at least ten days and ery-
throcyte and hemoglobin determinations were
done three times per week for two weeks and
weekly thereafter. Re-examination of a sample
of bone marrow was always performed at varying
times following vitamin Bi2 therapy.
The dosage schedule varied since one of our
purposes was the determination of a minimum
effective dose. Patients without neurologic disease
were given four micrograms or multiples thereof
in single doses. The total hematologic effect of
each dose was observed before giving additional
material. This method was followed until clin-
ical remission occurred and the patient was dis-
charged from the hospital. Thereafter the pa-
tients were maintained on three to five micro-
grams per week.
The patients with neurological manifestations
of pernicious anemia were given four to five
micrograms of vitamin Bi2 every other day until
a satisfactory clinical response was attained.
Thereafter they were maintained on ten to
twenty micrograms per week depending on indi-
vidual needs. All therapy was given intramus-
cularly.
RESULTS
The hematologic response to these extremely
small doses of vitamin Bi2 was gratifying. Sub-
jective improvement was obvious within forty-
eight hours and glossitis and bilirubinemia dis-
appeared rapidly. The reticulocyte response was
exceedingly good in all cases except one (Case 6)r
where the laboratory result is in question. It is
interesting to note that twelve micrograms, i.e.r
approximately one microgram per day for ten
days, usually induced a maximal clinical response.
In Case 6, however, sixteen micrograms induced
at best a suboptimal response. This patient’s
anemia was complicated by the presence of tabes
dorsalis and optic atrophy. Whether these com-
plications interfered with the response of his
bone marrow to vitamin Bi2 is conjectural. No
other adequate explanation could be found. That
vitamin BJ2 exerts its maturation effect rapidly on
the bone marrow can be ascertained by referring
to Table I which records the nucleated erythroid
TABLE I
Date
Sept. 7, ’48
Sept. 8, ’48
Sept. 9, ’48
Sept. 10, ’48
Megaloblasts
6.5
2
0
0
Early Erythroblasts
30.5
18.5
9.5
6.5
Late Erythroblasts
39.5
30.5
72.5
76.5
Normoblasts
74
88.5
321.5
647
Myeloid — Erythroid
1:1.5
1:1.4
1:4
1:7
ratio
Numbers of nucleated
erythroid
cells per
100
white blood
cells in the bone marrow on four successive days in a pa-
tient with pernicious anemia who received 6 gamma of
vitamin B12 on the first day.
components of the bone marrow per 100 white
blood cells in Case 2 on four successive days.
Six micrograms of vitamin Bi2 were given on the
day of the first aspiration, September 7, 1948.
In patients with neurologic relapse five micro-
grams every other day produced rapid clinical re-
sponse in all patients except one (Case 5). In
the latter, spinal cord disease had been present
for at least two years prior to therapy so that
very little improvement could be expected. He
felt much better and his gait was more steady
226
The Ohio State Medical Journal
TABLE II
HEMATOLOGIC AND CLINICAL DATA ON PATIENTS WITH PERNICIOUS ANEMIA TREATED WITH VITAMIN B
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for March, 1950
227
With combined systems disease.
Central nervous system syphilis with optic atrophy.
after therapy, although the neurologic abnormali-
ties were unchanged.
It was soon discovered that five micrograms
weekly would not maintain neurologic improve-
ment and larger doses in the range of ten micro-
grams twice a week were necessary. As would
be expected from previous experiences with liver
extract, patients with both hematologic and
neurologic relapse required more than the twelve
micrograms of vitamin B- to induce a clinical
remission.
CASE PROTOCOLS
Case 1: M.M., a 65-year-old white widow, was
admitted to the Cincinnati General Hosptial on
May 6, 1948, complaining of progressive weak-
ness of two months’ duration, dyspnea on exer-
tion, easy fatigability, sore tongue and anorexia.
Past history revealed that in 1945 the patient had
been treated in a local hospital for pernicious
anemia with refined liver extract. She was said
to have received a suboptimal response from
this therapy. There had been no intervening
therapy.
Physical examination revealed a chronically ill,
mildly malnourished white woman in no acute
distress. The sclerae were mildly icteric. An old
hemorrhage was noted in the fundus of the right
eye. The tongue was smooth, glistening and pale.
The lungs, heart and abdomen were entirely
normal, except for a palpable non-tender liver
IV2 cm. below the right costal margin. Neuro-
logical examination was normal.
Laboratory examinations revealed: Erythro-
cyte count, 1.490,000 per c. mm., hemoglobin 6.3
Gms. per cent, hematocrit 17 per cent, M.C.V.
114 cubic micrograms, M.C.H. 37 micromicro-
grams, M.C.H.C. 32 per cent, white blood count
2700 per c. mm., reticulocytes 4.6 per cent. Ani-
socytosis, poikilocytosis and hypersegmented poly-
morphonuclear leucocytes were noted in the peri-
pheral blood. The Wassermann reaction was
negative. Gastric analysis revealed histamine-
fast achlorhydria. Maturation arrest at the
megaloblastic stages of erythrocyte development
was found in the bone marrow. Serum bilirubin
totaled 2 mgs. per cent with 1.6 mg. per cent of
the indirect reacting type. An upper gastro-
enteric roentgenologic examination with barium
was normal.
On May 8, 1948, four micrograms of vitamin
B,o were administered intramuscularly. In three
days a repeat bone marrow aspiration revealed
complete reversion to the normoblastic level. On
the seventh day reticulocytosis reached a peak of
43.8 per cent. Clinical improvement was strik-
ing. By May 18, papillae could be seen on the
lateral margins of the tongue, and the appetite
had returned. The erythrocyte count rose to
2,200,000 per c. mm. and the hemoglobin to 8 gms.
per cent. A second dose of four micrograms of
vitamin Bi2 on May 26, 1948, produced a reticu-
locytosis of 14.3 per cent. The erythrocytes in-
creased to 2,840,000 per c. mm. A third dose of
four micrograms was given on June 19, 1948,
with a subsequent reticulocytosis of 3.8 per cent
and a rise in erythrocytes to 3,230,000 per c. mm.
and hemoglobin to 11.8 per cent. At this point
she was discharged from the hospital and has
been followed in our clinic on 3 to 6 micrograms
of vitamin Bi2 every week. Her blood counts rose
to, and have been maintained at, normal levels.
Case 3: R.P., a 73-year-old unmarried white
woman, was admitted to the Cincinnati General
Hospital on November 2, 1948, complaining of
numbness of the hands and inability to walk.
Pernicious anemia was diagnosed in 1939 at
which time she was treated with refined liver ex-
tract. In 1945 she was given folic acid, 30 mgs.
three times a week, orally, because she refused
further injections. In June, 1948, she experienced
a hematological relapse, her erythrocyte count
dropping from 4,480,000 per c. mm. to 2,490,000
per c. mm. On folic acid, 50 mgs. per day by
mouth, the blood count rose to 4,650,000 per
c. mm. in September, 1948. No neurologic mani-
festations were ever present. Six weeks before
entry the patient accidentally fell and sustained
a minor contusion of the right knee. Soon there-
after she began to complain of increasing weak-
ness, numbness in the hands and feet, drawing
sensation in the flanks and anorexia. The day
before admission she was unable to walk due to
extreme ataxia. She was admitted to the hos-
pital.
Positive physical findings were limited to the
nervous system. The cranial nerves were intact
except for partial 8th N. deafness bilaterally.
There was general, non-specific, weakness of all
muscle groups. There was definite ataxia in the
heel to shin test. Gait was wide-based and stag-
gering. The Romberg test was positive. There
was slight hynesthesia of the hands and feet. Per-
ception of vibration was absent over the lower
extremities up to about L 2-3 and over the finger
tips. The sense of position in the toes was
slightly impaired. The deep tendon reflexes were
active and equal. The Chaddock response was
abnormal bilaterally.
Laboratory determinations revealed: Erythro-
cytes 4,120,000 per c. mm., hemoglobin 13.8 Gms.
per cent, hematocrit 39 per cent, M.C.V. 94
cubic micrograms, M.C.H. 33 micromicrograms,
M.C.H.C. 35 per cent, white blood count 4200
per c. mm. Other laboratory findings were not
pertinent.
The patient was given five micrograms of
vitamin Bi2 every other day for four weeks.
Within the first week there was mild subjective
improvement. By the ninth day, vibration was
perceived in the fingers for the first time. The
Romberg test, although still positive, was im-
proved. The patient stated that she had much
more feeling in her hands. By the end of the
second week she was able to walk by herself. The
drawing in her hands was less annoying. Her
strength had improved. Neurological examina-
tion at the end of four weeks revealed vibratory
perception 20 per cent of normal in the fingers,
30 to 40 per cent over the sacrum, and absent in
the lower extremities. The reflexes were un-
changed. The Romberg sign was normal. The
patient was able to walk up and down stairs.
She was discharged from the hospital after four
weeks of therapy.
The dose of vitamin B,2 was changed to five
micrograms twice a week. Further improvement
did not occur. Recently we have increased the
dose to fifteen micrograms each week and have
noted very slow improvement.
DISCUSSION
In our brief experience, vitamin Bi2 has been
as effective as liver extract in the treatment of
pernicious anemia in relapse. Complete remission
has been induced in the blood, bone marrow and
228
The Ohio State Medical Jourtial
neurologic system. Glossitis and bilirubinemia
have disappeared. There is absolutely no evi-
dence from our experience or that of others that
vitamin B,2 is more effective than liver or will
induce a response qualitatively or quantitatively
different from liver. There is no evidence that it
will be effective where liver extract is not. In our
experience liver extract refractory megaloblastic
anemia and the anemia of cirrhosis are unaf-
fected, and in the experience of others, the same
is true of leukemia and any other type of liver
refractory anemia. The one real indication for
vitamin B12 occurs in the patient with pernicious
anemia who is sensitive to liver extract.
The effective dose is extremely small. On the
average a total of twelve micrograms will pro-
duce a maximal hematologic response. Such data
indicate that this compound is one of the most
potent in medicine. The fact that the dose is so
small suggests that vitamin Bi2 acts as an en-
zyme or catalyst in its role as a hematinic prin-
ciple.
It should be emphasized, as we stated previ-
ously, that minimum doses were utilized in this
study and it should not be assumed that these are
the optimum doses. In a larger series of cases it
would not be surprising if a certain number
would not respond to these minimal amounts. We
suggest for the routine treatment of pernicious
anemia the dosage schedule of five micrograms
of vitamin12 each day for ten days and five
micrograms each week thereafter until normal
hematological values are reached. Further ex-
perience will be necessary to determine the re-
quirements for long term therapy. For patients
with neurologic manifestations of pernicious
anemia a dose of ten micrograms per day is in-
dicated and should be continued if necessary for
two to six months until clinical remission is
achieved and no further improvement occurs.
Thereafter ten micrograms per week should be
satisfactory, although individual variation may
necessitate larger amounts.
It remains to be seen whether vitamin Bi2 will
be as effective as liver extract over a period of
years, but it is recommended for persons with
pernicious anemia who are sensitive to liver and
may even replace liver entirely if in the future
it can be produced inexpensively.
SUMMARY AND CONCLUSIONS
1. Vitamin B12 is effective in the treatment of
the hematologic, neurologic and glossal manifes-
tations of pernicious anemia.
2. One microgram of vitamin BJ2 is roughly
equivalent to one U.S.P. unit of liver extract and
twelve micrograms usually induces a satisfactory
hematologic remission. Five micrograms every
other day induces a satisfactory clinical response
in patients with combined system disease.
3. For routine treatment of pernicious anemia
we recommend five micrograms of vitamin Bi2
each day for ten days and five micrograms every
week thereafter. At least 10 micrograms daily
for several months will be required if neurological
abnormalities are found.
4. There is no evidence that vitamin Bi2 has
any more to offer a patient with pernicious
anemia than liver extract. At present, liver ex-
tract sensitivity is the one definite indication for
vitamin B12 therapy in pernicious anemia.
BIBLIOGRAPHY
1. Rickes, E. L., Brink, N. G., Koniuszy, F. R., Wood,
T. R., and Folkers, K. : Crystalline Vitamin Bi->. Science,
107:396, 1948.
2. West, R. : Activity of Vitamin Bi2 in Addisonian Per-
nicious Anema. Science, 107 :398, 1948.
3. Berk, L., Denny-Brown, D., Finland, M., and Castle,
W. B. : Effectiveness of Vitamin Bi2 in Combined System
Disease : Rapid Regression of Neurologic Manifestations and
Absence of Allergic Reactions in Patients Sensitive to In-
jectable Liver Extracts. New Eng. Jour. Med.. 239:328-
330, 1948.
4. Spies, T. D., Suarez, R. M., Lopez, G. G., Milanes, F.,
Stone, R. E., Toca, R. L., Aramburu, T., and Kartus, S. :
Tentative Appraisal of Vitamin Bi2 as a Therapeutic Agent.
J.A.M.A., 139:521, 1949.
5. Bethell, F. H„ Meyers, M. C., and Neligh. R. B. :
Vitamin Bi2 in Pernicious Anemia and Puerperal Macro-
cytic Anemia. Jour. Lab. and Clin. Med., 33 :147, 1948.
6. Berk, L., Castle, W. B., Welch, A. D., Heinle, R. W.,
Anker, R., and Epstein, M. : Observations on the Etiologic
Relationship of Achylia Gastrica to Pernicious Anemia. New
Eng. Jour. Med., 239:911, 1948.
Streptomycin in Treatment of
Progressive Primary Tuberculous Lesions
The results of streptomycin treatment in pro-
gressive primary tuberclosis may be summarized
as follows:
1. It uniformly lessened and in most cases
obliterated the toxic manifestations in 25 pa-
tients treated. The improvement usually became
apparent within a few days after the treatment
was begun.
2. It reversed the general downward clinical
course of the disease.
3. The physical findings improved and were
clearly demonstrable in 30 to 60 days after
treatment was begun.
4. The decreased roentgenologic findings fol-
lowed the improvement in the clinical picture.
5. Sputum conversion was completed in four
to five months in 89 per cent of progressive pri-
mary lesions.
6. The hospital stay was uniformly reduced
roughly from two to three weeks to six to eight
months’ time.
In spite of the fact, however, that streptomycin
has shown great promise especially in Progres-
sive Primary Tuberculosis in children it should
not be considered a cure-all; its use is still in
the experimental stage and larger numbers will
have to be observed over a longer period of
time before an exact and complete evaluation
of its worth in this field can be given. — McEnery,
Sweany, Turner, Chicago; 111. Med. Jour., Vol. 97,
No. 1, January, 1950.
for March, 1950
229
Causes of Failures in Patients in Whom Resuscitation
Was Attempted*
FRANK M. BARRY, M. D., and FREDERICK R. MAUTZ, M. D.
The Authors
• Dr. Barry, Cleveland, Ohio, is a graduate
of Western Reserve University School of Medi-
cine, 1938; diplomate, American Board/ of
Surgery; asst, surgeon. University Hospitals;
and asst. prof, of surgery, Western Reserve
University School of Medicine.
• Dr. Mautz, Cleveland, Ohio, is a graduate
of Western Reserve University School of Medi-
cine, 1933 ; diplomate, American Board of
Surgery; fellow, American College of Sur-
geons; member, American Physiological So-
ciety; member, American Assn, for Thoracic
Surgery; asst, surgeon, University Hospitals;
and asst. prof, of surgery, Western Reserve
University School of Medicine.
SOME of the physiological aspects of acute
cardiorespiratory failure have been dis-
cussed in the preceding papers. It is the
purpose of this paper to consider the problems
associated with the application of this informa-
tion to the surgical patient. Ideally it would be
better to prevent acute cardiorespiratory failure
in the operating room, and wise management will
undoubtedly prevent many of these catastrophies;
but it also seems fairly evident that in spite
of good management, and until our knowledge
has been extended, there will continue to be
cases of sudden unexpected death.
We can be pessimistic and accept these as
inevitable fatalities and hope that we as in-
dividuals do not have many such experiences in
a lifetime, or we can accept the challenge of
the problem and make a maximal effort to use
all available physiologic knowledge in an at-
tempt to resuscitate those cases in which phy-
siologic death is in the process of stealing our
patient.
WHY A RARE EVENT?
Although successful resuscitations have been
reported both from cardiac standstill and ventri-
cular fibrillation, the recoveries represent only
a very small fraction of all of the patients
who develop these difficulties. Why, then, is
successful resuscitation such a rare event? In
an attempt to get at least a partial answer to
this question we have reviewed a group of pa-
tients in whom resuscitation from acute circu-
latory failure was attempted by exposing the
heart and trying to restore a coordinated heart
beat and reestablish the circulation of the blood.
In the past two years it has been our aim
to attempt resuscitation by direct exposure of
the heart whenever acute cardiorespiratory
failure has developed in an operating room. We
think that every surgeon, regardless of his spe-
cialization, who is in command of an operating
room must be prepared to make important de-
cisions swiftly and at least to institute the
early steps of resuscitation so as to restore the
flow of oxygen to the brain, which is the all-
important consideration in successful resuscita-
tion.
There have been ten attempted resuscitations
in the study group, only one being completely
* Part V of a Symposium on “Acute Cardiorespiratory
Failure: Requirements for Successful Resuscitation,” pre-
sented at the Annual Meethig of the Ohio State Medical
Association, Columbus, April 20, 1949.
successful. The others showed varying degrees
of recovery, but had irreparable cerebral dam-
age due to anoxia and eventually succumbed.
A few of these cases will be reviewed in some
detail, since they point out various obstacles
to successful resuscitation.
FIRST CASE
The first case to be reviewed is that of a well-
developed and well-nourished 16-year-old white
girl with a chronic mastoid infection and choles-
teatoma. She was taken to the ENT operat-
ing room. The posterior auricular region was
infiltrated with 20 cc. of 1 per cent procaine solu-
tion with 8 drops to the ounce of 1-1000 adre-
nalin. She had received morphine sulphate gr.
1/6 Atropine gr. 1/150 as premedication. Her
blood pressure rose from 100/70 to 170/50 after
the procaine injection, and she complained of a
violent headache, retched, vomited, and had
a generalized convulsion. Following this, the
pulse and blood pressure could not be obtained.
A tracheal tube was immediately inserted by the
anesthetist and an attempt made to massage
the heart by pressing against the epigastrium.
Intracardiac adrenalin was given. There was
no apparent response to either of these measures.
Within five minutes time a surgeon was called,
the chest exposed and opened through an inter-
costal incision. Ventricular fibrillation was seen
to be present. Cardiac massage was begun and
maintained for 20 minutes before a spontaneous
coordinated beat was obtained by electrical shock-
230
The Ohio State Medical Journal
ing. During the period of massage an adequate
cerebral circulation was maintained as evidenced
by the fact that spontaneous respiratory effort
was resumed after four to five minutes of direct
cardiac massage. The patient recovered a normal
pulse and respirations but died twenty-four hours
later with convulsions and hyperpyrexia without
regaining consciousness.
This patient might possibly have been suc-
cessfully resuscitated if all the factors delaying
the opening of the chest had been eliminated.
Once the chest is opened and the circulation is
being maintained by cardiac massage, loss of
time is not so serious a factor as before, but
every effort must be made to eliminate all delays
in the procedure.
SECOND CASE
The second case is that of a 56-year-old man
having bronchograms done in the X-ray de-
partment, on the second floor of the hospital.
The patient’s throat was cocainized with the
usual dose of cocain. After 20 minutes, topical
anesthesia was not entirely satisfactory, and a
second application of cocaine was made into the
trachea. The total dose used was considered
within the limits of safety. However, the
patient immediately became unconscious and
stopped breathing. In the X-ray department
there were no facilities available for resuscita-
tion other than prone pressure artificial respira-
tion. The anesthesia department was called and,
in an estimated six minutes, brought gas
machine, tracheal intubation equipment to the
floor, but then it was decided to take the pa-
tient to the operating room, and another 6
to 10 minutes were consumed getting the pa-
tient into an operating room and getting a
thoracic surgeon to open the chest and start
cardiac massage.
The heart, which was in a state of cardiac
arrest, was readily started by gentle massage.
The patient rapidly developed a palpable pulse,
measurable blood pressure, showed signs of re-
turning peripheral circulation, and began in a
short time to show spontaneous respiratory
activity. Within an hour he showed generalized
muscular twitching which progressed into violent
generalized convulsions. He died with hyper-
pyrexia in about twenty-four hours. Could direct
resuscitative measures have been instituted im-
mediately when the heart stopped there would
have been a better chance of success in this
case.
Another cause of failure of the resuscita-
tion procedure is cumulative biochemical dis-
turbances that accompany a prolonged period
of respiratory insufficiency. This is most fre-
quently seen in long transpleural operations.
When the breathing mechanism of a patient is
for any reason impaired during operation, it
is the custom for the anesthetist to administer
higher oxygen concentrations to prevent anoxia.
A patient’s skin color can be maintained fairly
normal by such a method although more precise
methods of study may show varying degrees
of hypoxia. The carbon dioxide exchange during
such a time is apt to be forgotten. The only
way for carbon dioxide to obtain exit from the
body is to accumulate until the diffusion partial
pressure is sufficient to permit the carbon dioxide
to again flow from the body. If such a condi-
tion persists for a considerable time, a serious
acidosis may develop. This is believed to
precede the sudden circulatory collapse which
comes without warning to some of these patients.
EXAMPLE OF TYPE
The next case is probably an example of
this type of disturbance.
A 15-year-old girl was subjected to a left
lower lobe lobectomy and lingulectomy for
severe bronchiectasis of long standing. The
dissection was moderately difficult due to lymph
nodes and fibrosis around the hilus of the lobe,
but everything seemed to progress satisfactorily,
and blood loss was replaced by continuous trans-
fusion during the procedure. The procedure
was carried out without incident to the com-
pletion of the closure of the chest wall and
skin. When the patient was turned from the
side to her back and the anesthesia was being
discontinued, the patient suddenly became pulse-
less. There had been no anesthetic agent ad-
ministered for 30 minutes. The wound was
rapidly opened and the heart found in stand-
still. Heart beat was restored by the use of
massage, adrenalin, and calcium chloride. The
patient maintained a circulation which was poor
in quality and did not improve. She did not re-
gain consciousness and died twelve hours later.
It is extremely difficult in transpleural opera-
tions to maintain pulmonary ventilation exactly
at a normal level. It is our belief that this
can only be done in long operations by con-
trolled breathing — either by intermittent com-
pression of the breathing with the hand or by
a mechanical method such as is discussed else-
where in these papers. This introduces new
problems into the management of the anesthesia
which time does not permit us to outline at
present, but augmented and controlled breath-
ing is finding wide application in thoracic sur-
gery. It is doubtful whether there is much in-
dication for this in non-thoracic surgery since
the breathing mechanism is exceedingly depend-
able when we do not place too much of a
burden on it in the way of heavy premedications
and depressing doses of anesthetic agents.
AFFECTS OF ANOXIA
The affects of anoxia must not be ignored.
We must remember that when the skin is
for March, 1950
231
cyanotic the myocardium, too, is cyanotic.
Anoxia is most easily not recognized in colored
patients and in anemic patients. The following
is an example:
A 20-year-old Negro male had an extra-
pleural exploration of the posterior mediastinum
through a posterior rib resection for a medi-
astinal abscess. His induction was uneventful,
but he developed cyanosis as the procedure
progressed and suddenly his pulse and pressure
became imperceptible. Intratracheal tube was
in place so there was no interruption of the
oxygen supply to the lungs. Time was taken
to pack the posterior wound closed, and the
patient was turned and an anterior incision
made and the heart massaged. The elapsed
time from the stoppage to restoration of cir-
culation by massage was four or five minutes,
and there was return to normal spontaneous
respirations in thirty minutes. He too never
regained • consciousness and soon began to have
muscular twitching. He developed hyperthermia
and died within twenty-four hours. The ques-
tion as to the presence of mediastinal reflexes
in this man was brought up but more or less
discarded in favor of the presumed cumulative
effects of severe anoxemia. This has been well
demonstrated lately by the studies made with
continuous photo-electric estimations of the
hemoglobin saturation with oxygen done by
Hartman and McClure, who have shown that
rather marked deficits may exist even in the
presence of normal gross appearance of the
patients. That this effect limits the patient’s
ability to tolerate complete anoxemia to the
brain cannot be doubted. Again in this case
some time was lost on the part of the surgeon
to at least superficially close his operative wound.
This could have been better done after the beat
of the heart had been restored.
Another example of this same phenomenon was
one of the saddest cases that we have had. A
33-year-old colored man who was an excellent
physical specimen and in whom we had an in-
terest because he had had a gastrectomy for
peptic ulcer some years before, was given a
gas-oxygen-ether anesthetic for an appendec-
tomy for acute appendicitis. Induction was
stormy, and as so often the case in a large
muscular individual, there was much retching
and vomiting. The trachea was aspirated, the
anesthetic discontinued, and 100 per cent oxygen
given. The heart and respirations ceased. An
intratracheal tube was passed, intracardiac adre-
nalin given, and the heart exposed. It was in
standstill. Procaine was given intracardially,
and the heart started off with a- normal
mechanism soon after massage was instituted.
Spontaneous respirations appeared in forty
minutes, but the patient again developed con-
vulsions and hyperpyrexia and died in five
hours. Again the factors that defeated the
surgeon were the time used in making the
diagnosis and entering the chest, and the prob-
able factor of preceding cyanosis limiting the
ability of the brain cells to tolerate anoxemia.
Pre-existing shock is another factor that seems
to limit the ability of the patient to recuperate
from cardiac arrest, although in these instances
perhaps the cardiac arrest is only a part of the
mechanism of death in shock, and restoration of
the heart beat merely delays death.
SHOCK CASES
We have had two cases in which shock seemed
to be the factor that precipitated cardiac stand-
still.
First, a 32-year-old colored male was stabbed
in the abdomen, and the knife blade broke off
in the abdomen. He was brought to the hospital
with no pulse nor blood pressure. Blood pres-
sure was restored rapidly to 150/50 with the
use of intra-arterial transfusion, and he was
explored. The bleeding was coming through
the pancreas, and this area was sutured. This
done, the patient’s bleeding stopped and all
seemed well until the anesthetist said that the
patient had no pulse; we realized that the
*
bleeding stopped because of circulatory failure.
The chest was opened, and the heart started
readily, but it was about eight minutes from
the time that the surgeon noted that the ab-
dominal bleeding had stopped before a notice-
able circulation was obtained. The patient lived
three hours, did not develop convulsions, but
remained in shock, i. e., blood pressure remained
below 80/60. At autopsy there were holes in
the abdominal aorta and the celiac axis. We
perhaps had underestimated the degree of this
patient’s shock and had not treated it exten-
sively enough, which may be something to think
about in the use of interarterial transfusion
where the peripheral blood pressure is so readily
restored.
Another example of this same type of prob-
lem was a 46-year-old colored woman who had
had numerous abdominal operations, the last,
three months before admission, for intestinal
obstruction. She was admitted on this occasion
with a five-day history of intestinal obstruction.
She was prepared by the usual methods, we
thought adequately, and given 14 mg. of ponto-
caine intrathecally for an anesthetic. Her pulse
and respirations ceased, and the heart was ex-
posed and massaged immediately. It was in
standstill and started with the first touch of the
hand but recovered its vigor only after the pa-
tient was given adrenalin and neosynephrine
to support the peripheral circulation. The patient
gradually regained a better pulse and over a
period of time the blood pressure was restored
to normal. The respirations never returned to
normal, and the patient began to have convulsions
and died in six hours. Here the cause of death
232
The Ohio State Medical Journal
was the period of anoxemia of the brain, but the
mechanism was lack of circulation blood due
to shock rather than anoxemia as in the previous
cases, for the circulation was not interrupted
for more than two or three minutes.
SUMMARY
The obstacles to better results in resuscitation
procedures seem to be:
1. Inability to recognize the exact time of
cessation of the circulation so that cardiac mas-
sage can be immediately instituted.
2. Delay in opening the chest and restoring
the oxygenation of the brain by artificial pul-
monary ventilation and cardiac massage.
3. Delay in getting necessary drugs and shock-
ing device and other equipment necessary in
restoring the circulation.
4. Pre-existing organic disease such as those
involving heart, lungs, and brain.
5. The effects of anoxia, hypercapnia, and
surgical shock.
Some of the conclusions and recommendations
are obvious:
1. Better equipped and staffed operating rooms.
2. All procedures that might require resuscita-
tive measures must be done where those meas-
ures are immediately available.
3. All surgeons must be prepared to carry
out resuscitative procedures — including cardiac
massage and defibrillation of the ventricles.
4. Great care must be exercised in not open-
ing the chest unless there is complete circula-
tory arrest or the damage done might easily
outweigh the benefits. Direct writing electro-
cardiogram in every operating room would be
a great help in making such a decision.
5. Even if there are few successful resuscita-
tions, a better understanding of the physiology
involved will greatly aid in the prevention of
these catastrophies.
The Human Dentition
Owdng to the effects of civilization, the teeth
of the higher classes of both the American and
European peoples are often decayed, which is
not so much the effect of a weakness of the
structure of the teeth as it is the result of un-
natural foods and habits.
The closer the human family approaches the
natural methods of life and the teeth are made
to perform their normal functions, the more
often do we find a better structure and arrange-
ment of the dental organs. — William F. Nelson,
D. D. S., Wilmington, Del.; Delaware State Medi-
cal Journal, Volume 22, Number 1, January, 1950.
The Story Behind the Word
Some Interesting Origins of Medical Terms
Gonorrhea — The name of this disease is derived
from the Greek words, “gonos,” meaning seed,
and “rhoia,” meaning flow. The term is actually
a misnomer due to the fact that ancient physi-
cians erroneously believed that the discharges
of gonnorhea in the male were an involuntary
loss or flow of semen or seed, instead of a dis-
charge of pus. The origin of the term is usually
attributed to Galen, who lived in the Third Cen-
tury A. D., but some historians say the term
goes back to Hippocrates or about 460 B. C.
Skeleton — Literally this word means a dried
body or a mummy. It is derived from the Greek
word, skello, meaning “I make dry.” Originally,
it meant the bones of any animal dried and re-
tained in their natural position.
Testicle — Derived from the Latin word “testi-
culus” which is a diminutive of the Latin word
“testis” meaning a witness and hence “testicle,”
a witness or proof of virility.
Gleet — This designation for the chronic stage
of urethritis is descriptive of the muco —
purulent discharge which is present. Gleet is
derived from the old middle English word
“glet,” which in turn comes from the French
term “glette,” meaning the “froth of an egg.”
There is also the low German word “glett”
meaning slippery.
Hymen — Hymen was the ancient Greek my-
thological God of marriage and nuptial song. He
is remembered by us medically in the term we
use to designate the delicate female membrane
which is supposed to be ruptured on the wedding
night.
Aphrodisiac — These sex-exciting drugs derive
their name from the classical Greek mythology
and are named in honor of Aphrodite the Greek
Goddess of Love.
Epsom Salts — So called after Epsom Downs in
Surrey, England, from whose waters it was
originally obtained.
Piles — A term descriptive of the appearance of
the lesion and derived from the Latin word
“pila” meaning a ball or globe.
Privy — This essential structure of our rural
civilization has many designations such as, out-
house, backhouse, Chick Sale, or necessary; but
technically and most universally used is the term
“privy.” This term is derived from the French
word “prive” or private which in turn comes from
the Latin word privus meaning “ones own” or
“assigned to private uses.”
Catarrh — A name descriptive of the condition.
It is derived from the Latin “catarrhus” which
in turn stems from the Greek words “kata” or
down and “rhea,” I flow.
Harry Wain, M. D., Mansfield, Ohio.
for March, 1950
233
Low Calcium and Mineral Oil Treatment of Poliomyelitis —
Three- Year Report
BERT C. WILEY, M.D.
THIS method of treatment was developed
by the Physical Medicine Department of
the Miami Valley Hospital, Dayton, Ohio,
near the end of the 1945 poliomyelitis season.
It is based upon the theory that the poliomyelitis
virus requires ionized calcium for its propaga-
tion, and that the virus or its toxin is distributed
throughout the body as a fat-soluble material.1’ 2
The chief change made in this treatment dur-
ing the past two years has been the addition of
Benadryl. It is given subcutaneously in 10 to 25
mg. amounts every 4 to 6 hours as needed to
stop or prevent the formation of increased
pharyngeal mucus. This routine has enabled us
to keep the air-ways satisfactorily open. Aspira-
tion has been needed only initially or when the
dosage or timing of the drug were not properly
adjusted. It has been the greatest single factor
in reducing the morbidity and mortality of our
bulbar cases.
The essentials of our mimeographed check-
list of initial orders follow:
1. Low calcium, high carbohydrate, low vitamin
D diet.
2. Only SOFT water urged: 1500 to 2500 cc per
day.
3. Sodium acid phosphate gr 5 to 30, 3 times
a day with meals.
4. Mineral oil 1/2 to 2 oz stat., then 1/2 to
1-1/2 oz at bedtime daily.
5. Prostigmine bromide 7-1/2 to 15 mg p. o.
four times a day, 20 minutes before meals and at
bedtime (for smooth muscle stimulation).
6. Phenobarbital gr 1/4 to 1/2 three times a
day, and at bedtime as long as thought necessary.
7. Aspirin or APC q4h for pain or temperature
of 100° or over, as long as thought necessary.
8. Cold wet packs for fever of 102° or over,
as long as thought necessary.
9. SS enema stat., then q. o. d. as long as
thought necessary.
Prostigmine Methyl Sulphate 1/2000 1 cc
“H,” 10 minutes before subsequent enemas if
initial enema is not expelled well, as long as
thought necessary.
10. If unable to void:
a. Try hot water bottle to suprapubic
region, as long as thought necessary,
b. Catheterize q6h for three times, then
c. Insert Foley, drain q4h, and irrigate
with Aqueous Zephiran 1/20,000 q8h.
11. For increased pharyngeal mucus:
a. High shock position (30°).
b. Aspirate as long as thought necessary,
c. Benadryl 15-25 mg “H” q6h.
12. Have respirator ready start with: 0-4 posi-
tive pressure; 10 to 15 negative suction; 20-26 R.
Submitted August 17, 1949.
The Author
• Dr. Wiley, Dayton, Ohio, is a graduate of
Ohio State University College of Medicine, Co-
lumbus, 1943; diplomate, American Board of
Physical Medicine and Rehabilitation; mem-
ber, American Congress of Physical Medicine;
and director. Department of Physical Medicine,
the Miami Valley Hospital.
This private general hospital provided an ex-
cellent opportunity to compare the results ob-
tained with this treatment and the results
obtained with other currently good poliomyelitis
management. Practically all cases not given
the low calcium and mineral oil treatment were
handled by well-qualified members of the At-
tending Staff of pediatricians, internists or
orthopedists. The cases given “other treatment’'
are definitely not controls, since all other
aspects of their management was not the same
as that for the “treated” cases. They were
merely not given the low calcium and mineral
oil treatment, but were given what was con-
sidered good management. Yet they do serve
as a valid gross basis for comparison. Those
patients included in the “not possible” list ar-
rived in too poor a condition to take anything
orally, either voluntarily or by gavage, and so
Numbers Treated
s
.3^2 ^
JC
c ■-
'o O C
c
72^ 41
O !* 8
V
£
» T.
£ <=
i Sits
s- -C
0) c6
.C O'
^ C ai
o •*-• $»(
? c
J§H
OH
hz
1946 41 4 2
1947 62 14 3
1948 36 7 2
139 25
Complete
Recovery
£
0)
P —»
JiO c
B
<u
« T.
° g J
u £
E =
v es
a
> S o>
P w
Year
jSh
OH
HZ
No. %
No. %
1946
26 61.8
1
25.0
0
1947
37 59.7
3
21.5
0
1948
18 50.0
1
14.3
0
81 58.3
5
20.0
0
234
The Ohio State Medicai Journal
Complete Recovery
or Insignificant Impairment
Year
£
3_
3 _ 3
°g|
jin
-m
G
0)
. s
Si'S
jz i>
-m u
OH
o>
-m3
§«
£ °
-ti Pi
So
hZ
No. % No. %
1946 33 78.6 2 50.0 0
1947 46 74.2 8 57.0 0
1948 24 66.7 3 42.9 0
103 74.0 13 52.0 0
Deaths
Year
3„
Be
3 _ 3
U 3 £
S- £
> «J 3
C Q;
o*- s-
g
3 3
.c 3
-m>
OH
ju
+> 3
§’®
e|
PH
2|
HZ
No.
%
No.
%
No.
%
1946
0
-
0
0.0
2
100.0
1947
0
2
14.3
3
100.0
1948
0
— -
0
0.0
2
100.0
0
—
2
8.0
7
100.0
Days
Onset
to Walk
Year
3 —
J)
25 1
-M
G
-M 3
G
3 _ 0)
<L>
O 3 g
. s
«J 3
JZ 0>
£ °
5 Pm
£3
ill
OH
HZ
1946 ...
. 25.6
39.3
1947
21.6
50.4
1948 ...
—
18.9
44.1
—
22.0
44.6
Days Duration of
Follow-Up
Year
£
3_
U +5
V 3
X 0)
+J i.
OH
3
-3
| s
J£
So
H Z
1946
106.7
94.15
6.5
1947
113.4
58.6
6.0
1948
123.5
80.3
4.0
114.5
77.7
5.5
form a definite limitation upon this treatment
regime.
The preventive possibilities of this regime3
apparently have never been significantly tried.
At least no patients were admitted who had
carried out the preventive recommendations.
SUMMARY
1. There were no deaths among any polio-
myelitis patients who were admitted in time to
try the low calcium and mineral oil treatment,
and upon whom it was used.
2. When the results in 139 poliomyelitis pa-
tients who were given the low calcium and
mineral oil treatment during the past three
years, are compared with the results of 25
poliomyelitis patients admitted during the same
period, to whom this treatment could have been
given but electively was not, the following data
are obtained:
a. There were nearly three times as many
complete recoveries among the “treated’' pa-
tients.
b. There were over 40 per cent more “treated”
patients who achieved either complete recovery
or functionally insignificant residual impairment
than the “other treatment” patients.
c. On the average, the “treated” patients were
able to walk in about one-half the time.
The chief factor in favor of further trial of
the low calcium and mineral oil treatment is that
it has resulted in apparent benefit to patients
who otherwise could be offered little, in the light
of our present knowledge of poliomyelitis.
BIBLIOGRAPHY
1. Wiley, Bert C. : Preliminary Report: Low-Calcium
Treatment of Poliomyelitis. O. S. M. J., 41:12, pp. 1103-6,
Dec., 1945.
2. Wiley, Bert C. : Poliomyelitis Analysis. O. S. M. J.,
42:7, pp. 724-7, July. 1946.
3. Wiley, Bert C :. Low Calcium and Mineral Oil Treat-
ment of Poliomyelitis. O. S. M. J., 43 :12, pp. 1255-7, Dec.,
1947.
Care of the Newborn
The neonatal period still contributes over 60 per
cent of deaths that occur during the first year of
life — despite the fall in neonatal mortality from
31 to 21 per 1000 live births in the past 15 years.
Modern care of the newborn is concerned with
attention to factors that may operate before and
during birth as well as in the neonatal period.
The health and nutrition of the mother from con-
ception on may effect the embryo and fetus and
be responsible for congenital malformations, abor-
tions, stillbirths and premature births.
Modern obstetric management protects the
infant from traumatic injury during delivery but
the injurious effects of anoxemia, responsible for
58 per cent of liveborn infant deaths, are far
from being controlled.
The major causes of disease in the newborn are
anoxic injuries, traumatic injuries, infections, con-
genital defects and erythroblastosis. Some anoxic
injury can be arrested or minimized through
the prophylactic use of oxygen. When the anoxic
injury is accompanied by generalized edema
the administration of fluid is contraindicated. The
mortality due to erythroblastosis fetalis has fallen
as the result of early delivery in indicated cases
with immediate replacement transfusion. Many
congenital malformations; tracheo-esophageal
fistulae; absence of the bile ducts; various type
of intestinal obstruction; and diaphragmatic
hernias now have an excellent chance of being
cured by surgery if promptly diagnosed. There
is good reason to believe that epidemic diarrhea
of the newborn can be eliminated through im-
proved nursery technique and the application of
simple epidemologic principles. — S. H. Clifford,
M. D., Boston; Jour, of Maine Med. Assn., Vol. 41,
No. 1, Jan., 1950.
for March, 1950
235
Unusual Fracture of Cervical Spine with
Marie-Strumpell Disease
HARVEY R. HATHAWAY, M. D.
MR. F. C., a white male, 37 years old, was
walking in shorts in his kitchen after a
bath looking for an electric light cord.
He fell on the floor on his right shoulder when
he stumbled over a box jn the dark. A flash of
light was noted accompanied by a snap in his
neck and pain. However, he arose and called on
the telephone himself, reporting his experience,
stating he had no paralysis, weakness or pares-
thesia, only discomfort in his neck. After rest-
ing in bed for two hours, he developed trouble
in breathing, his lower jaw tending to protrude.
When he voluntarily replaced his jaw, dyspnea
occurred.
Past history of severe rheumatoid arthritis in
1933 with ankylosis of entire spine and sacro-
iliac joints. There was only 15 to 20° motion
in his hip joints. He was struck by an auto
in 1943 with a compression fracture of L 4 ver-
tebra, making a good recovery.
Physical examination two hours after his
present injury revealed no unusual respiratory
difficulty, but he talked with a little dysphonia.
Patient was lying on his left side with a rigid
neck. Patient gagged easily, but nasopharynx
appeared normal. Examination of entire body re-
vealed no other abnormalities. There was no
peripheral weakness nor abnormal reflexes of
extremities. Blood pressure, 120/70; pulse 100.
After examination the patient developed dif-
ficulty in breathing and tried to raise up in bed.
In one minute respiration was normal on lying
down again. Arrangements were made to hos-
pitalize the patient by ambulance. Approxi-
mately two hours forty-five minutes after his
injury and before the ambulance arrived, the
patient again developed dyspnea, asking for a
hose from the enema bag. He developed cyanosis
and died.
The patient was transported to Lakewood Hos-
pital where postmortem examination revealed
35 to 40 cc of blood infiltrated into soft tissue
of the prevertebral area extending from the third
to fifth cervical vertebrae. There was narrow-
ing of the hypopharynx just above the glottis,
and slight edema of the mucuous membrane.
Also, separation was described between the 4th
and 5th cervical vertebrae with an irregular
fracture line. The dura appeared intact. No
subdural or subarachnoid hemorrhage was found
in the brain. No free blood in the spinal canal.
After fixation, microscopic examination of the
midbrain, pons, medulla, cerebellum and upper
cervical spinal cord revealed no gross lesions.
Final significant anatomical diagnoses:
1. Fracture of cervical vertebrae at junction
of 4th and 5th.
2. Hemorrhage into adjacent paravertebral
and prevertebral tissue with partial stenosis of
Submitted July 14, 1949.
The Author
• Dr. Hathaway, Lakewood, Ohio, is a gradu-
ate of Western Reserve University School of
Medicine, 1930; and assistant visitant in sur-
gery, Lakewood Hospital.
the glottis. Slight edema of larynx. Marked
rheumatoid arthritis of vertebral column. Pas-
sive hyperemia and focal hemorrhage in lungs.
FIGURE I
3. Slight generalized arteriosclerosis.
X-ray plates made postmortem exaggerate
the deformity as shown in Figure 1.
I shall appreciate explanation of the cause
of death of this patient.
The Sex Deviate
The drama of sex begins in childhood and many
psychologic and biologic situations produce de-
viations in sex development. The basis for nar-
cissistic displacements, for guilt feelings, and for
defensive sadistic impulses can be laid bare to
an adolescent so that he can adjust to and control
his tendencies even if they cannot be eradicated.
— E. E. Mayer, M. D., Pittsburgh; Penna. Med.
Jour., Vol. 53, No. 1, January, 1950.
236
The Ohio State Medical }ournal
Sympathectomy and Phlebectomy for Post-Phlebitic Ulcer* *
RICHARD HOTZ, M. D., and FRED M. DOUGLASS, Jr., M. D.
The Authors
• Dr. Hotz, Toledo, Ohio, is a graduate of
University of Cincinnati College of Medicine,
1933; fellow, American College of Surgeons;
diplomate, American Board of Surgery; at-
tending surgeon, St. \incent’s, Toledo Mercy,
and Maumee Valley Hospitals, Toledo.
• Dr. Douglass, Toledo, Ohio, is a graduate
of Jefferson Medical College of Philadelphia,
1944; and resident surgeon, St. Vincent’s Hos-
pital.
THE post-phlebitic ulcer is a chronic in-
durated indolent ulcer of the lower ex-
tremity following deep obstruction, usually,
thrombophlebitis or phlebothrombosis, of the
femoral system. It is characterized by chronicity,
inflammation, local necrosis, peripheral and gen-
eral saphenous varices, evidence of local phle-
bitis and edema, and most importantly by cold,
wet feet.
The phlebitic or stasic ulcer is conceived in
obstruction, maturated in stasis, born of trauma
and infection, and perpetuated by local tissue
anoxia. It is evident, therefore, that therapy
directed toward the cure of the mature stasic
ulcer must take into account all phases of its
origin and development rather than the correction
of but one or two of these.
It must be emphasized at the onset of this
discussion that we are interested in a special
form of ulcer to be differentiated from the
simple varicose ulcer. The latter is shallow,
relatively clean, with evident long saphenous
insufficiency, and no evidence of deep obstruction.
Until recently, various tests for the competency
of the deep venous circulation had been con-
sidered mandatory before treating such varicose
ulcers. Therefore, many patients with true post-
phlebitic ulcer have been denied the elemental
therapy of eliminating superficial stasis for fear
of increasing leg edema.
The purpose of the combined operation is to
eliminate both superficial and deep venous stasis,
to remove large pools of stagnant blood about
and beneath the ulcer, and to relieve the local
tissue anoxia by increasing the arterial and
arteriolar blood supply to the affected area.
The surgical management of varicose veins and
their complications needs no documentation.
Since Celsus first performed phlebotomy for
thrombis, to this time, the surgical treatment
of superficial varices has come through progres-
sive stages until there is general recognition
of the need for ligation of the tributary veins
about the foramen ovale and the removal or
destruction of the major superficial channels and
their communicating veins.
The value of surgical therapy for deep phle-
bitis, whether acute or chronic, and for phlebo-
thrombosis, has been less clear until recent years.
Sporadic incidences of ligation of the external
femoral vein appear in the literature but no
Presented before the Section on Surgery at the Annual
Meeting of the Ohio State Medical Association, Columbus,
April 19, 1949.
* From the surgical service of F. M. Douglass Sr., and
the Maumee Valley Hospital.
concerted attack against thrombo-embolism by
ligation was made until Homans1 showed the
safety of such a procedure. Repeated publica-
tions by Homans,2 Ochsner,3 et al., Allen* and
associates, Linton5 and many others have estab-
lished the rationale and safety of femoral in-
terruption in acute phlebitis. Its merits when
contrasted to heparin and dicumarol therapy, so
favored by Murray,6 Bower,7 and most recently
Wise8 and associates, is not statistically evident
at this time and is not subject to discussion here.
Through the years ligation of the chronic
femoral veins has been avoided though Homans
suggested this as a rational and harmless oper-
ation in 1937. It remained for Buxton, Coller®
and their associates to report their favorable
experiences in ligating the external femoral for
chronic phlebitis. They conclusively demon-
strated that edema and ulceration were not in-
creased by such ligation, but that stasic ulcers
improved or healed without evidence of un-
toward sequelae in 24 consecutive cases. Soon
Linton,10 Hinder11 et al., Ochsner,12 and others
reported similar favorable results.
Simultaneous ligation of the saphenous system
and of the external femoral vein was the logical
conclusion of these clinical investigations. Linton
and Hardy,10 ,13 Vaughn,14 Rees and Slavin15 have
shown enhanced venous return following com-
bined operation with healing of stasic ulcers and
a reduction in edema of the operated limbs in a
majority of cases.
Ochsner and DeBakey16 have long advocated
paravertebral block of thrombotic extremities,
after they noted that the associated angiospasm
contributed much to the edema and pain of such
limbs. They, Nicholson17 and Niade,18 have shown
that remarkable relief of pain and edema follows
this simple treatment. The fundamental re-
for March, 1950
237
searches of Laufman19 and associates has clearly
shown the relationship between thrombosis and
arterial spasm, so that anti-spasmodic therapy
has been established in scientific evidence as well
as in clinical experience. It remained for Shu-
macker and Abramson20 to show the value of
lumbar sympathectomy in chronic stasic ulcers
following frostbite. The relief of local tissue
anoxia by lumbar sympathectomy in the presence
of ulcers has subsequently been advocated by
the same authors,21 by Krontiris,22 Voris,23
Lisker,24 and several others. Patients who have
a marked degree of arteriosclerosis were formerly
thought to be beyond the aid of lumbar sym-
pathectomy. Jemerin,25 Trimbell,26 et al., de
Takats,27 and associates, have shown that a large
measure of relief from both pain and edema can
be given these individuals despite the lack of
confirmatory laboratory evidence that sym-
pathectomy will increase arterial flow. It is
therefore possible to give many older patients
with stasic ulcer a measure of relief despite
their advanced arteriosclerosis.
The basis for rational surgical therapy for
chronic stasic ulcer is therefore evident from the
clinical investigations outlined.
SELECTION OF PATIENTS
The patients selected for evaluation in this
study are those who have had long standing
venous obstruction of one or both lower extrem-
ities with chronic painful ulcers and who have
not responded to conservative measures of local
support, local chemical treatment, control of
infection by chemotherapeutic means and who
have in each instance had the local fungus in-
fections adequately controlled. The latter factor,
as pointed out by Thompson,28 is frequently a
troublesome complication of stasic ulcer, and may
in fact be the major cause for failure of treat-
ment. Many of the patients furthermore, had
previous surgery on the superficial venous system
ranging from simple ligation to stripping of the
saphenous system with local excision and skin
grafting of their ulcers as first advocated by
Homan29 in 1917. No patient was included in
this series who showed satisfactory response
to the conservative measures outlined. Each
patient also showbd evidence of peripheral
angiospasm as demonstrated by cold, moist feet,
and tendency to cyanosis upon standing. Com-
parative studies of skin temperatures were made
before and after paravertebral block.
PREOPERATIVE CARE
Each patient received a period of hospitaliza-
tion preceding surgery. The patient was placed
at bed rest with elevation of the affected ex-
tremity, local moist compresses, systemic chemo-
therapy in the form of penicillin, and in several
instances the use of tetra ethyl ammonium
chloride intravenously. When the edema had
subsided to an optimum degree, and the ulcer ap-
peared grossly clean, the patient was subjected
to operation.
OPERATION
All cases operated were given low spinal anes-
thesia. The patient was prepared in a tilt posi-
tion, a large sandbag under the hip and flexion
of the thigh and knee of approximately thirty
degrees each. Sympathectomy was then per-
formed after the following method described
by deTakats.30 A segmental incision is made
with its mid-point opposite the anterior supe-
rior spine and in the direction of the fibers
of the external oblique muscle. Dissection is
carried in a gridiron manner to the peritoneum.
The peritoneum is dissected away from the lateral
and posterior musculature, the ureter is re-
tracted with the peritoneum until the aorta
or inferior vena cava can be retracted mesially.
The second and third lumbar ganglia and com-
municating branches are then resected. The
peritoneum, transversalis and internal oblique
muscles are then allowed to fall into place and
interrupted sutures are placed in the external
oblique muscle and fascia. The sandbag is then
removed, the patient returned to a normal posi-
tion and the entire extremity is prepared and
draped. A femoral incision is made, extending
from the mid part of the inguinal ligament to the
apex of the femoral triangle. The saphenous
vein is isolated and its contributary branches
divided. The report of saphenous vein is
resected to the sapheno-femoral junction. The
femoral vein is then dissected, the profounda
identified, and the femoral vein interrupted by
division immediately inferior to the profunda.
The divided saphenous vein is stripped as far as
possible by the method introduced by Babcock.81
If impossible to strip the vein adequately, segmen-
tal ligation is performed. Regardless of the local
treatment of the veins it is essential to remove
the venous channels immediately adjacent to the
ulcer. In several instances, in this series, the
local ulcer was resected with primary grafting,
with a split thickness graft. The operated ex-
tremity is then wrapped snugly with Ace band-
ages and large compression dressings particu-
larly in the thigh area. The patient is kept at
bed rest for a period varying from three to
ten days, dependent upon the degree of edema
present at the time of operation. The patient
is allowed up when free of pain and edema. The
patient is cautiously ambulated for short increas-
ing periods of time until able to take care of his
ordinary needs. All patients were operated with
cotton suture technique.
RESULTS OF THE OPERATION
Sixteen consecutive patients were treated in
the manner outlined above with minor variations
238
The Ohio State Medical Journal
OPERATIVE TREATMENT AND RESULTS
Case
Age
Duration
Symptoms
Previous Surgery
Operation
Result
R.B.
73
38 yr.
18 yr.
edema
ulcer
Saphenous ligation
Left Sympathectomy Femoral
Lig.
Healed
Slight edema
A.M.
46
5 yr.
2 yr.
edema
ulcer
Saphenous ligation
Left Sympathectomy Femoral
Lig.
Healed
No edema
A.P.
68
3 yr.
3 yr.
edema
ulcer
Repeated debridement and skin
grafts
Left sympathectomy Femoral
Lig. Saph. stripping-graft
Healed
No edema
A.O.
67
25 yr.
5 yr.
edema
ulcer
No previous
Left and right sympathectomy
femoral lig. saph. stripping
lig.
Healed
Slight left edema
No right edema
S.L.
38
7 yr.
7 yr.
edema
ulcer
Saphenous stripping
Right sympathectomy femoral
lig.
Healed
Slight edema
F.B.
52
10 yr.
8 yr.
edema
ulcer
Saph. lig. mult.
Left saph. stripping
Left sympathectomy
Left femoral lig.
Healed
Mod. edema
W.L.
38
5 yr.
5 yr.
edema
ujcter
Left saph. lig. 1943
Femoral Lig. 1944
Left sympathectomy
Healed
Slight edema
M.H.
69
20 yr. edema
? ulcer
Various palliative
Left Sympathectomy Femoral
lig. saph. stripping
Healed
Some edema
S.T.
62
12 yr.
12 yr.
edema
ulcer
Sapr. injections, etc.
Left sympathectomy saph.
stripping
Healed
No edema
A.G.
67
10 yr.
10 yr.
edema
ulcer
Saph. stripping
Skin graft
Left Sympathectomy Femoral
Lig.
Not healed
No pain
L.B.
74
15 yr.
15 yr.
edema
ulcer
None
Left sympathectomy saph. lig.
multiple femoral ligation
Healed
Mod. to severe edema
L.O.
65
2 yr.
2 yr.
edema
ulcer
None
Left sympathectomy femoral
ligation saph. stripping
Healed
No edema
O.N.
70
12 yr.
10 yr.
edema
ulcer
None
Left sympathectomy femoral
ligation saph. stripping
Not healed
Regression
Slight edema
C.N.
18
2 yr.
1 yr.
edema
ulcer
Mult, ligation
Bilateral stripping
Bil. sympathectomy femoral lig-
ation excision ulcer and graft
Recurrent ulcers
No edema
w.s.
44
6 yr.
6 yr.
edema
ulcer
Saph. Lig.
Right sympathectomy femoral
ligation
Healed
No edema
J .G.
34
5 yr. edema
Arthritis
Bilat. saph. lig.
Bilat. sympathectomy femoral
ligation
Healed
No edema
depending upon whether or not they had prior
surgical treatment to the saphenous system.
There were three of these with bilateral opera-
tions making nineteen extremities so treated.
Of this group the average age, exclusive of one
nineteen-year-old male, was 58 years.
Thirteen of the 16 patients and 15 of the 19
ulcers are healed and have not recurred after
normal ambulation. The period of follow-up
is from two to fifteen months, and is too short
to determine the final result. The four ex-
tremities that are not healed are found in three
patients: (1) A 67-year-old arteriosclerotic male,
who has marked regression in his ulcer but will
need excision of the ulcer and grafting. (2) An
18-year-old male who had bilateral operation
with complete excision of ulcers. The ulcers
have reoccurred. This patient had severe edema
and pain preoperatively, is now free of edema
and pain, but we have been unable to heal his
ulcers. (3) A 70-year-old female who has had
regression in her ulcer but still has moderate
edema of the leg and who will need local ex-
cision and grafting.
All patients had ambulatory edema at the time
of admission to the hospital. Eight patients
have no edema on a full work schedule; six
patients have slight to moderate edema after
being on their feet four hours or longer, and
two patients continue to have severe edema
showing little or no improvement over their
preoperative state. The table gives a brief
summary of each patient.
ILLUSTRATIVE CASE REPORTS
Two cases are presented in detail to illustrate
the result in (a) old chronic long standing ulcer
in a woman with severe arteriosclerosis, and
(b) a relatively young active male with a short
history of ulcer unimproved by ordinary therapy.
Case A. Mrs. R. B., aged 73 was first seen
in December, 1945, with a huge edematous left
leg, approximately three times the size of the
right one. There was a large 8x3 cm. ulcer
over the internal malleolus. She gave a history
of thrombophlebitis following delivery thirty-
eight years previous with increasing disability
and edema, up to this time. The ulcer had been
present for eighteen years. She had been un-
able to do housework for eight years. Saphenous
ligations, injections and skin graft had been at-
tempted without success. She disappeared from
our service until May of 1948, when she presented
the same picture but with a completely encircling
ulceration about the left ankle. The left foot
and leg were cold, and moist, and brawny in-
duration extended to the knee. She was placed
on elevation, paravertebral block, chemotherapy
and moist compresses. X-ray of the involved
leg showed myositis ossificans, generalized
throughout all of the muscles of the left lower
leg. The response to paravertebral block was
satisfactory with relief of pain and a rise in
temperature of 1 to 1.5 degrees C. On June 1,
1948, a left lumbar sympathectomy, external
femoral interruption, saphenous ligation and
stripping to the knee and biopsy of the ulcer were
performed. On March 1, 1949, she had slight
for March, 1950
239
edema with complete healing of the huge ulcer
except for a small dry fibrotic area the size
of a thumb nail. She is normally ambulatory.
^ *
Case B. A. W., 46-year-old male, a boiler-
maker, came on the service in June of 1948, with
history of pain, edema and induration in the
left leg since herniorrhaphy in 1943. He had had
serial ligations and saphenous stripping else-
where with follow-up extending over a two-year
period. He developed ulcer in 1945 which per-
sisted despite treatment. He had relief of pain,
edema and a reduction in size of ulcer whenever
at bed rest for a prolonged period. Examination
showed left leg indurated to the knee with large
deep ulcer 8x6 cm. located above the internal
malleolus. The feet were cold and moist. There
was no evidence of varices. Hospitalization at
bed rest with chemotherapy reduced the indura-
tion and edema. Paravertebral block reduced
pain and raised the skin temperature 2 to 2.%
degrees C. A left lumbar sympathectomy with
external femoral interruption was performed in
August, 1948. The ulcer healed during the pa-
tient’s stay in the hospital and he returned to
normal duty in three weeks. In March, 1949,
he had no edema or pain. There was complete
healing of his ulcer on a full work schedule.
SUMMARY
A rational surgical treatment for post-
phlebitic or stasic ulcer is presented. It con-
sists of lumbar sympathectomy for angiospasm,
interruption of the external femoral vein and
resection of the superficial saphenous varices
to the ulcer level. In severe ulceration excision
of the ulcer and its vascular bed with skin
grafting, accompanies the operation.
No untoward results were encountered in six-
teen patients operated. Thirteen had complete
healing of their ulcers. Eight patients were re-
lieved of all edema, six were improved and two
showed no improvement.
BIBLIOGRAPHY
1. Homans, J. : Venous Thrombosis in the Lower Limbs.
Its Relationship to Pulmonary Embolism. Am. Jour. Sur-
gery, 38:316, 1937.
2. Homans, J. : Exploration and Division of the Femoral
and Iliac Veins in the Treatment of Thrombophlebitis of the
Legs. New England Jour. Medicine, 224:179, 1941.
Homans, J. : The Late Results of Femoral Throm-
bophlebitis and Their Treatment. New England Jour. Medi-
cine, 235:249, 1946.
3. Ochsner, A. : Thrombophlebitis, editorial. Surgery,
6:129, 1939.
Ochsner, A., and DeBakey, M. E. : Thrombophlebitis
and Phlebothrombosis. South Surgeon, 8:269, 1939.
Ochsner, A., and DeBakey, M. E. : Therapy of Phle-
bothrombosis and Thrombophlebitis. Arch. Surg., 40 :208,
1940.
4. Allen, A., Linton, R., and Donaldson, G. A. : Venous
Thrombosis and Pulmonary Embolism : Further Experience
With Thrombectomy and Femoral Vein Interruption.
J. A. M. A., 128:397, 1945.
5. Linton, R. R. : Diagnosis and Treatment of Thrombo-
Embolic Disease. Med. Clin, of North America, 30:1068,
1946.
6. Murray, G. : Anticoagulants in Venous Thrombosis
and Prevention of Pulmonary Embolism. S. G. & O., 84 :665,
1947.
7. Bauer, G. : Heparin Therapy in Acute Deep Venous
Thrombosis. J. A. M. A., 131 :196, 1946.
8. Wise, W. D., Loker, F. F., and Brambel, C. E. :
Effectiveness of Dicumarol Prophlaxis against Thrombo-
embolic Complications Following Major Surgery. A Four-
Year Study of 3,304 Cases. S. G. & O., 88 :486, 1949.
9. Buxton, R. W., Farris, J. M., Moyer, C. A., and
Coller, F. A.: Surgical Treatment of Long Standing Deep
Phlebitis of the Leg. Surgery 15:749, 1944.
Buxton, R. W., and Coller, F. A. : Surgical Treat-
ment of Long Standing Deep Phlebitis of the Leg. II. A
Supplementary Report. Surgery, 18 :663, 1945.
10. Linton, R. R., and Hardy, I. B. : Post-Thrombotic
Sequelae of the Lower Extremity. Treatment by Superficial
Femoral Vein Interruption and Stripping of the Saphenous
Veins. Surgical Clinic of North America, Oct., 1947, pp 1171.
11. Himler, W. C., Krygrer, J. J., Kennedy, J. C., and
Sneeden, V. S. : Etiology and Prevention of Thrombosis of
Deep Leg Veins : A Study of Four Hundred Cases. Surgery,
17:178, 1945.
12. Ochsner, A.: Venous Thrombosis. J. A. M. A., 132:827,
1946.
13. Linton, R. R., and Hardy, L. B. : Post-Thrombotic
Syndrome of the Lower Extremity. Surgery, 24 :452, 1948.
14. Vaughn, A. M. : Multiple Retrograde Saphenous Vein
Ligation and Phlebectomy with Aid of Malleable Intraluminal
Guide. Surgery, 21 :851, 1947.
15. Rees, H. C., and Slevin, J. G. : Surgical Management
of Vascular Leg Ulcers. Surgery, 21:575, 1947.
16. Ochsner A., and DeBakey, M. E. : Therapeutic Con-
siderations of Thrombophlebitis and Phlebothrombosis. New
England Jour. Med., 225:207, 1941.
Ochsner, A. : The Use of Vasodilatation in the Treat-
ment of Venous Thrombosis. S. G. & O., 84:659, 1947.
17. Nicholson, M. J. : Treatment of Thrombophlebitis by
Paravertebral Block. Surgical Clin. North America, 24 :538,
1944.
18. Naide, M. : A Test for Vascular Tone in Humans and
Its Application to the Study of Vascular Disease with Special
Reference to the Etiology and Prevention of Thrombo-
phlebitis. Am. Jr. M. Sc., 207:606, 1944.
19. Laufman, H., and Method, H. : The Role of Vascular
Spasm or Recovery of Strangulated Intestine ; Experimental
Study. S. G. & O., 85 :675, 1947.
Laufman, H., Martin, W. B., and Tuell, S. : The
Pattern of Vasospasm following Acute Arterial and Venous
Occlusions. S. G. & O., 87 :641, 1948.
20. Shumacker, H. B., and Abramson, S. I. : Sympathec-
tomy in Trench Foot. Annals of Surg., 125 :203, 1947.
21. Shumacker, H. B. : Surgery in Peripheral Vascular
Disease. Surg. Clin. North America, April, 1948, pp 294.
Shumacker, H. B., and Abramson, S. I. : Sympathec-
tomy for Stasic Ulcer. S. G. & O., 88 :417, 1949.
22. Krontiris, A. : Experiences with Sympathectomy for
Sequelae of Trench Feet. Amer. of Surgery, 125 :507, 1947.
23. Voris, H. C. : Sympathectomy in Peripheral Vascular
Disease and Hypertension. Surg. Clin, of North America,
Feb., 1947, pp 139.
24. Lisker, S. : Chronic Leg Ulcers. Surg. Clin, of North
Amer., Dec., 1947, pp 1555.
25. Jemerin, E. E. : Sympathectomy in Peripheral Arterio-
sclerosis. Annals of Surgery, 129 :65, 1949.
26. Trimble, I. R., Cheney, W. S., and Moses, W. R. :
The Operative Atta.cjc on Organic Vascular Disease. Sur-
gery, 15 :655, 944.
27. de Takats, G-, Fowler, E. F., and Risley, T. C. :
Sympathectomy in the Treatment of Peripheral Vascular
Sclerosis. J. A. M. A., 181 :495, 1946.
de Takats, G., and Gray, M. H. : Sympathectomy for
Peripheral Vascular Sclerosis. J. A. M. A., 133 :441, 1947.
28. Thompson, K. W. : Studies on Relationship of Der-
matomycosis to Ulceration and Gangrene of Extremities.
Yale Jr. Biol. & Med., 16:665, 1944.
29. Homans, J. : The Etiology and Treatment of Vari-
cose Ulcers of the Leg. S. G. & O., 24 :300, 1917.
30. de Takats, G. : The Technique of Lumbar Sympathec-
tomy. Surg. Clin. North America, 1946.
31. Babcock, W. W. : A New Operation for the Extirpa-
tion of Varicose of the Leg. New York Med. Jr., 86:153,
1907.
Carcinoma of the Stomach
The charts of 69 patients during 81 hospital
admissions for carcinoma of the stomach were
studied in relation to the presence of fever and
to its etiology: 14.81 per cent of the patients
had no fever; 24.69 per cent had fever associated
with infection or other pathological conditions
exclusive of neoplasm; 12.35 per cent had fever of
doubtful origin, it was probably neoplastic but
infection could not be entirely ruled out; 48.15
per cent had fever unrelated to any cause besides
neoplasm.
It is concluded that low-grade intermittent
fever is a frequent sign of carcinoma of the
stomach. When infection is eliminated, it will
still be present in approximately 50 per cent of
the patients with this disease. — Berlin & Porter;
Virginia Med. Monthly, Vol. 77, No. 2, Feb., 1950.
240
The Ohio State Medical Journal
The Early Management of Face and Jaw Injuries
BRUCE C. MARTIN, M. D.
The Author
• Dr. Martin, Columbus, Ohio, is a graduate
of Washington University School of Medicine,
1935; diplomate, American Board of Surgery;
chief of plastic section. White Cross Hospital;
and instructor, Ohio State University College
of Medicine.
THE purpose of this paper is twofold.
First to present the problems of face and
jaw injuries, and secondly, to plea for early
replacement of the foundation structures.
During the past two decades the increase in
incidence of face and jaw injuries has been ap-
palling. The war just finished resulted in many
thousands of such cases and initiated considerable
study of this problem. The military injury is
usually caused by high velocity missies. In the
case of the civilian injury, the human body is
the high velocity missle, and the damage is the
result of contact with some unyielding object,
most often the dash or windscreen of an auto-
mobile.
RESULTS OF DELAYED TREATMENT
Military experience has shown that these in-
juries profit by the use of a surgical team. The
prime object of surgery is the preservation of
life, of sight, of function of injured parts, and
restoration of contour of the face. Most severe
face and jaw injuries will be grouped into that
awful category of “head injuries” and will be-
come the recipients of expectant treatment. This
period of expectancy will often be drawn out
with the result that facial bones will become
united in positions of terrible deformity. Eye-
balls will be in depressed positions with diplopia,
teeth in malocclusion, nasal passages will be
occluded, and the general contour of the face
flat and dish like. It is not uncommon to read
the clinical histories of these patients and find
that they were classified as severe head injuries
only to see operative reports of extensive de-
bridement of compound fractures of extremities a
few hours later. We feel that with cooperation of
the surgical team, this dreadful period of wait-
ing can be shortened. With early replacement of
facial bones, the foundation structure, extensive
and often unsuccessful late plastic procedures
can be avoided.
PRINCIPLES OF SOFT TISSUE CLOSURE
I shall not waste time with the problem of
preparation of these patients for surgery, other
than to emphasize the importance of adequate
airway. Anoxemia will rapidly increase the
extent of cerebral injury. Little time need be
devoted to soft tissue injury, the principles of
conservation of tissue, closure in layers, atrau-
matic technique, careful skin suturing are well
known and widely practiced. One must debride
tissue with great care. Even in cases requiring
rapid closure, sutures should be placed close
Presented before the Section on Surgery at the Annual
Meeting of the Ohio State Medical Association, Columbus,
April 19-22, 1949.
to the wound edge to prevent extensive ladder
marks which may require the sacrifice of valua-
ble tissue later. All fixed points — ala of nose,
commissure of the mouth, corners of the eyelids
and brows, must be replaced accurately.
PATTERNS OF FACE AND JAW FRACTURES
Injuries to the bones of the face follow
certain definite patterns and these depend on
which “peaks of contour” received the brunt
of the force first. It is of no interest to show
photographs of these patients. As far as the
surgeon is concerned they all look alike — as
Sir A. H. Mclndoe says, “They are all brothers
and sisters, their only difference is in sex.”
Their swollen features usually hide their identity.
Probably the most common injuries are those
of the mandible. The mandible is almost a bone
ring — a fracture in one portion usually leads to
a second break. The classical fracture is one in
the region of one second molar and opposite
mental foramen. When only one fracture is
evident, look carefully to the condyle. Its fracture
is common and often missed because of poor
X-rays. All fractures of the mandible anterior
to the ramus must be considered compound be-
cause of the intimate attachment to the mucoper-
iosteum. Teeth in line of fracture must be ex-
tracted unless essential to maintaining position.
The question of drainage of the fracture site
is one of surgical judgment. A fracture of 24
to 48 hours’ duration, poorly immobilized, and
with considerable laceration of the mucoper-
iosteum within the mouth will profit by external
drainage.
Damage to the middle third of the face will
fall into definite patterns. These resemble the
ripple one sees when a stone is dropped into
water. The nose is the high point and carries
the brunt of force. First the nasal bones let
go and the first ripple is formed. As the violence
increases the nasal bones are driven into the
face and the maxillae separate, usually through
the maxillary frontal suture, and the infraor-
bital foramen so that the upper jaw becomes free
floating inverted keystone. With increasing vio-
jor March, 1950
24L
lence the third ripple occurs. The nose is driven
deeply into the face like a wedge. The lines
of the inverted keystone are extended to in-
clude the fracture of the attachments of the
zygomas and spreading of the medial wall of
the orbit. The orbital floors are usually de-
pressed, diplopia may be present and cere-
brospinal fluid leak through the nose is often
seen. The entire central third of the face is
separated from the skull.
LATERAL VIOLENCE TO FACE
Lateral violence to the face usually takes a
rather definite pattern. The malar eminence
takes the first blow. This bone promptly lets go
its attachments and becomes impacted into the
maxillary sinus. The lateral half of the orbital
floor is depressed. Often fracture lines run up the
medial wall of the orbit and involve region of
the pulley and double vision results. I feel
that this is more important than position of
the globe in regard to diplopia. With increase
in violence the opposite maxilla usually lets go
through the infraorbital foramen and lateral
wall of the antrum.
As one can well imagine there are many
deviants from these patterns. The so-called
Guerins fracture, which is a simple transverse
fracture of the maxilla, is not uncommon. A
similar transverse fracture through the superior
orbital fissure is occasionally seen. Both of these
result from violence applied to the alveolar ridge
of the upper jaw.
ASSESSMENT OF INJURY
The proper assessment of the extent of these
injuries is largely clinical and is not easy. It
is difficult for the surgeon to realize that here
“one must treat the patient not his X-rays.
X-ray examination may show devastating frac-
tures while clinically there is little displacement.
Unfortunately the reverse may be true.
It is at this point that the team play comes
into action. The neurosurgeon must weigh care-
fully the intracranial damage and choose the
proper time for intervention. Most procedures
for repositioning facial bones can be done at
the bedside. Reduction of nasal and ethmoidal
plate fractures can be done rather simply by
elevation with a knife handle and retained by a
mattress suture of stainless steel over buttons
behind the nasal bones. This procedure often stops
spinal fluid leaks and was found reasonably safe
in the European Theater.
TREATMENT
Fractures involving the maxilla and mandible
present less of a problem. Simple mandibular
fractures almost invariably can be handled by
continuous loop wiring with associated elastic
traction, as described by Col. Roy Stout, U.S.A.,
D.C. Edentulous patients present the only prob-
lem. Some variations of splint can usually be
applied. Where there is no dentition, sectional
splints can be made and circumferential wiring
done. Fractures of the maxilla can be reduced by
traction to the lower jaw, thus placing the teeth
in occlusion. When this is accomplished a simple
elastic chin strap to head cap will serve to draw
the maxilla or the central facial segment in its
proper place.
Most external pin fixation devices are to be
condemned and their employment is largely due
the failure of the surgeon to explore the alterna-
tives a clever dental colleague may have to offer.
In the early days of the war, Prof. Kilner made
the statement that he doubted whether or not
an adequate method of immobilizing a distal
edentulous fragment of the mandible would be
found. I believe Kilner’s doubts were justified —
certainly the uncertain and often dangerous ex-
ternal fixation devices have not been the answer.
The depressed fracture of the zygoma with its
associated fractures of the maxilla are common.
Several approaches to this problem have been
used. Sir H. D. Gilles has described the temporal
approach for elevation of this structure. This
procedure is excellent for elevation of the frac-
tured arch but as for elevation of the malar com-
pound is less than useless. There is usually a
comminutation of the orbital floor with de-
pression, blood and often loose bone fragments
in the antrum. Any operation devised for re-
positioning this bone must consider these factors:
(a) to drain this compound fracture, and (b)
elevate the orbital floor. One must enter
the sinus through the Caldwell Luc approach.
The orbital floor is repositioned under direct
vision. The antrum is cleared of debris. Drainage
can be provided into the nose and the position of
the zygoma maintained with packing.
In conclusion, “Injuries of the facial bones
demand immediate and prompt attention to pre-
vent permanent deformity. (2) The management of
injuries of the bones of the face is a team propo-
sition. (3) Management of soft tissue injuries
of the face, in the acute phase, is secondary to
that of the foundation structures.”
Experience and Wisdom
Remember that experience is never finished and
wisdom is never complete; that we are always
more likely to meet the common than the un-
usual, but that what appears at first to be a
simple and familiar clinical problem may yet be
something we have never met, even something
hitherto unrecorded; that no problem is so
straightforward that it does not need careful
study, or so difficult that some solution will not
appear if we seek steadfastly. — Sir Heneage
Oglivie, K.B.E., British Medical Journal, No.
4629, September 24, 1949.
242
The Ohio State Medical Journal
Diagnosis and Treatment of Acute Thrombophlebitis
LAWRENCE N. ATLAS, M.D.
IT IS NOT appreciated sufficiently that acute
thrombosis of the veins of the lower ex-
tremities and pelvis is potentially a lethal
and disabling disease. As a complication of
childbirth, surgery, debilitating illness, and
trauma, thrombi may form in the deeply situated
veins of the leg or pelvis. Unless the vein reacts
to the thrombus which it contains by becoming
inflammed, the pathological process is asymp-
tomatic. For that reason, extensive peripheral
thrombosis with fatal pulmonary embolism may
occur with no premonitory symptoms or signs.
Conversely, phlebitic reaction to thrombosis with
manifest fever, pain, edema, and regional tender-
ness to palpation may not supervene until the
patient has survived pulmonary embolization.
DIAGNOSIS
Symptoms and signs are dependent on the loca-
tion, extent, and intensity of the acute phlebitic
process. In a majority of instances, thrombo-
phlebitis originates in the deep veins of the calf
musculature; and subsequently may extend into
the popliteal, femoral, and iliac veins.
Acute thrombophlebitis of the deep veins of
the calf manifests itself by moderate fever, deep-
seated pain and tenderness in the calf muscula-
ture, and a positive Homans’ sign. The latter
consists of pain produced in the calf musculature
by passive dorsiflexion of the foot. There may
be some reflex arterial spasm with subjective
and objective coldness of the foot.
Edema of the ankle and leg does not appear
until the femoral vein becomes inflamed and
occluded sufficiently high to obstruct drainage
from the profunda femoris and great saphenous
veins. At this stage fever, pain, and regional
tenderness are more pronounced. In the thin
subject, the thrombosed and inflamed popliteal
and femoral veins may be felt as firm, tender
tube-like structures.
Massive edema of the entire lower extremity
with severe pain and high fever indicate ob-
struction and inflammation of the iliac vein.
This is the stage of so-called milk leg or phleg-
masia alba dolens. Phlegmasia alba dolens may
appear suddenly without premonitory symptoms
and develop with great rapidity; and when it
does, thrombosis of the pelvic veins with ex-
tension into the iliac vein should be suspected.
Acute thrombosis and/or inflammation of the
femoral or iliac veins may induce, by virtue of
a spinal cord sympathetic nerve reflex, intense
Submitted March 7, 1949
The Author
• Dr. Atlas, Cleveland, Ohio, is a graduate of
Western Reserve University School of Medi-
cine, 1930; fellow, American College of Sur-
geons; assistant clinical professor of surgery^.
Western Reserve University; member of sur-
gical staffs in charge of peripheral vascular
clinics, Cleveland City and Mount Sinai Hos--
pitals.
spasm of the adjacent artery. The limb becomes
ischemic and may simulate the clinical picture
of acute arterial thrombosis with coldness, pallor
or cyanosis. In fact, the arterial spasm may, if
not relieved, eventuate in thrombosis and ulti-
mate gangrene of the foot and leg. This is more
apt to occur in the elderly with sclerotic
peripheral arteries. Reflex arterial spasm com-
plicating acute ilio-femoral thrombophlebitis
can be distinguished from primary ilio-femoral
arterial thrombosis by virtue of the fact that
in the former, the ischemic limb is swollen and
the superficial veins distended; while in the
latter, the limb is shrunken and the superficial
veins collapsed.
Within recent years, an X-ray technique for
visualizing the venous pattern of the lower ex-
tremity has been perfected. Venography is prov-
ing to be invaluable for confirming the diagnosis
of deep venous thrombosis and in locating the
site of the thrombotic process. It is employed
routinely when the signs and symptoms of
peripheral thrombophlebitis are suggestive but
equivocal, when it is necessary to determine
whether the thrombus has extended into the
popliteal or femoral vein (the importance of this
will be discussed under treatment), or when a
patient has suffered pulmonary embolization and
it is desirable to locate the source of the embolus.
TREATMENT
Prophylaxis is important. Early ambulation
following parturition and surgery reduces the
incidence of thromboembolic complications. If
ambulation is not feasible, the patient should be
encouraged to move his legs. Active or passive
“bicycle” exercises are particularly good. Sur-
gical stirrups which exert pressure on the calf
or popliteal space should be well padded, as
should all straps which bind the legs down to
the operating table. If the patient gives a history
for March , 1950
243
of a previous attack of thrombophlebitis, anti-
coagulants are administered prophylactically.
In so far as active treatment of manifest
thrombophlebitis is concerned, there are fun-
damentally two distinct approaches to the prob-
lem : the inhibition of intra-vascular clotting
through the use of anti-coagulant drugs; and
the mechanical blocking of thrombosed veins by
surgical exploration and ligation of the femoral
vein. While each method has its enthusiasts to
the exclusion of the other, both methods have
their place depending on specific indications.
Anticoagulants are preferred:
1. WThen the thrombophlebitic process is
limited to the leg and has not ex-
tended into the popliteal vein; and
the patient has not suffered an epi-
sode of pulmonary embolization.
Under these circumstances, anti-
coagulant drugs inhibit the spread of
the thrombotic process during that
period when the thrombus already
present becomes fixed to the vein wall
and the phlebitic process subsides.
2. When the condition has progressed to
the stage of phlegmasia alba dolens.
After the iliac vein becomes throm-
bosed and inflamed, pulmonary em-
bolization rarely occurs. In addition to
inhibiting further thrombus forma-
tion, anticoagulant drugs seem to ex-
pedite resolution of the phlebitic
process; and it has been my observa-
tion that the severe pain, high fever,
and massive edema associated with
acute iliac thrombophlebitis subside
quite rapidly when anticoagulant
drugs are administered.
3. When an individual has experienced
pulmonary embolization and the
source of the embolus cannot be de-
termined. While it is true that the
majority of pulmonary emboli come
from thrombosed veins within the
lower extremities, they can and do
originate elsewhere; and when they
do, an ill-advised femoral vein opera-
tion is worse than useless.
Femoral vein surgery is preferred:
1. When it can be demonstrated that
the popliteal or femoral vein con-
tains a thrombus, particularly if the
attendant phlebitic reaction is not
sufficiently intense to fix the thrombus
in situ. It should be borne in mind
that anticoagulant drugs have no
effect whatsoever on a thrombus
which has already formed; and that
the detachment of a large thrombus
from the popliteal or femoral vein is
responsible for fatal pulmonary em-
bolization. In view of the grave risk
attending popliteal and femoral vein
thrombosis it is safer to surgically
block egress of emboli by means of
femoral vein ligation than to depend
on anticoagulant drugs.
2. When it can be determined that the
peripheral thrombotic process respon-
sible for an episode of pulmonary em-
bolization is within the leg or thigh.
An initial episode of non-fatal pul-
monary embolization will be followed,
in 50 per cent of cases, by other
episodes; and each succeeding attack
carries a greater risk of mortality.
The prevention of repeated episodes
of pulmonary embolization consti-
tutes a major therapeutic problem.
Surgical prophylaxis, when indicated,
is unquestionably the ideal procedure.
The treatment of reflex ilio-femoral arterial
spasm must be prompt and vigorous if arterial
thrombosis is to be prevented. Paravertebral in-
jection of procaine into the lumbar sympathetic
ganglia is effective and dependable only when
performed by one skilled in the use of the
method. The intravenous administration of
tetra ethyl ammonium chloride (Etamon)
is an effective substitute for paravertebral
block. Since relaxation of spastic arteries is
followed by a marked increase in peripheral
blood flow, a loosely attached thrombus may be
“washed out” of the limb with resultant pul-
monary embolization. This eventuality can be
prevented by a preliminary femoral vein liga-
tion.
THE TECHNIQUE OF ANTICOAGULANT
THERAPY
There are two substances available each of
which is effective in inhibiting intravascular
clotting. They are heparin and dicumarol.
Heparin acts directly on the intravascular blood
clotting mechanism by neutralizing thrombo-
kinase. It is administered either intravenously
or intramuscularly. Once injected its action is
immediate. However, the effect of a dose of
50 mgs. is not longer than four hours. A trans-
fusion of freshly drawn whole blood counteracts
the effect of heparin at once and is a very ef-
fective antidote.
Dicumarol acts indirectly on the intravascular
blood clotting mechanism by interfering with
that portion of liver function which is con-
cerned with the formation of prothrombin. It
is administered orally, and twenty-four to forty-
eight hours must elapse before its effects be-
come manifest clinically; but once ingested, the
effects of the drug may continue for a week or
244
The Ohio State Medical Journal
longer. In a sense, dicumarol is a liver poison.
Should it become necessary to increase the
prothrombin content of the blood, this can be
accomplished only by repeated transfusions of
freshly drawn whole blood and by attempting to
reverse the toxic hepatic disfunction by ad-
ministering large parenteral doses of vitamin
K.
A routine for administering anticoagulant
drugs has been established. As a preliminary
control, the prothrombin activity of the blood is
determined by suitable laboratory procedures. A
single dose of 300 mgs. of dicumarol is then ad-
ministered orally; and to cover the lag in time be-
fore it becomes effective, heparin is also started.
A dose of 50 mgs. is injected either intravenously
or intramuscularly every four hours for forty-
eight hours. It has been my practice of late
to administer heparin by deep intramuscular
injection. If a small quantity of procaine is
added to the heparin solution, deep intramuscular
injection is painless, safe, and very effective. On
the morning of the second day and every morn-
ing thereafter, prothrombin determinations are
done. An attempt is then made to establish a
maintenance dose of dicumarol which will keep
prothrombin activity within the range of 25
to 35 per cent of normal.
Evidence of abnormal bleeding must be looked
for particularly from the gastro-intestinal tract
and kidneys. Anticoagulants should not be used
in the presence of liver disease, tuberculous
cavitation, gastro-intestinal ulceration, or any
other condition where hemorrhage could prove
disastrous.
THE TECHNIQUE OF FEMORAL VEIN
EXPLORATION
The operation is usually performed under local
infiltration anesthesia. A vertical incision is
made over the proximal three inches of the
femoral vein and continued upwards over the
external iliac vein where it crosses the horizontal
ramus of the pubis to enter the pelvis. The
great saphenous vein is exposed and its junc-
tion with the femoral vein defined. Care is
taken not to injure the great saphenous vein
since it serves as an important collateral. The
upper portion of the femoral vein, the junctions
of the profunda femoris and great saphenous
veins with the femoral vein, and the lower por-
tion of the external iliac vein are visualized.
Two silk ligatures are passed around the femoral
vein between the saphenous and profunda femoris
veins. (It is an error to ligate below the profunda
femoris. A thrombotic process occasionally de-
velops in the profunda femoris system in the
thigh and may extend into the common femoral
vein if the ligation is performed below the
confluence of the profunda femoris and super-
ficial femoral veins.) The femoral vein is opened
between the ligatures. All thrombotic tissue ex-
tending beyond the contemplated point of liga-
tion is aspirated; and when a free flow of blood
from the proximal portion of the vein is ob-
tained, the ligatures are tied. The vein is sec-
tioned if there is sufficient space between the
ligatures to do so safely.
A Modern Tendency
There is a modern trend for the members of
various specialties to gather together and seclude
the radiographs illustrating conditions with
which they deal, and the X-ray departments and
hospitals are so much the poorer because this
valuable material is lost to the general use of
the hospital and the special use of the radiologist.
Radiology knows no bounds of specialization.
The radiograph is a measure of the relative
density and a record of the contrast outlines
and structures of all tissues on and between the
two skin surfaces which bound the area. We
therefore need radiologists who understand all
the evidence presented to inspect the whole,
for there is a tendency on the part of specialists
to be obsessed by evidence which appears to
involve their specialty. Only good can come from
whole-hearted co-operation, but harm will result
to patients from seclusion and isolated activities,
for which the responsible person may be called
upon to bear the blame.
Requests for X-ray examinations are made
on forms which have a space with some such
heading as “Conditions revealed by the clinical
examination on which radiological evidence is
required.” Those clinicians who co-operate and
desire all the help which the radiologist can give,
the men who really taught me my radiology, fill
in this space with facts gleaned from the clinical
examination that are invaluable to the radiologist.
Those men who ape a knowledge of radiographic
technique and want the radiographs, but no
assistance otherwise, use this space for giving
instructions with certain cryptic signs, designed
to impress the radiologist with their great
knowledge of radiographic technique, such as,
“A. P. and L.,” and if they wish to display
their profound knowledge they add also, “P. A.
and oblique.” Such requests fail to convey any
suggestion of confidence in the radiologist, and
certainly do not invite him to share the respon-
sibility; consequently he loses the stimulus for
good work and the patient suffers accordingly
from the defective interpretation of the radio-
graphs.
Radiography, together with other ancillary
services to clinical medicine, is being used extrav-
agantly and is one of the chief contributors
to the increased cost of medical service. — James
F. Brailsford, M. D., British Medical Journal, No.
4630, October 1, 1949.
for March, 1950
245
Primary Torsion of the Great Omentum: Case Report
DAVID B. GILLIAM, M.D.
PRIMARY torsion of the great omentum is
a rare condition, there being very few cases
reported in the literature. By primary tor-
sion is meant a twisting of part or all of the
omentum on its axis, not associated with hernia
or adhesions to abdominal viscera. Eitel re-
ported the first case of this kind in 1899.
I have recently operated upon a case of this
kind which was diagnosed as acute appendicitis.
CASE REPORT
A male, aged 34, white, married, was em-
ployed as a taxicab dispatcher in a small nearby
city. He had previously enjoyed excellent health.
Thirty-six hours before admission he began to
have sharp pains in the abdomen, but continued
to work. On returning to his home he went to
bed thinking the pain would wear off. The pain
did not abate but became worse and he called
his physician who referred him to St. Anthony’s
Hospital with a diagnosis of acute appendicitis.
On admission his temperature was 102.6; pulse
116; and respiration 32. He appeared intensely
ill and the abdomen was very rigid. The great-
est point of tenderness to palpation was over
McBurney’s point. There had been no nausea or
vomiting. The white count was 26,200 with
85 per cent total neutrophils. The urinalysis
was negative. Immediate laparotomy was in-
dicated, the tentative diagnosis being acute ap-
pendicitis.
The abdomen was opened by a right pararectus
incision. There was a large amount of sero-
sanguineous fluid liberated under tension. Almost
immediately a large darkened mass presented
itself in the abdominal incision. This was brought
out of the abdomen and identified as omentum
which was rolled on itself and twisted very
tight at the proximal attachment to the trans-
verse colon. It was suspended by a cord like
twist about an inch in diameter and looked
like an umbilical cord with large dilated veins.
It was a volvulus of the great omentum which
had twisted on its axis six or seven times
shutting off the circulation and resulting in
hemorrhage and necrosis. There was no surgical
difficulty in removing this mass. The narrow
section by which it was suspended was crushed
between two Kocher artery forceps, cut between,
and the mass removed. The proximal stump was
ligated with catgut. The appendix was removed
prophylactically. A Penrose drain was inserted
to carry off the remaining abdominal fluid and
the abdomen closed in the usual manner. The
drain was removed in twenty-four hours and
healing was uneventful. He left the hospital in
eleven days.
The pathological report on the specimens re-
moved was as follows:
Gross: The specimen consists of an omentum
and an appendix. The omentum is extremely
large weighing 700 grams, it shows extensive
hemorrhage and some areas of fibrous thicken-
ing. The appendix is 4.5 cm. long, 8 mm. in
diameter and is intensely congested.
Microscopic: Sections of the omentum show
Submitted July 15, 1949.
The Author
• Dr. Gilliam, Columbus, Ohio, is a gradu-
ate of Ohio State University College of Medi-
cine, 1917; fellow, American College of Sur-
geons; and chief of surgery, St. Anthony^s Hos-
pital.
extensive areas of hemorrhage and exudation-
The lumina of the vessels is occluded by clots
which in some instances appear to be of ante
mortem nature. The lumen of the appendix con-
tains some blood clot and mucus. The mucosa
is intact. The wall shows no abnormality.
Diagnosis: Hemorrhage and necrosis of omen-
tum, probably due to strangulation.
COMMENT
Cowell who, in 1924, reviewed the literature
of torsion of the omentum unassociated with
hernia found only 18 cases reported. McWhorter,
in 1928, increased this number to 26, which in-
cluded two personal cases. Of these 26 cases
18 were in males, the average age being 38
years. The youngest patient was one year old..
Omental torsion is only one of many conditions
which may present the general symptom com-
plex suggestive of acute appendicitis. One
should consider perforated duodenal ulcer, rup-
tured gallbladder, acute pancreatitis, intestinal
obstruction, ureteral calculus, and diseases of the
genital adnexa in male and female. Many of
these conditions give rise to a general symp-
tomatology of grave intra-abdominal disease
which calls for immediate surgical intervention.
Appendicitis presents itself under so many
varying forms that in a case of omental torsion,
a correct preoperative diagnosis could at most
not be more than a guess. For this reason,
the diagnosis of omental torsion, in nearly all
recorded cases, where the lesion occurred unas-
sociated with hernia, was a postoperative one.
Of course there is always the possibility that
a primary torsion of the omentum may be as-
sociated with an acute appendicitis. Removal
of the omentum is not dangerous to life as the
principal function of the omentum is to protect
the intestines and other abdominal viscera from
injury. The prognosis of surgical removal of the
omentum is favorable. McWhorter states that
the operative mortality of all cases reported is
less than 14 per cent.
BIBLIOGRAPHY
1. Thorek : Surgical Errors and Safeguards. -J. B. Lip-
pincott, Philadelphia. 4th Edition, 1943, page 513.
2. Keen, W. W. : Surgery. W. B. Saunders Co., Phila-
delphia, 1908, Vol. 4, page 630.
3. DaCosta, J. C. : Modem Surgery. W. B. Saunders Co.,
Philadelphia, 1915, page 956.
246
The Ohio State Medical Journal
The Purpose of Receiving Hospitals
EUGENE E. ELDER, M.D.
The Author
• Dr. Elder, Youngstown, Ohio, is a graduate
of University of Budapest, 1922; superin-
tendent, Youngstown Receiving Hospital.
THE purpose of Receiving Hospitals should
be threefold. One, treat mentally ill pa-
tients immediately in regard to acute mental
conditions with enough strength to give neces-
sary treatments any time of the day so that
sedatives, which do actual harm to mental pa-
tients, should not be used. In our experience,
shock treatments are the best sedatives and
with it sleep can be restored with a few treat-
ments and physical restraints are avoided, as
well as long excited and confused periods of
hospitalization. This is especially true with de-
pressed and agitated patients, also some manics,
because of their mental activity and antagonism
toward sedatives. In one way the overactivity
of the brain and in the other the oppressive
effect of sedatives are so antagonistic that the
patient will become more confused and more
restless and sleepless. This applies especially
to barbiturates.
If we compare the treatments previous to the
shock treatment era, we can recall how a manic
patient spent four or five months in hospitals
under ten to twelve grains of luminal, in
divided doses, usually one, and one-half grain
tablet each three hours, including night doses.
Very seldom did this medication change the pa-
tient’s mental condition or shorten much the
period of hospitalization. In fact, the illness
lasted four to six months whether any medica-
tion was given or not. In addition to this,
acutely disturbed patients were always in phy-
sical restraint.
PRESENT TREATMENT
How different people are treated now, with
intensive electric shock treatment as soon as
they arrive in Receiving Hospitals. The manic
period of extreme restlessness and noisiness
quiet down in three to four days, having two
to five electric shock treatments, following which
a moderate number of treatments are given,
two or three per week. In most cases no
physical restraint is necessary. The same ap-
plies to catatonic excitement, depressed and
agitated conditions. Even in the organic group,
for example in paretics, a few electric shock
treatments are in order if they are unmanage-
able and overactive until such time as fever
therapy can be started. Even in these cases,
shock treatments act as a good sedative.
With such immediate and intensive treat-
ments we cut down the hospital stay of pa-
tients an average of five weeks. Our results
were 75 per cent home remissions with an
Submitted May 18, 1949.
average of 14 per cent to 17 per cent readmis-
sions. These readmission cases receiving the
same treatments as previously and sent home
again. Of course, in treating mental cases one
has to be aware of the fact that patients
usually go back under the same home condi-
tions in which they became ill. The same
hysterical mother in one case, the same step-
mother in the other, or the same alcoholic hus-
band in another case. Very seldom is it pos-
sible to change the home environment during the
five weeks the patient is hospitalized with us,
although patients are followed to their home
environment by the social worker, who tries
to help and explain the wrong influences of in-
laws or other unhealthy conditions. To arrive
at a 75 per cent home remission of the
average mental case, we need much more help,
more nurses and attendants.
DISTRIBUTION OF PERSONNEL
According to the American Psychiatric Asso-
ciation the regulations are one nurse for each
four patients, and one attendant to each six
patients, which should be followed. During the
four years of operation of our hospital, we
had almost fifteen registered nurses and fifteen
to sixteen attendants to an average of 75 pa-
tients in the house. Of course, this help was
divided into three shifts. The turnover of
nurses and attendants was quite large during
1948, approximately 51, but we were always able
to secure new nurses and attendants for replace-
ment, so that we were able to give treatments
at any time during the day, also the necessary
emergency care during the night.
We do not believe that we should wait until
cardiography and chest X-rays are made in
order to qualify for electric shock treatment, be-
cause of the invaluable loss of time. It is
remarkable to see a patient who had the first
good night’s rest in months, having received
all the possible barbiturates before admission,
change for the better after a few treatments,
restored to sleep and on the road to recovery.
Of course, there are some patients whose physi-
cal conditions do not warrant shock treatments,
like seniles, decompensated heart conditions, or
for March, 1950
247
other physical deformities, who have to receive
some mild sedation, and in this regard, especially
in sclerotics, we find theominal very helpful.
In general, however, as to acute mental cases
with confusion and hallucinations, we do not use
any sedatives.
The second purpose of Receiving Hospitals
is to avoid legal commitments with permanent
court records, court procedures, also hearings
and exposures, and waiting in jails for vacancies
in State Hospitals. The majority, about 65 per
cent, of the patients were voluntary and came
to the hospital on their own initiative for
treatments, signed a voluntary admission form
and with this signature underwent all the treat-
ments needed; electric shock treatment, insulin
shock treatments, narcosynthesis, etc.
Only about 10 to 15 per cent of the admissions
had to be court placement cases, because of law
violations, homicidal or suicidal tendencies or
refusal to sign voluntary admission forms. How-
ever, in these cases there is no permanent court
record. Therefore, they are called court place-
ments and not court commitments. About 8 to
10 per cent of the admissions are emergency
cases, who are so disturbed that they cannot
be handled at home. They are usually seniles
or arteriosclerotics who are waiting here for
State Hospital commitments.
RECORD MAY BE STIGMA
Having a permanent record at the Probate
Court is not indifferent to a patient who may
have only one mild manic attack during his
whole lifetime, for which he was called and
branded as irresponsible, insane or lunatic, not
able to sign a document and deprived of his
legal rights for a long term. But more than the
legal rights he was hurt more as an individual
in case of marriage or other legal procedures.
The person’s records may be seen at the Probate
Courts. In the case of a reactive depression,
due to a person’s misfortune out of his control,
this person could not marry because of a court
paper marking him irresponsible or lunatic, in
the old phraseology. This is all past history
because any patient may come to the Receiving
Hospitals and be handled as a voluntary patient
without any court documents on him, providing
he signs a voluntary admission form.
The third important purpose of Receiving
Hospitals would be to educate and train interns,
residents and nurses in psychiatry, psychody-
namics and psychosomatics. This is much harder
to fulfill especially in hospitals having no
university medical school affiliation. Others not
having this affiliation are Summit County, Mas-
sillon, Dayton and Toledo Receiving Hospitals.
Columbus, Cincinnati and Cleveland Receiving
Hospitals have the advantage of possible univer-
sity medical school affiliation.
KEEPING UP WITH MEDICINE
• In the genesis of heart failure, the important
point is that the organ blood flow is not adequate.
* * *
• Serum albumin seems to be of some help in
the treatment of severe pre-eclamptic toxemia
by replacing the lost serum albumin and increas-
ing the urinary output.
5k ifc >);
• I often wonder why we could not have as in-
telligent a campaign against alcoholism as we
have against cancer, polio, and heart disease.
❖ ❖ ❖
• Physicians are prone to consider nasal vaso-
constrictors an innocuous preparation to be dis-
pensed freely, and used at the patient’s discretion.
❖
• With respect to the possible role of the “new
vitamin for guinea pigs” in human nutrition, it
is intriguing to speculate on the possible rela-
tion between the wrist stiffness in the guinea
pigs and arthritis in the human being.
❖ 5k 5k
• Beside the absence of an organic cause, there
are two features that are characteristic of psy-
chogenic headache. First, it is described as being
continuous in a way that no headache induced
by organic disease could be. Secondly, the
manner of the description is often typical and
this in itself is but another symptom of the
underlying mental state.
sk 5k ?k
• The building-up of the individual who is under-
weight, in the absence of disease, resolves itself
into an analysis not only of the previously ob-
served dietetic regimen, but also of the daily
habits.
:k 5k 5k
• In pediatric practice, streptomycin has become
of utmost importance in the treatment of
meningitis due to H. influenzae type B, chronic
bacillary urinary tract infections, pertussis, and
tuberculous meningitis.
5k 5k 5k
• The occurrence of bilateral cataract in eyes
of young adults that were previously normal, has
been reported innumerable times as being caused
by allergic reactions.
^ 5*c 5k
• Sixty-six per cent of persons over 75 years of
age in this country die from cardiovascular-renal
diseases.
:k 5k 5k
• With the widespread use of antibiotics, many
physicians have unfortunately come to believe
that acute appendicitis is no longer a serious
disease. This concept is still dangerous. — J. F.
248
The Ohio State Medical Journal
James E. Bauman’s Service to the State of Ohio
ROBERT G. PATERSON, Ph.D.
PART I
I FIRST met “Jim” when I became Ex-
ecutive Secretary of the Ohio Society for
the Prevention of Tuberculosis in May, 1911.
He was a veteran then with almost twenty years
of service. From that date down the years
until today, Jim has always been a “tower of
strength” not only to the tuberculosis movement
but to the entire field of public health in Ohio.
Throughout the years, especially after 1904,
Jim has either drafted alone or in cooperation
with others practically every health law to be
found in the Ohio Public Health Manual. In
pursuing this task he was ever cognizant of
the state of public opinion at the given moment
and constantly exerted a restraining influence
upon those of us who were impatient with the
slowness that seemed to characterize public
opinion, legislative action and governmental con-
trols. He not only aided in molding the shape
and form of public health in Ohio but the in-
dividuals as well with whom he worked, and
I was one of them.
HOST WOULD TESTIFY
There are a host of others who would bear
similar testimony if they could be heard today.
A few of the early workers are present in this
audience — Dr. J. H. J. Upham, Dr. Herbert M.
Platter, William C. Groeniger, Dr. Lear H. Van
Buskirk, Leo F. Ey and Dr. Emery R. Hayhurst.
Among the many written expressions of the
influence Jim exerted I have selected two that
seem best to reflect that influence.
Dr. Frank G. Boudreau, Director of the Mil-
bank Memorial Fund, New York City, writes:
“You took me under your wing soon after
I arrived in Columbus in 1911, and from
then until 1925, when I left for Geneva
you were certainly the most important in-
fluence in my life and work. You might dis-
pute the fact that I learned any law through
my contact with you, but I did learn the im-
Read at the presentation of a plaque to the Department
of Health of Ohio, in honor of James E. Bauman, Tuesday,
December 20, 1949, State Office Building, Columbus, Ohio.
portance of precision in thought and speech,
besides picking up a few ideas about print-
ing and proof-reading. I do not wish to hold
you responsible for my course in life, but
I do say that your influence and teaching
helped me in my successes and were not
implicated in my failures.
“Quite a number of your apprentices,
like myself, who from time to time left
you to make their own way in the world,
owe you a debt of gratitude for the care
and friendship which you lavished on them
in their formative years. I wish I could turn
the clock back, and accompany you once
more to a meeting of township and village
health offices, to hear and answer such ques-
tions as, ‘What do you do when you fumi-
gate a house if a dog has been in contact
with the patient?’
“These good old times do not come back
but the memory of you and your work is
just as fresh in my memory as if we had
been working together in 1949 instead of
1911.”
WARMEST ADMIRATION
Dr. Allen W. Freeman, at present consultant
to the Department of Health, State of Mary-
land, former Commissioner of Health of Ohio
and later professor and dean of the School of
Hygiene and Public Health at Johns Hopkins
University in Baltimore, has written:
“I wish with all my heart that it were
possible for me to come to Columbus to do
honor to old Jim on this occasion. Although
nearly thirty years have elapsed since we
worked together during the period of my
service in Ohio, I have retained for him
sentiments of the highest and warmest ad-
miration and affection. Unfortunately, my
physical condition is such that I find it neces-
sary strictly to limit my activities, and it is
impossible for me to undertake so long a
journey.”
How can one compress in the time allotted,
the fifty-seven years of service Jim rendered in
behalf of the health of the people of Ohio ?
It is obviously impossible. So I have elected to
select certain peaks in the development of health
legislation in Ohio as illustrative of the kinds
for March, 1950
249
of problems that confronted Jim and which he
helped to solve.
The peaks I have selected are:
1. Political organization for support of the
idea of a state health authority culminating
in the establishment of the State Board of
Health under Governor Joseph B. Foraker
and the work of Dr. Charles Oliver Probst
as secretary for twenty-five years from
1886 to 1911.
2. Appeal to the people of the state for
a revamping of the organization of the state
health organization under Governor James
M. Cox and the work of Dr. E. F. McCamp-
bell as secretary from 1912 to 1916.
3. Education of the people throughout the
state on the local level for understanding
and support of public health work under
Governor James M. Cox and Dr. Allen W.
Freeman, Commisisoner of Health, 1917 to
1921.
4. The integration of the public health
program on the state and local levels under
Governor John W. Bricker and Dr. Roger
Heering as Director of Health, 1939, and
Dr. John D. Porterfield, 1947 to date.
PERIOD I. 1870-1911
Between 1869 when the first State Board of
Health was established in this country by the
State of Massachusetts and 1886 when Ohio
created such a board, the thirty-second in the
nation, there are sporadic evidences that a few
leading men in Ohio, medical and lay, were
busy at the task of trying to interest public
opinion to demand such services at the hands
of the state government. No one can read the
early Transactions of the Ohio State Medical
Society from 1870 to 1886 without being aware
of the “voices crying in the wilderness.”
Among these were Dr. J. R. Black, Newark,
Ohio, who in 1870 presented a paper entitled
“The Importance of a Concerted Account of
the Prevailing Diseases and their Management
throughout the State,” and in 1871 discussed
“Sanitary Science” in which he laid down ten
rules or laws designed to secure the health
of the individual. These ten rules or laws were:
1. Breathing pure air.
2. Adequate wholesome food and drink.
3. Adequate out-door exercise.
4. Adequate and unconstraining covering for
the body.
5. The exercise of the sexual function only
for, and no interference with, the normal func-
tion of reproduction.
6. A habitation in the climate for which the
constitution of the body is adapted.
7. Pursuits which do not cramp or overstrain
any part of the body or subject it to the
action of irritating or poisonous substances.
8. Personal cleanliness.
9. Tranquil states of the mind and adequate
rest and sleep.
10. No intermarriage of near blood relations.
Again in 1873, Dr. Black presented a “Report
on a State Board of Health” in which he pointed
out the public health evils that existed in the
state and said:
“The remedy for such evils as these is
not in a State Board of Health, but in edu-
cating the public mind on this subject so
that it may perceive the necessity and the
benefit which enlightened sanitary legis-
lation is capable of conferring. A State
Board of Health, without laws empowering
it with a field of control, would be only a
state figure-head, or more properly a set of
mere closet-office dignitaries, seeking and
pleading for some information that would
give them a show of usefulness.”
All of this, remember, was written almost
eighty years ago. It probably is true that in
the intervening years we have expanded and
refined this program of public health due to
more exact knowledge, yet Dr. J. R. Black is
one of the neglected pioneers of our public health
movement in Ohio. I stress his contributions
because they were the first feeble foreshadowing
of the kind of work which Jim was able to do
in later years.
CONSERVATISM OF PROFESSION
Additional reports were made by Dr. W. W.
Jones of Toledo in 1874 on “State Medicine and
Public Hygiene” in which he commented upon
the conservatism of the profession with respect
to this subject. He stated that one “element of
this conservatism is found in the dislike (com-
mon among the profession) to associate medical
truth with the partisan politics of the country
and a fear that governmental cooperation would,
through its influence, result in failure to advance
the true interests of science.”
In a report of a Committee on a State Bureau
of Health made in 1875 it was stated that two
bills on the subject were introduced in the
General Assembly. There was a difference of
opinion as to whether the State Bureau should
be a State Board, consisting of several members,
or simply a Commissioner. Neither bill passed.
Dr. E. H. Hyatt, of Delaware, reported for
the Sanitary Committee in 1876 that a bill was
drafted creating a Sanitary Board, with power
to elect a superintendent of vital statistics,
at a salary of $3,000. The bill failed to pass
because the General Assembly “did not wish, at
that time, to create any new salaried offices.”
These failures of the General Assembly to act
led to the adoption in 1878 by the Ohio State
Medical Society of a resolution introduced by Dr.
Jonathan Morris, of Ironton, that the Society
itself should set up a committee of one in
each county to secure reliable information rel-
250
The Ohio State Medical Journal
ative to the prevailing diseases within the
borders of the State. It was found that this
committee was too unwieldy and in 1880 the
committee was discharged and a new one consist-
ing of seven members was appointed.
Dr. D. N. Kinsman, of Columbus, reported on
“Sanitary Science” in 1881 and after reviewing
the epidemic diseases confronting the profession
and the people of Ohio, he concluded with this
statement:
“The establishment of a State Board of
Health in the State of Ohio is demanded by
political economy, and the humanitarian
spirit of the times. This board should be
composed of men of known scientific ability,
who should be appointed regardless of their
political opinions. To this end the Medical
Profession should use its influence, and not
cease till the purpose is accomplished.”
At the 1882 meeting of the Society, the entire
problem was discussed again. Dr. Starling Lov-
ing, of Columbus, in his presidential address,
really took the gloves off and minced no words
in taking his colleagues to task in relation to
their support of their own State Society; their
attitude toward the State Government; their
attitude toward Homeopathy; and the failure
of the General Assembly to pass a bill in 1881
creating a State Board of Health. Among
other things he said:
“The measure failed, mainly, as I am in-
formed, through the influence of one or two
members, assisted by interested lobbyists,
who were displeased that homeopathy was
not placed in the bill on equality with the
regular medical profession, and this, with
the non-recognition of eclecticism was the
cause of the failure of a similar bill presented
some years since.”
In this same year Dr. J. R. Black, Newark,
again presented a paper on “Preventable Dis-
eases” and Prof. Edward Orton, President of
the Ohio State University, read a scholarly
paper on “The Relation of the State to Public
Health,” in which he came out strongly for the
establishment of a State Board of Health.
AGITATION BROADENED
On February 14, 1884, Dr. R. Harvey Reed,
of Mansfield, removed the agitation for the
creation of a State Board of Health from the
restricted confines of the Ohio State Medical
Society to a broader arena when the organiza-
tion of the Ohio State Sanitary Association was
effected. Its membership consisted of physicians
and laymen interested in sanitation and the
prime purpose of the Association was to secure
a board of health for the State of Ohio.
In his capacity as secretary of the Association,
Dr. Reed took the initiative in writing a bill
for the establishment of such a board and was
active in steering it successfully through the
General Assembly.
Joseph Benson Foraker, of Cincinnati, wrho
has been called by Everett Walters in his re-
cent biography of Foraker, “an uncompromising
Republican from Hamilton County,” was elected
Governor in 1885 and took office in January, 1886.
In his message to the General Assembly on
January 11, he said:
“It is both prudent and a duty to pro-
vide as well as possible against probable
dangers, for the protection of the life and
health of the people. It is bad policy to
delay such legislation, until emergencies
against which it would provide, shall have
arisen. Such a board ought to be created at
once.”
The bill establishing the State Board of Health
became law on April 14, 1886, and in accord
with the provision of the Act, Governor Foraker,
on April 23, appointed the members of the first
board. It consisted of seven members with the
Attorney General, ex-officio, a member. Of the
seven members, five were Republicans and two
were Democrats. There was one Homeopathic
physician, all the others were from the regular
profession. Unfortunately, Governor Foraker did
not know, or chose to ignore, the long struggle
that had preceded the final enactment of the
law nor did he know, or again ignored, the men
who had labored so diligently to bring the act
into being. Not one of the men who had in-
terested himself in the sanitary problem of the
state either in the Ohio State Medical Society or
the Ohio State Sanitary Association was recog-
nized. The appointments seem to have been
dictated purely by political considerations.
FIRST MEETING
The State Board of Health held its first meet-
ing in Columbus on April 30, 1886, and organized
by electing Dr. W. H. Cretcher, Belief ontaine,
president and appointing Dr. C. G. Ashman, the
health officer of Cleveland, as secretary. Dr.
Ashman resigned the position in June and Dr.
Guy Case of Cleveland was appointed as his
successor. Dr. Case resigned July 27 and Dr.
Charles 0. Probst, of Columbus, was appointed
secretary on the same date. His salary was set
at $1,600 and the total budget for the work
of the board was $5,000. His office was a desk
in the office of the Attorney General who out of
kindness took Dr. Probst under his wing. Dr.
Probst was twenty-nine years of age and had
received his degree from Miami Medical College,
Cincinnati, in 1882.
This early period is detailed because it had
a continuing influence upon the development
of the work of the State Board of Health and
particularly upon Dr. Probst as its secretary.
He had to steer a careful course between the
partisan politicians, the widespread and dis-
sident medical theories as represented by the
regular, homeopathic and eclectic schools, the
resentment of local authorities toward state in-
jor March , 1950
251
terference and a profound local ignorance of
sanitary matters as well as an indifference in
the general population.
That Dr. Probst was successful in his efforts to
pacify all these points of view and yet push for-
ward the state program is attested by his twenty-
five years as a pioneer public health admin-
istrator. No recounting of his services is
needed here. The record is available in the
Annual Reports of the Ohio State Board of
Health from 1886 to 1912; in the Monthly
Sanitary Record and its successors from 1888;
in Jim’s excellent account entitled “Dr. Probst
and Public Health in Ohio” in the Memorial
Volume dedicated to Dr. Probst in 1934; and in
Dr. Probst’s delightful paper entitled “Recol-
lections and Reminiscences of Public Health
Service and Public Health Workers” written in
1930 for private circulation.
AUGUST 81, 1892
Jim was employed by Dr. Probst on August 31,
1892, as “clerk and messenger with some jani-
torial duties in addition.” Thus began a rela-
tionship that gradually grew from employer
and employee into one of teacher and pupil,
ripened into close professional ties and finally
into a warm personal friendship which lasted
forty-one years, until Dr. Probst’s death on
April 2, 1933.
(To Be Concluded in April Issue.)
The Hoyt Family 1839-1949
Two brothers, William and Charles Hoyt
settled respectively in Hillsboro and Chillicothe,
each heading a line of three generations of
homeopathic physicians. William Hoyt I was
born in Canada in 1839 and moved to Vermont
when he was fourteen. He served three years
in the Union Army in the Civil War. He then
graduated at the Cleveland Homeopathic Medi-
cal College in 1867, and practiced in Hillsboro
with honor and success for 52 years — until his
death. The records show he delivered almost
4,000 babies in those days when all were home
deliveries with few hospital facilities or trained
nurses. He also occupied many positions of
trust in his community.
His son, William Hoyt II, is a graduate of
Hahnemann College in Philadelphia, and is now
one of the representatives of the homeopathetic
school on the Ohio State Examining Board, in
his third term. At home he had been County
Health Commissioner for fifteen years and
County Coroner for fourteen years. Dr. W. M.
Hoyt II practiced with his father occupying only
three different office locations in 81 years, and in
this office is an unbroken record of every case
treated from the first prescription of Dr. Hoyt I
in 1867 until the present time, a record difficult
to duplicate anywhere.
Dr. William Hoyt II has one son, Charles Wm.
Hoyt, who also graduated at Hahnemann Col-
lege in Philadelphia, and after eight years of
practice, is specializing in anesthesia in a two-
year course in Philadelphia at Hahnemann.
Daughter Annie of Wm. Hoyt I also studied
medicine, graduating from Pulte College in Cin-
cinnati, and studied for one year in Germany.
She practiced with her father until her marriage
to Dr. W. B. Robinson, and their oldest child
graduated from Yale Medical College and prac-
tices at Mt. Gilead, Ohio.
PIONEER PRACTICE
It seems that there should be some outstanding
story out of the pioneer practice of Dr. Wm.
Hoyt I and here is what was hastily remembered
by his son, Dr. Wm. Hoyt II. “There were
many experiences similar to other doctors of
the period, and unusual events such as delivery
of a baby where the people lived in a house
with only a roof and three sides, the fourth
being open for an open fire with no semblance
of fire-place or chimney, the floor but the bare
ground, the bed but a pile of leaves with grain
sacks over them; of attending the great-grand-
son of a full-blooded Cherokee Indian Chief
right here in this territory; of a case of pneu-
monia treated in a house where you could stand
by the bed and look out through cracks in the
roof and see the snow flying; of operating on
a ruptured appendix with the child on the top
of the sewing machine and only the wash boiler
for sterilizer and shaped ether cone from bail-
ing wire, and where the cracks of the floor were
so wide you could stick your hand through and
scratch the pigs on the head, and having the
patient get well; of a patient who apparently
thought he could walk on water (as the Bible
relates) but sank; of examination of a woman
who pulled a dog out from her feet under the
feather-bed as a foot-warmer, and many more
that are similar.”
CHARLES HOYT
The youngest brother of Dr. Wm. Hoyt I,
Charles Hoyt, got his medical education at
Pulte, Cincinnati, graduating in the late seven-
ties. He located in Chillicothe, Ohio, in 1881,
and started another family line of homeopathic
physicians. He was president of the Ohio State
Homeopathetic Society in 1913. His oldest son,
Loy, graduated from Hahnemann in Philadelphia
in 1909, and practiced with his father until his
death, and is still in active practice. Loy’s
oldest son, Charles, graduated from Physicians
& Surgeons in New York. He served in the
armed forces in the last war and is now associated
with his father in Chillicothe. Every one of the
Hoyt family have carried on the family medical
traditions in a record almost impossible to
equal in quantity and quality of high service —
Lucy S. Hertzog, M. D., Chardon, Ohio.
252
The Ohio State Medical Journal
^7(me to ‘Ttta&e
Hotel Reservations
for the
1950 Annual Meeting
Ohio State Medical Association
Cleveland, Ohio . . . May 16, 17, 18
NAME AND LOCATION
SINGLE
DOUBLE
DOUBLE
TWIN BED
ALLERTON HOTEL, 1802 E. 13th St.
$3.50-6.50
$5.50-10.00
$6.00-10.00
AUDITORIUM HOTEL, 1315 E. Sixth St.
$3.50-3.75
$4.50-5.00
$5.50-6.00
$7.00
$7.50 and Up
CARTER HOTEL, PUBLIC SQUARE
$4.75-7.00
$7.00-10.00
$8.00-12.00
CLEVELAND HOTEL (Headquarters Hotel)
$4.50
$6.50-9.00
$9.00-14.00
HOLLENDEN HOTEL, 610 Superior Ave.
$3.50-8.00
$5.50-10.00
$7.00-14.00
OLMSTEAD HOTEL, Superior & E. Ninth
$3.00-6.00
$5.00-8.00
$7.00-9.50
$7.00-9.50
STATLER HOTEL, Euclid at E. 12th St.
$4.00-6.00
$7.00-10.00
$8.00-12.00
HOTEL RESERVATION BLANK
Mail the coupon to hotel selected
Manager Hotel, Cleveland, Ohio
You are requested to reserve the following accommodations during the period of the Annual Meeting
of the Ohio State Medical Association, May 16, 17, 18, 1950, or for such other period as may be
indicated herein.
□ Single Room with Bath CD Double Room with Bath Price
□ Twin Bed Room with Bath CD Suite
Arriving May at A. M. P. M.
PLEASE VERIFY MY RESERVATION
Name
Address
for March, 1950
253
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Photo Courtesy The Wooster Daily Record
254
The Ohio State Medical Journal
Annual Meeting Instructional Courses . . .
ONE of the popular Educational features of the Annual Meeting in Cleveland, Tuesday, Wed-
nesday and Thursday, May 16, 17 and 18, will be the series of Instructional Courses. Since
these courses were instituted as a part of the Annual Meeting scientific program several years
ago, they have become more and more popular with members.
For the benefit of those who have not had an opportunity to attend any of these courses,
here is how they are conducted. The “class” consists of from 50 to 100 doctors who have previously
made reservations for a particular course. The discussion is conducted by a moderator and a
panel of three or more clinicians, each of whom is -a recognized authority in a particular phase of the
subject under discussion.
No formal presentations are made. After each discussant has had an opportunity to orient
the audience on his phase of the medical topic, the moderator throws the discussion open by direct-
ing questions to the various members of the panel. Questions from the audience usually are the
basis of the major part of the discussions. Every effort is made to keep discussions meaty and to
the point. Problems are discussed from the standpoint of the physician in everyday practice.
Attendance to the Instructional Courses will be limited. Admission will be by ticket only.
Therefore, those who plan to attend should apply for tickets in advance of the meeting.
A special folder on the Instructional Courses and other Annual Meeting events will be mailed
to each member in the near (future. This folder should be read carefully since it will give informa-
tion on how to secure Instructional Course tickets.
An application envelope for ordering Instructional Course tickets will accompany the folder.
This envelope should be filled out, per instructions, and mailed to the Columbus Headquarters Office
where applications will be filled. Because of limited facilities, applications will be filled on a first-
come, first-served basis. Tickets will be mailed well in advance of the meeting to those who apply.
There will be no registration fee for the courses, nor will there be a registration fee for
any of the scientific sessions.
The Committee on Scientific Work under the chairmanship of Dr. Martin W. Diethelm,
The Instructional Courses constitute only one phase of the vast Scientific Program of
the 1950 Annual Meeting. Other features include: General Sessions at which Specialty Sections
will present programs to the interest of physicians in all branches of medicine; Medical Topics
of the Day, panel discussions in which clinical procedures are emphasized; National Affairs, —
talks by Senator Robert A. Taft of Ohio and Dr. George F. Lull, secretary and general manager
of the A. M. A.; Scientific Exhibits, Technical Exhibits, Meeting of the House of Delegates,
Auxiliary Meeting, Annual Banquet. The complete program of the 1950 Annual Meeting will
be publishsed in thhe April isssuse of The Joui'nal.
On the facing page, the Cleveland Hotel, headquarters for the 1950 Annunal Meeting, is
superimposed over an aerial view of University Hospitals, adjuncts of the Western Reserve
University School of Medicine.
The Cleveland Hotel is a landmark of the city, well known to previous convention goers.
The University Hospitals, although not playing a direct part in the scientific program of the
Annual Meeting, are keystones in the history and progress of medical education and medical
practice in Ohio. All scientific features of the Annual Meeting will be held in the Cleveland
Public Auditorium.
Fourteen Informal Discussion Groups Will Provide Doctors With Wide
Range of
From Which To Choose At Cleveland Session
for March, 1950
255
Toledo, has invited as moderators for these courses physicians, each of whom is known, not only as
an authority in his field, but as a capable instructor.
The scientific program for the 1950 Annual Meeting will get under way on Tuesday, May 16.
The first of the series of Instructional Courses will be held from 9 to 10:30 a. m. on Wednesday,
May 17. The second series will be held from 10:30 a. m. to 12 noon, also on Wednesday. The
third series will be held Thursday from 10:30 a. m. to 12 noon.
This means that a doctor may include in his schedule three complete Instructional Courses,
in addition to the other scientific features being offered. These refresher courses offer an excellent
opportunity for physicians to discuss daily practice problems with authorities in the various fields
of medicine.
A. C. ERNSTENE, M. D.
Moderator, Course 1
‘Treatment of Heart Dis-
ease”
H. B. DAVIDSON, M. D.
Moderator, Course 3
“Blood Transfusions”
Following is a list of subjects to be covered
in courses with brief description of each:
Course 1 — “Treatment of Heart Disease,” Wed-
nesday, May 17, 9 to 10:30 a. m.; Moderator, Dr.
A. Carlton Emstene, Cleveland; Panel — Dr. John
W. Martin, Cleveland, congestive heart failure;
Dr. R. W. Scott, Cleveland, myocardial infarction;
Dr. R. K. Bartholomew, Dayton, Cardiac arrhy-
thmias.
Course 2 — “Office Anesthesia”; Wednesday,
May 17, 9 to 10:30 a. m.; Moderator, Dr. K. C.
McCarthy, Toledo; Panel — Dr. Alfred S. Gardiner,
Cincinnati; Dr. F. W. Clement, Toledo; Dr. Roger
L. Tecklenberg, Lima.
Course 3 — “Blood Transfusions”; Wednesday,
May 17, 9 to 10:30 a. m.; Moderator, Dr. Horace
B. Davidson, Columbus; one of the panel of dis-
cussants will be Dr. Warren Wheeler of the
Children’s Hospital, Columbus; other panel mem-
bers will be announced.
Course 4 — “Drug Therapy in the Aged”; Wed-
nesday, May 17; 9 to 10:30 a. m.; Moderator, Dr.
Joseph I. Goodman, Cleveland; Panel — Dr. Sieg-
fried Baumoel, Cleveland, cerebral and sedative
drugs; Dr. Harold Feil, Cleveland, cardiovascular
and pulmonary drugs; Dr. Reginald A. Shipley,
Cleveland, endocrine and related medication.
k. c. McCarthy, m. d.
Moderator, Course 2
‘Office Anesthesia”
J. I. GOODMAN, M. D.
Moderator, Course 4
“The Use of Drugs in the
Aged”
A. C. BARNES, M. D.
Moderator, Course 5
“Diagnosis and Treatment
of the Infertile Couple”
Course 5 — “Diagnosis and Treatment of the
Infertile Couple”; Wednesday, May 17, 9 to 10:30
a. m.; Moderator, Dr. Allan C. Barnes, Colum-
bus; Panel to be announced.
Course 6 — “Osteoporosis and Other Diseases of
Bone”; Thursday, May 18, 9 to 10:30 a. m.;
Moderator, Dr. Charles A. Doan, dean of the
Ohio State University College of Medicine, Co-
lumbus; Panel — (to be announced).
Course 7 — “Poliomyelitis”; Thursday, May 18,
9 to 10:30 a. m.; Moderator, Dr. James G.
Kramer, Akron; Panel — Dr. Alex J. Steigman,
C. A. DOAN, M. D.
Moderator, Course 6
“Osteoporosis and Other
Diseases of Bone”
256
The Ohio State Medical Journal
J. G. KRAMER, M. D.
Moderator, Course 7
“Poliomyelitis”
C. F. McKHANN, M. D.
Moderator, Course 9
“Care of Newborn and
Premature”
F. N. SILVERMAN, M. D.
Moderator, Course 11
“Pediatric Roentgenologic
Diagnosis”
C W. HARDING, M. D.
Moderator, Course 13
“Understanding and Treating
the Alcoholic”
New York, National Foundation for Infantile
Paralysis; Dr. Warren Wheeler, Children’s Hos-
pital, Columbus; Dr. Walter M. Solomon, Cleve-
land; Dr. Albert L. Bershon, Toledo.
Course 8 — “Prolonged Labor”; Thursday, May
18, 9 to 10:30 a. m.; Moderator, Dr. Richard D.
Bryant, Cincinnati; Panel — Dr. A. Hirsheimer,
Dayton; Dr. N. E. Wentsler, Akron; Dr. Burdett
Wylie, Lakewood; Dr.. Dean Sheldon, Sandusky.
Course 9 — “Care of the Newborn and Pre-
mature”; Thursday, May 18, 9 to 10:30 a. m.;
Moderator, Dr. Charles F. McKhann, director of
pediatrics, University Hospitals of Cleveland.
Panel to be announced.
Course 10 — “Antibiotics”; Thursday, May 18,
9 to 10:30 a. m.; Moderator, Dr. Maurice A.
Schnitker, Toledo; Panel — Dr. Charles F. Ram-
melkamp, Department of Preventive Medicine,
Western Reserve University School of Medicine;
Dr. Norman W. Thiessen, Lakewood; Dr. John
E. Brown, Jr., Columbus.
Course 11 — “Pediatric Roentgenologic Diag-
nosis”; Thursday, May 18, 10:30 a. m. to 12 m.;
Moderator, Dr. Frederic N. Silverman, director,
Department of Roentgenology, Children’s Hos-
pital, Cincinnati; Panel — Dr. Eugene Saenger,
Cincinnati; Dr. James F. Martin, Cincinnati; Dr.
W. H. R. Howard, Cincinnati; Dr. John Caffey,
New York.
Course 12 — “Injuries to the Chest”; Thursday,
May 18, 10:30 a. m. to 12 m.; Moderator, Dr.
Donald M. Glover; Panel — Dr. Edward Harlan
Wilson, Columbus; Dr. William Falor, Akron;
Dr. Vinton E. Siler, Cincinnati; Dr. Stanley Hoerr,
Cleveland.
Course 13 — “Understanding and Treating the
Alcoholic”; Thursday, May 18, 10:30 a. m. to
12 m.; Moderator, Dr. Charles W. Harding, Co-
lumbus. Panel to be announced.
Course 14 — “Emergencies in Eye, Ear, Nose
and Throat”; Thursday, May 18, 10:30 a. m. to
12 m.; Moderator, Dr. Claude S. Perry, Colum-
bus. Panel — Dr. Albert L. Brown, Cincinnati,
Blunt trauma to eye (A) hemorrhage and Rx.
(B) other changes; Dr. Charles I. Thomas,
Cleveland, (1) Chemical burns and irritants,
(2) corneal transplant, what it can and cannot
do; William H. Evans, Youhgstown, (1) hemor-
rhage of nose and throat, (2) emergency care
of fracture of the nose; Dr. Daniel W. Brickley,
Jr., Marion, (1) acute ear infections, middle
and external, (2) foreign bodies in ear.
R. D. BRYANT, M. D.
Moderator, Course 8
“Prolonged Labor”
M. A. SCHNITKER, M. D.
Moderator, Course 10
“Antibiotics”
D. M. GLOVER, M. D.
Moderator, Course 12
“Injuries to the Chest,
Abdomen and Spine”
C. S. PERRY, M. D.
Moderator, Course 14
“Emergencies in Eye, Ear,
Nose and Throat”
for March, 1950
257
Doctors, Educators Discuss School Health
Representatives of More than Fifty County Societies Spend Sunday
In Columbus to Attend Unique Conference Sponsored by Association
INTEREST of the medical profession in school
health was emphasized by a conference held
in Columbus on February 5. Representatives
of 50 County Medical Societies responded to an
invitation of the Ohio State Medical Association
and heard the subject discussed from various
viewpoints by authorities in respective fields.
Dr. Carl A. Lincke, President of the Ohio
State Medical Association, presided at the meet-
ing and reviewed the medical professions in-
terest and activities in the field of school health.
In his introductory remarks, he brought out the
fact that the American Medical Association has
been working with the National Education Asso-
ciation for more than 30 years on the subject
of school health.
Through the efforts of the Committee on School
Health of the Ohio State Medical Association,
headed by Dr. Thomas E. Shaffer, local com-
mittees on school health have been formed by
three-fourths of the 88 county medical societies
throughout the State, Dr. Lincke revealed. The
Association’s committee and local committees, he
said, are working in harmony with the Ohio
Department of Education, the Ohio Department
of Health, the Ohio Congress of Parents and
Teachers, the Farm Bureau, the Grange and
other organizations which are vitally interested
in school health.
The general theme of the discussion was “How
Can We Work Together.” Approximately 110
persons were present to hear the theme discussed
by a panel of discussants and a representative
of the A. M. A.
TYPICAL PROGRAM DESCRIBED
H. C. McCord, superintendent of Worthington
Public Schools, described the school health pro-
gram in effect in his schools. His is one of
about 22 similar programs instituted six years
ago under sponsorship of the Kellogg Foundation
which operates through the Ohio Department of
Education.
The program started with a class in health,
under direction of an instructor who was given
special refresher courses at Ohio State Univer-
sity. The program then broadened. Represen-
tatives of all organizations in the community
were invited to offer suggestions on formulating
policy. Policy is formulated by a group which
includes the school principal, nurse, physical edu-
cation teacher, elementary school principal, two
physicians and a dentist. A card is kept on file
for each student. Information on the card in-
cludes parents’ instructions in case of accident or
serious illness.
Mr. McCord emphasized the need of school-
doctor cooperation on physical examinations of
students and stated that he believed doctors
should be compensated for their time in this
work.
NEED DOCTORS’ HELP
Dr. W. P. Cushman, associate professor of
physical education at Ohio State University, dis-
cussed the subject of why the teacher needs the
help of the physician. The teacher, he said,
knows that as high as 20 per cent or more of
youngsters will develop vision defects that will
impair learning. Hearing defects also impair
learning. The teacher should know if a pupil
is an epileptic or a diabetic; whether he has had
polio or rheumatic fever or suffers from some
other handicap. When a child returns after an
acute illness, the teacher should know if he is
in condition to try to make up for lost time.
Questions often come up, especially in health
classes, Dr. Cushman, as to the status of limited
practitioners, or the value of certain patent
medicines. The teacher, he emphasized, needs
advice from a doctor on many such questions.
P. T. A. PRESIDENT SPEAKS
Mrs. R. C. Bickel, Columbus, president of the
Ohio Congress of Parents and Teachers, gave a
general picture of what the Congress is doing in
school health. In the field of health, she said,
the Congress has six committees — one each on
dental hygiene, health, mental hygiene, school
lunch, social hygiene and summer roundup.
The summer roundup of preschool children in
most communities, she said, is conducted by par-
ents taking their children to the family doctor for
a check up and for immunization. In some com-
munities a clinic is held at the school to which
parents bring their children.
Another program of the Ohio Congress of
Parents and Teachers is that of sponsoring health
conferences in each of the nine dis'ricts of the
State, through the Ohio Department of Healh..
OHIO EDUCATION OFFICIAL
Paul E. Landis, supervisor of health, physical
education, recreation, and safety, Ohio Depart-
ment of Education, described the health proT
grams in schools as provided by the Department
of Education and local school boards. Mr. Landis
pointed out that the medical profession must
provide the technical and professional services
TO BE A GOOD CITIZEN, YOU MUST
BE REGISTERED TO VOTE
258
The Ohio State Medical journal
School Health Committeemen Hear Problems Discussed
O. S. M. J. Staff Photos
Fifty County Medical Societies were represented
at the Conference of School Health Committees
of Ohio’s County Medical Societies in Columbus
on February 5 under sponsorship of the Ohio
State Medical Association.
1. Part of the group of approximately 110 are
shown as they enjoyed luncheon at the Hotel
Fort Hayes before entering into a discussion of
the general theme, “How Can We Work To-
gether.’’ At the speakers’ table are six panel
discussants, and the principal speaker of the
afternoon. They are (left to right) :
(a) W. P. Cushman, Worthington, associate
professor of physical education, Ohio State Uni-
versity ;
(b) Dr. John D. Porterfield, director of the Ohio
Department of Health, Columbus;
(c) Paul E. Landis, supervisor of health, phy-
sical education, recreation and safety, Ohio State
University ;
(d) Mrs. R. C. Bickel, Columbus, president of
the Ohio Congress of Parents and Teachers;
(e) Dr. Carl A. Lincke, Carrollton, President
of the Ohio State Medical Association, Chairman
of the Conference.
(f) Fred V. Hein, Ph. D., Chicago, consultant in
health and fitness. Bureau of Health Education,
American Medical Association.
(g) Dr. Thomas E. Shaffer, Columbus, chair-
man of the Committee on School Health of the
Ohio State Medical Association; and
(h) H. C. McCord, superintendent of the
Worthington Public Schools.
2. Dr. Hein is shown as he discussed health edu-
cation on national and local levels.
3. This photograph shows Dr. Shaffer conduct-
ing a general discussion on school health prob-
lebs on the local level. Seated are Mr. Landis
and Mrs. Bickel.
4. Mr. McCord gave a practical review of the
school health program as it is working in Worth-
ington Schools.
5. Dr. Cushman described school health as ap-
plied on the college level.
See article on facing page for more
details.
for March, 1950
259
in the administration of school health service
programs.
The physician, he said, should know that the
school health service includes the operation of
those agents or agencies which aim to con-
serve, protect and improve the health of school
children. Physicians can give suggestions for
construction and provision of restroom or first
aid room; they can give advice on facilities for
drinking water and sewage and waste disposal;
they can advise effective means of establishing
health education programs.
STATE HEALTH DIRECTOR
Dr. John D. Porterfield, director of the Ohio
Department of Health, explained the role of the
Department and local health departments in
school health programs. He explained how health
officials, especially a health nurse, can act as
liaison between school and family. He explained
also how the health department acts as an
inspection agency for school facilities. He also
suggested that school health program and health
detection centers might be more closely co-
ordinated. He explained also the educational
program of the health department in its relation
to school health.
Dr. Thomas E. Shaffer, medical director of the
University faculty, is chairman of the Com-
mittee on School Health of the Ohio State
Medical Association. Dr. Shaffer discussed re-
lationship between school health programs and
physicians of the community and emphasized the
need of cooperation on the part of doctors. Dr.
Shaffer also exlained the functions of the
Association’s Committee on School Health and
how it is attempting to stimulate organiza-
tion of such committees in each county society.
Approximately three-fourths of the county so-
cieties now have school health committees, he
said.
Dr. HEIN OF A. M. A.
Fred V. Hein, Ph. D., Chicago, consultant in
health and fitness, Bureau of -Health Education
of the American Medical Association, com-
plimented the Ohio State Medical Association
for instituting such a meeting, and said that to
his knowledge it was he first of its type staged
anywhere.
Dr. Hein explained the functions of his Bureau
which is directed jointly by him and a doctor of
medicine. The Bureau of Health Education
attempts to bring together thinking of educators
and doctors on the subject of school health. It
goes into the various states and tries to stim-'
ulate and to help in the development and expan-
sion of school hetalth programs.
The Bureau, he explained, is in position to
offer practical and technical advice on the use
of appliances such as germicidal lamps in
classrooms, the use of certain testing apparatus
in health examinations, and the like. The Bureau
Notice of Discontinuance
If Dues Are Not Paid
If you are receiving The Jom'nal as a
member of the Ohio State Medical Asso-
ciation and have not paid your 1950 dues,
your name automatically will be dropped
from the mailing list. That means that this
is the last issue of The Journal you will
receive until such time as your 1950 dues
are forwarded through your county medical
secretary. The Association’s dues are pay-
able in advance for the fiscal year Janu-
ary 1-December 31. If you have not paid
your 1950 dues, please forward them im-
mediately to your county society secretary.
offers materials for extensive educational pro-
grams. One of its features is an unlimited
number of prepared radio programs on school
health and other phases of health which are
loaned to county societies for arrangement with
local stations.
The Conference was concluded with a “Clinic
on Local School Health Activities,” conducted
by Dr. Shaffer. Questions from the floor were
discussed by the panel of speakers.
In addition to school health committeemen
of county societies, the following members of
the Committee on School Health of the Ohio
State Medical Association were present: Dr.
Shaffer, Dr. Frank A. Holloren, Springfield; Dr.
Margaret O’Neal, Zanesville; Dr. Charles F.
Good, Cleveland; Dr. Roy E. Shell, Van Wert;
Dr. Carl A. Wilzbach, Cincinnati; and Dr. T. L.
Light, Dayton.
Members of The Council present were: Dr.
Lincke; Dr. A. A. Brindley, Toledo, Past-
President; Dr. H. T. Worstell, Columbus, Treas-
urer; Dr. D. W. Heusinkveld, Cincinnati, Coun-
cilor of the First District; Dr. Merrill D. Prugh,
Dayton, Councilor, Second District; Dr. Fred W.
Dixon, Cleveland, Councilor, Fifth District; Dr.
Paul A. Davis, Akron, Councilor, Sixth District;
Dr. J. P. McAfee, Portsmouth, Councilor, Ninth
District; Dr. H. M. Clodfelter, Columbus, Coun-
cilor, Tenth District; Dr. J. S. Hattery, Mans-
field, Councilor, Eleventh District. Messrs.
Charles S. Nelson, Executive Secretary, George
H. Saville and Gordon Moore, of the headquarters
office also were present.
Since the end of World War II tuberculosis
case finding has been pushed in an ever widen-
ing area, and at present about 10,000,000 persons
a year are receiving X-ray examinations. — Metro-
politan Life.
IF YOU’RE NOT REGISTERED TO VOTE,
VISIT YOUR ELECTION BOARD
260
The Ohio State Medical Journal
First Hill-Burton Hospital Completed . . .
Three Other New Institutions To Be Opened in Near Future; More
Than 37 Projects Now on Approved List; 22 Are Under Construction
Photo Courtesy The Wooster Daily Record
This is a view of the newly completed Wooster Community Hospital, scheduled to open with ceremonies on March 4.
FIRST of the hospital projects in Ohio con-
structed under the Hill-Burton Law will be
officially opened when the Wooster Com-
munity Hospital is scheduled to be dedicated on
March 4.
This is a general hospital and public health
center with facilities for 70 beds and 21 bassinets.
Total cost of the project has been estimated at
$1,369,986.66 of which the Federal government
furnished a third.
Other projects scheduled to be opened in the
very near future are:
The Memorial Hospital of Fayette County,
Washington Court House, with facilities for 34
beds, constructed at a cost of $630,000 of which
the Federal government furnished one-third.
This is a combination general hospital and health
center.
Richland County Tuberculosis Sanitorium,
Mansfield, an 84-bed sanitorium constructed at
a cost of $788,025.58.
Mount Saint Mary Hospital, Nelsonville, gen-
eral hospital and health center with 74 beds;
total cost, $1,256,965.98 of which the Federal
share was one-third.
Public Law 725, or the Hill-Burton Law, ori-
ginally appropriated $75,000,000 of Federal funds
as grants-in-aid for hospital construction. The
amount has since been increased to $150,000,000.
Ohio became eligible for participation in the
program as of the fiscal year July 1, 1947- June
30, 1948. Twenty-one projects were approved
for participation under the first two years’ ap-
propriations. Nearly six million dollars in
Federal funds are available to Ohio each year
under the new appropriation through June of
1955.
NEW PROJECTS
Following are new projects in addition to
the 21 previously approved, which have either
complete or preliminary approval of the Surgeon
General :
The Chronic Disease Hospital of Hamilton
County, Cincinnati; 440 beds; construction cost,
$4,695,528.27 (Federal share, $1,195,528,27).
The Cuyahoga County Chronic Disease Hos-
pital; in conjunction with present Cuyahoga
County Tuberculosis Hospital at Warrensville;
400 or more beds; cost $5,829,400 (Federal share,
$829,400).
Williams County Hospital, Montpelier; 34 beds;
cost, $550,000 (Federal share, $183,333.33).
Adams County Hospital, West Union; cost,
$375,000 (Federal, $125,000).
Brown County Hospital, Georgetown; cost,
$600,000 (Federal, $200,000).
Molly Stark Tuberculosis Sanitorium, Canton;
cost, $750,000 (Federal, $250,000).
Marietta Hospital; 55-bed addition to present
hospital; cost, $600,000 (Federal, $200,000).
St. Marys Hospital, St. Marys; 50 beds; $750,-
000 (Federal, $250,000).
Alliance City Hospital; addition to present
hospital; $1,575,000 (Federal share, $525,000).
Euclid-Glenville Hospital (suburban Cleveland);
$3,000,000 (Federal, $1,000,000).
Lawrence County General Hospital, Ironton;
$124,699.98 (Federal, $41,566.66).
Mercy Hospital, Portsmouth, $1,624.00 (Federal
share on equipment only, $160,000).
Good Samaritan Hospital, Sandusky; addition
for March, 1950
261
to existing1 hospital plus equipment; $771,000
(Federal, $257,000).
Dettmer Hospital, Piqua-Troy area; $1,700,000
(Federal, $497,109).
Morrow County Hospital, Mt. Gilead; equip-
ment only, $93,000 (Federal, $31,000).
Springfield Mercy Hospital, equipment only,
$329,302.56 (Federal, $109,767.52).
New Members of O. S. M. A.
I
Following are the names of new members of
the Ohio State Medical Association, since Janu-
ary 1, 1950. The list shows the county in which
they are affiliated, city in which they are prac-
ticing, or temporary addresses in cases where
physicians are taking postgraduate work.
ALLEN COUNTY
Charges L. Blumstein,
Lima
Oliver A. Horak, Lima
Asa C. Jones, Jr., Lima
Howard C. Kingsbery,
Lima
Harry Warshawsky, Lima
AUGLAIZE COUNTY
Robert J . Herman,
Wapakoneta
BELMONT COUNTY
Robert N. Lewis,
St. Clairsville
BROWN COUNTY
Kevin C. McGann,
Georgetown
BUTLER COUNTY
Robert C. Dunn, Middle-
town
Betty B. Owens, Middle-
town
William I. Owens, Middle-
town
CLARK COUNTY
Max D. Graves, Spring-
field
Herman L. Guyselman,
Springfield
Maurice Tatelman,
Springfield
CLINTON COUNTY
Robert E. Suer, Wilming-
ton
COLUMBIANA COUNTY
Joseph T. Noe, East
Liverpool
COSHOCTON COUNTY
George D. Mogil, Coshoc-
ton
CRAWFORD COUNTY
Bernard M. Mansfield,
Gallon
CUYAHOGA COUNTY
Hugh R. Anderson, Lake-
wood
Joseph M. Black, Cleve-
land
Kent L. Brown, Cleveland
Arthur F. D’Ale^andro,
Cleveland 9
Ear] S. Hallinger, Jr.,
Cleveland
Charles A. Hubay, Cleve-
land
Robert C. Kirk, Cleveland
William F. Kubicek, Jr.,
Cleveland
A. Engle Lenhert, Cleve-
land
Alan R. Moritz, Cleveland
Frank J. Rack, Cleveland
Charles E. Richards,
Cleveland
Lewis A. Steinhilber,
Cleveland
Joseph A. Votypka,
Cleveland
Paul R. Zeit, Cleveland
DARKE COUNTY
Daryl M. Parker, Hollans-
burg
DELAWARE COUNTY
Robert A. Vogel, Dela-
ware
ERIE COUNTY
John R. Mellen, Milan
Harold E. Snedden,
Sandusky
Richard H. Williamson,
Huron
FAIRFIELD COUNTY
Lloyd L. Kersell, Lan-
caster
Carl R. Reed, Lancaster
Floyd R. Town, Lancaster
FRANKLIN COUNTY
Alfred Adler, Columbus
A. Waite Bohne, Columbus
George T. Brooks, Colum-
bus
C. Joseph Cross, Columbus
James K. DeVore, Colum-
bus
Dorothy E. Eshbaugh,
Columbus
John P. Garvin, Columbus
James R. Gay, Columbus
George R. Hoeflinger,
Hiiliards
Raymond L. Jennings,
Westerville
Frank C. Long, Jr., Co-
lumbus
William O. McNellie, Co-
lumbus
W. Hugh Missildine, Co-
lumbus
Samuel W. Robinson, Co-
lumbus
John P. Smith. Columbus
Robert F. Sylvester, Jr.,
Columbus
Philip H. Welch, III, Co-
lumbus
FULTON COUNTY
Francis E. Elliott,
Wauseon
Cal S. Kellogg, Swanton
Keith S. Wemmer, Delta
GALLIA COUNTY
James A. McMurrin,
Gallipolis
GREENE COUNTY
Ernest Hoffman, Jr..
Yellow Springs
HAMILTON COUNTY
John B. Chewning, Cin-
cinnati
William T. Collins, Cin-
cinnati
Philip R. Dobert, Cincin-
nati
Barbara Ann Hewell,
Cincinnati
Charles A. Mangham,
Cincinnati
Charles J. Miller, Cincin-
nati
Alvin Nathan, Cincinnati
John Joseph Phair, Cin-
cinnati
William B. Rudemiller,
Cincinnati
Arthur C. Utrecht, Cin-
cinnati
Otto W. Wilton, Cincin-
nati
Jean Paul Wozencraft,
Cincinnati
Joseph F. Wright, Cin-
cinnati
HANCOCK COUNTY
R. Grant Janes, Findlay
HIGHLAND COUNTY
John R. McBride, Hillsboro
George L. Morris, Hillsboro
JACKSON COUNTY
Alvis R. Hambrick, Wells-
ton
LAKE COUNTY
Anthony J. DiCello,
Painesville
LUCAS COUNTY
Horace E. Allen, Toledo
Shoichi Asahina, Toledo
George S. Bova, Toledo
Robert G. Fish, Toledo
Frederick V. Gipson,
Toledo
Donald Haselhuhn,
Toledo
Leo B. Janis, Toledo
Felix B. Martin, Toledo
Jack W. Millis, Toledo
Anthony J. Regent, Toledo
Charles L. Stevers,
Toledo
John J. Tansey, Toledo
MAHONING COUNTY
James A. Patrick,
Youngstown
MARION COUNTY
William B. Leffler, Marion
MEDINA COUNTY
Carl J. Ferber, Valley
City
MONTGOMERY COUNTY
Henry J. Caes, Dayton
Jesse P. Kuperman, Dayton
David B. Roth, Dayton
Harold J. Schneider, Day-
ton
Samuel P. Studybaker,
Miamisburg
Nicholas J. Thompson,
Dayton
PICKAWAY COUNTY
Warren R. Hoffman,
Ashville
PORTAGE COUNTY
Walter W. Lang, Kent
SANDUSKY COUNTY
Donald C. Haugh, Fremont
SHELBY COUNTY
Richard H. Breece,
Jackson Center
John H. Kerrigan, Sid-
ney
George J. Schroer, Sidney
STARK COUNTY
Cyril V. Gross, Canton
John Dueber Joliet, Canton
Richard H. Kelty, Canton
William S. Rothermel,
Canton
TRUMBULL COUNTY
Joseph A. Browning,
Warren
Gene D. Fry, Girard
John A. Grima, Warren
UNION COUNTY
Malcolm Maclvor, Marys-
ville
WASHINGTON COUNTY
William R. Stewart,
Marietta
WAYNE COUNTY
Seymour C. Boor, Creston
Robert A. Davison, Shreve
Joel F. Pratt, Wooster
WOOD COUNTY
Floyd A. Nassif, Luckey
Course on General Surgery
“Practical Problems in General Surgery” is the
subject of a continuation course to be presented
on April 6, 7, and 8 by the Frank E. Bunts
Institute and the Cleveland Clinic. On Friday eve-
ning, April 7, Dr. Daniel C. Elkin of Emory Univer-
sity, Dr. Claude Beck of Western Reserve Uni-
versity Medical School, and Dr. R. B. Turnbull
of the Cleveland Clinic will take part in a
symposium on “Vascular Surgery.” On Satur-
day morning, April 8, Dr. George G. Finney of
Johns Hopkins University and others will present
Panel Discussions on surgery of the colon, pan-
creas, biliary tract, and stomach and duodenum.
Inquiries regarding the complete program and
registration can be addressed to the Director of
Education, Frank E. Bunts Educational Institute,
2020 East Ninety-third Street, Cleveland 6, Ohio^
ARE YOU REGISTERED TO VOTE?
IF NOT, ACT PROMPTLY
262
The Ohio State Medical Journal
Columbus Blood Center Ranks High . . .
Local Red Cross Unit Ranks Fourth of Centers in Nation
And Is Lower Than All Others in Cost Per Pint Furnished
THE Red Cross Blood Program is designed
to bring the benefits of blood to everyone
without charge. The Franklin County
Regional ’ Center, opened in Columbus December
7, 1948, was the 18th to be put into operation
nationally. It now ranks fourth in the entire
country in the collection of blood. As of Decem-
ber 31, 1949, this center was topped only by
Los Angeles, Philadelphia, and Washington, D. C.,
The average national cost, in the 33 regional
Red Cross centers now operating, for recruit-
ing, processing, and distributing blood, is $18.60
per pint. During the first six months of 1949,
the costs through the Franklin County Center
were $7.41 per pint — the lowest average in
the nation. This center is the only regional
in the order mentioned.
COLLECTIONS
Red Cross records, December
in pints of blood in 26 counties
Red Cross center in Ohio.
AND DELIVERIES BY COUNTIES AND INSTITUTIONS
7, 1948, through December 31, 1949, show the following collection and
distribution
County
Collections
Deliveries
Shelby
658
738.5
Miami — Troy _
635
873
Piqua ...
575
1,210 -
_. 771
1,644
Richland ....
1,491
1 .985.5
Delaware
810
407.5
Madison
376
* (no hospital)
Pickaway
162
(no hospital)
Champaign
362
266
Crawford — Bucyrus
466
300
Crestline
229
...122
Galion
225
..... 920
.196
708
Ashland
500
267.5
Athens
678
287
Logan
821
304
Knox
556
850
Fairfield
. 1,005
566
Marion
1,149
1,197.5
Coshocton .
602
395
Hardin
388
338
Licking
1,323
537
Ross
688
517
Fayette
. . .. 265 .
(no hospital 1
Union .
277 .
(no hospital)
Perry (one visit)
67
32
Hocking ._
89 .
50
London Prison Farm ..
311
Mansfield Reformatory
1.135
Woman’s Reformatory
52
Ohio State Penitentiary
1,235
Franklin County
- . 8,240
** 13,176
TOTAL
25,379
Other Regions
24,298.5
39
TOTAL
* They may avail themselves of Red Cross blood in the hospital to which they are sent.
** 30 per cent of Franklin County distributions are made to out-of-town patients hospitalized in Columbus.
24,337.5
Heart Research Grant
Award of $60,961 in Public Health Service
grants for four non-Federal heart research proj-
ects investigating hardening of the arteries,
high blood pressure and the effect of chemical
and electrical substances on the heart, has been
announced. The grants were made by the Na-
tional Heart Institute to three medical schools
and a private foundation.
Part of the grant was awarded to the Cleve-
land Clinic Foundation, where Dr. Irvine H. Page
will investigate endocrine glands to determine
their role in the development of high blood pres-
sure and hardening of the arteries.
Domus Medica
The Domus Medica, international center of
medical welcoming organizations, occupies a
new office at 111 East Oak St., Chicago. This
organization has corresponding offices in the
principal countries of the world. Physicians
may write to the Domus Medica for informa-
tion or for international contacts, as well as
for scientific, cultural, artistic and tourist view-
points. Physicians who plan to visit foreign
countries are invited to contact Dr. Valentin
Charry, delegate of Domus Medica, at the
Chicago address.
for March, 1950
263
Northern Tri-State To Meet In
Grand Rapids, April II
The Northern Tri-State Postgraduate Medical
Association, which includes Indiana, Ohio and
Michigan, will hold its 77th Annual Meeting
in Grand Rapids, Mich., April 11. Further
information may be obtained from Dr. James
E. McMeel, secretary, 133 S. Main St., South
Bend, Ind.
Speakers and their subjects for discussion
include the following:
“The Present Therapy of the Commonest Skin
Diseases” — Dr. A. P. R. James, director of the
City Skin and Syphilis Clinics, Toledo.
“The Neurological Complications of Injury
to the Head and their Treatment” — Dr. Paul C.
Bucy, M. D., University of Illinois.
“The Place of Surgery in the Treatment of
Peripheral Vascular Disease” — Dr. G. DeTakats,
University of Illinois.
“Rupture of Bladder and Urethra,” Etiology,
Diagnosis and Treatment — Dr. Vincent J. O’Con-
nor, Northwestern University Medical School.
“Pathological Conference” — Dr. F. Hartman
and associates, Ford Hospital, Detroit.
“A Doctor Makes a Critical Survey of the
Medical Profession” — Dr. Paul R. Hawley, newly
appointed director of the American College of
Surgeons.
“Pharmacologic Approach to the Treatment
of Neurogenic Disorders” — Dr. Frederick F.
Yonkman, Ciba Pharmaceutical Products Co.
“Methods for Diagnosing the Types of
Anemias and the Choice of Medicines in their
Treatment.” — Dr. R. Isaacs, University of Michi- _
gan.
“The Management of the Diabetic Patient
by the General Practitioner” — Dr. J. H. Warvel,
Eli Lilly & Co.
“Anemias of Childhood, Plan for Diagnosis
and Outline of Treatment” — Dr. J. L. Wil-
son, University of Michigan.
Average Physician Exempt Under
New Wage-Hour Act
The average physician is not subject to the
provisions of the new Federal Wage-Hour Act,
calling for a minimum hourly wage of 75 cents
for employees because he is not engaged in inter-
state commerce.
If a physician’s practice would extend into an-
other state, he also would probably be exempt
under the provision which exempts employers
and employees of any retail service establish-
ment of which more than 50 per cent of the an-
nual dollar volume of sales of goods or services
are made within the same state.
Nurses and technicians employed by physicians
would be automatically exempt, in any event, as
they would be classified as professionals.
General Practice Chapter Elects
Dr. Dale E. Putnam, Westerville, is the 1950
president of the Franklin County Chapter of the
American Academy of General Practice. Dr.
Roger E. Heering, Columbus, was chosen presi-
dent-elect and Dr. Florence Lenahan, Columbus,
was elected secretary-treasurer.
Members of the Board of Trustees are: Drs.
R. W. Bonnell, Anthony R. Marsicano, Thomas
E. Rardin, Percy B. Wiltberger, Lovell W. Rohr,
Alice M. Bustin, Oscar L. Coddington, John N.
Cross, Joseph C. Forrester, John P. Urban,
J. J. Hughes, Henry W. Karrer, Adolf W. Verhoff,
Thomas P. Wangler and John W. Wilce, all of
Columbus.
A. M. A. Dues Deductible
The $25 dues of the American Medical Associa-
tion are deductible under the provisions of the
Federal Income Tax Law as professional ex-
pense.
The A. M. A. has requested the U. S. Commis-
sioner of Internal Revenue for an official ruling
on whether the 1949 special assessment is
deductible — a point on which there has been a
difference of opinion.
Discontinue Pay For Drugs
The State Industrial Commission has an-
nounced that physicians and hospitals will no
longer be reimbursed for the cost of penicillin
and streptomycin administered to claimants.
The reason given is that the cost of these anti-
biotics has decreased so materially that they can
no longer be considered “expensive drugs.”
There is no change in the fee schedule for
professional services.
Ohio Health Association
To Meet in Columbus
The annual meeting of the Ohio Public Health
Association will be held in Columbus, May 11-12.
President of the organization is Dr. F. E. Mahla,
Lucas County health commissioner. President-
elect is Dr. Carl A. Wilzbach, Cincinnati health
commissioner.
Among those appointed on the program com-
mittee are: Dr. Harry Wain, Richland County -
Mansfield commissioner, Chairman; Dr. Ollie M.
Goodloe, Columbus commissioner, and Dr. John
D. Porterfield, director of the Ohio Department
of Health.
Anyone engaged in or interested in public
health may become a member by sending in his
name, address, a note of special interest or field
and the $2 annual dues to Roy Haines, secre-
tary-treasurer, 15 Lawrence Block, Bellefontaine.
ARE YOU REGISTERED TO VOTE?
IF NOT, ACT PROMPTLY
264
The Ohio State Medical Journal
Antihistaminic Drugs . . .
Food and Drug Administration Issues Memorandum Outlining
Policy in Regard to Over-Counter Sale of Tablets to Public
A MEMORANDUM from the Washington of-
fice of the Federal Food and Drug Ad-
ministration furnishes background on the
release of antihistaminic drugs now being sold
directly to laymen by drug stores. It also shows
how the Food and Drug Administration deals
with drug firms in the marketing of a new drug.
The memorandum was sent to the Ohio De-
partment of Health from the Cincinnati District
Offices of the Administration, under direction of
Mr. K. L. Milstead. It is quoted herewith in
full as it appeared in Ohio’s Health, publication
of the Ohio Department of Health.
± * :fs
STATEMENT RE ANTIHISTAMINIC DRUGS FOR
LAY USE
New drug applications have recently been made
effective for oral antihistaminic tablets for lay
use. Additional new drug applications for
similar products will be made effective in the
near future. Not all of the firms have definitely
decided to market their products and, in some
cases, the proposed name may be changed before
the drug is marketed.
The firms have been told that, in our opinion,
the claims should be restricted to relief of
symptoms of the common cold and of hay fever.
The Administration’s position is summarized in
its letter of November 7, 1949, to the National
Better Business Bureau, Inc., New York, New
York.
NO PANACEA
“Answering the specific questions in your
letter of October 28 which deals with anti-
histamine tablets, we certainly do not believe
that anyone and everyone who takes one of these
tablets at the first symptoms of a cold will have
his cold stopped.
“We assume that you are in general familiar
with the research which began some years ago
and which resulted in the manufacture of a
number of medicines which have in some cases
the ability to counteract the effects of histamine.
“These drugs have until recently been re-
stricted to sale on prescription. They have been
conclusively shown to be very helpful in hay
fever, certain types of sensitization rashes, and
in several other conditions generally believed
to be due to reactions to histamine release. On
the other hand, for some unexplained reason,
they appear to possess very limited value in
conditions such as asthma which also are gen-
erally believed to be related at least in part to
the release of histamine.
NUMBER OF INVESTIGATIONS
“More than a year ago a number of investi-
gators expressed the view that the early symp-
toms of colds are allergic in origin. They be-
lieved that colds should be benefited by anti-
histamine therapy. Probably Dr. J. M. Brew-
ster, medical officer in the United States Navy,
is largely responsible for the present extensive
interest in the use of antihistamine drugs for
the prevention and treatment of the common cold.
“Publications dealing with clinical trials which
he has made of a number of these products are
to be found in the U. S. Naval Bulletin 47:811,
1947, and in the same publication 49:1, 1949. He
was also author of an article which appeared
in Industrial Medicine, 18:217, 1949. There are
other published clinical investigations and we
have also seen reports of clinical studies which
have not as yet appeared in print.
“The net impression which these articles as a
whole convey to our medical staff is that a
number of investigators who may be regarded as
competent to conduct controlled clinical studies
have reached the conclusion that, in the case of
many colds, if therapy with antihistamine drugs
is begun immediately when the first symptoms
appear the symptoms may be suppressed and for
all practical purposes the cold aborted.
“Some investigators are so optimistic as to
ascribe these benefits to some 80 per cent to 90
per cent of the persons treated. They practically
all agree that the effectiveness of the medication
decreases when the medication is not started
early in the course of the cold.
AVAILABLE EVIDENCE
“The available scientific evidence at this time
is that probably the antihistamine drugs have
a legitimate place in cold therapy. We are very
skeptical of the breadth of the claims which
purveyors of the product wish to make in selling
medications in this class to the lay public.
“Our skepticism arises first because a statis-
tically sound clinical study of the effect of any
medicine in the common cold is most difficult.
This is further complicated when the medica-
tion must be taken at the first sign of a cold to
manifest maximum results. It is common experi-
ence of all of us to believe that we can recog-
nize the first symptoms of a cold.
“Many times we are wrong since after having
undertaken no treatment whatsoever we just
jor March , 1950
265
do not develop a cold. Another factor that in-
troduces uncertainty into the situation is that in
spite of much research a precise definition of
the common cold has never been forthcoming.
“Most authorities agree that the illness which
the public refers to as the common cold is not a
single disease. It probably involves a number of
different diseases which manifest the same or
similar symptoms. We do not believe that any-
one at this time can say authoritatively whether
or not the antihistamines will affect all of these
disease entities.
ADVERTISING
“Your letter refers to advertising. You, of
course, know that the Federal Trade Commission
rather than ourselves is responsible for the en-
forcement of the statute which deals with ad-
vertising. When manufacturers have asked our
advice concerning proposed labeling we have
urged conservatism in claims for these new pro-
ducts and have sought to bring about a full dis-
closure of the sort of facts which we have dis-
cussed in this letter.
“We are not naive enough to believe that this
advice will be followed literally. From a law
enforcement standpoint the prospect of tre-
mendous sales of these products with growing in-
tense competition is quite likely to engender the
broadest possible claims. Our responsibility will
be to learn the precise facts and to ascertain
them in such a way that they can be presented
convincingly in a court of law.
“Unfortunately, evidence of this sort cannot be
accumulated quickly and we regretfully con-
clude that there will be a substantial period of
time before this situation can be adequately dealt
with.”
(Signed) A. E. Rayfield.”
Canal Zone Needs Doctors
The Panama Canal needs civilian physicians for
duty in the Canal Zone. This need has arisen
because the Army is withdrawing a large num-
ber of commissioned medical officers who have
been assigned to duty with the Panama Canal,
according to an announcement from the Wash-
ington office of the Panama Canal.
Starting salaries range from $6,750 to $9,500.
Transportation is provided appointee and family.
Opportunity is open to gain experience in tropi-
cal country, with opportunity for specializing in
several branches. Further information may be
had from B. F. Burdick, Chief of Office, Panama
Canal, Washington 25, D. C.
Poisons claim the lives of more than 2,000
persons a year, most of them children under five,
according to Ohio’s Health.
TO BE A GOOD CITIZEN, YOU MUST
BE REGISTERED TO VOTE
Athens County Society Deplores
Criticism of U. M. W. Fund
The following resolution was passed unani-
mously by the Athens County Medical Society
at a meeting on January 10, 1950:
“Resolved: Inasmuch as it has come to our
attention that severe criticism of the medical
setup of the Welfare and Retirement Fund of
the United Mine Workers of America has falsely
and fraudulently been represented as having
come from ‘a spokesman for the medical pro-
fession’ in the vicinity of Nelsonville, Ohio, be
it hereby resolved that The Athens County Medi-
cal Society having jurisdiction in the territory
mentioned hereby reaffirms the full approval
previously given to the medical section of this
Fund by our representative in the Council of
the Ohio State Medical Association.
“Having worked with those in charge of the
medical aspect of the administration of this
Fund, we have been much impressed with the
fairness and understanding shown by them and
deplore the fact that this unfair and dishonest
newspaper report was published.”
New Health Education Discs
Are Available
The A. M. A. Bureau of Health Education
has produced a series of three new electrical
transcriptions which are available free, on a
loan basis, to state and county medical so-
cieties.
Your Child Goes To School” is a series of 13
programs based on unsettled and sometimes con-
flicting questions relating to the health of school
children. The programs are summarized by D.
A. Dukelow, M. D., and Fred V. Hein, Ph. D.,
the medical and educational consultants respec-
tively for the Bureau of Health Education.
“The Living Proof” is a series of 13 tape-
recorded experiences delivered in the voices and
words of patients themselves together with inter-
views of the physicians under whose care these
patients made progress toward recovery or
learned to live with their affliction. This series is
exceptionally high in human interest and dramatic
impact. It is based upon a successful series de-
veloped and broadcast by the Chicago Industrial
Health Council and in its original form received
numerous radio awards. It has not been heard
outside of Chicago, and the A. M. A. has exclusive
rights outside of Chicago for the next four years.
“Doctors Make History” is a series of 13
dramatic narratives with music, each dealing
with the life of an outstanding American physi-
cian who also was a distinguished citizen aside
from his professional eminence.
The entire series was produced under the
general supervision of Dr. W. W. Bauer and
Harriet Hester.
266
The Ohio State Medical Journal
Buckeye News Notes . . .
Ashtabula — Dr. Alfred A. DeCato succeeded
Dr. Donald D. Forward as medical staff presi-
dent at Ashtabula General Hospital.
Ashtabula — Dr. E. M. Wright of Coshocton
spoke before the Ashtabula County Association
of Life Underwriters on the theme that the in-
fringement of private enterprise by the Federal
government is just one step toward a socialistic
state.
Ashtabula — Dr. C. E. Case was honored at an
informal party upon having completed 45 years
as local surgeon for the New York Central
System. Top district officials of the Railroad
were present.
Bowerston — Dr. Edward L. Miller has moved his
practice to Dennison, His practice has been
taken over by Dr. Carl Nicosia, formerly of
Buffalo, N. Y.
Cincinnati — The Cincinnati Medical Women’s
Club, Branch 11, A. M. W. A. and the Cincinnati
Women Lawyers held their third annual dinner
meeting at the Cincinnati Club January 31,
with Dr. Gustav Echstein as guest speaker.
Cleveland— Dr. Donald A. Kelley succeeded Dr.
Edward M. H. Castle as physician for the
Cleveland Indians.
Cleveland — Dr. Claude S. Beck headed the
committee which made arrangements for the
symposium on “Recent Advances in Cardiovascu-
lar Surgery” on Jan. 21 in Washington, sponsored
by the Surgery Study Section of the National In-
stitutes of Health of the Public Health Service.
Columbus — Dr. Charlotte Winnemore has been
appointed medical director of the Columbus
Regional Blood Center.
Columbus — Dr. Daniel J. Whitacre is the new
chairman of the Northeast District Committee,
Boy Scouts of America. The district includes
Linden, Westerville and East Columbus.
Columbus — Dr. Margot Deckert, acting chief of
the Division of Child Hygiene of the Ohio De-
partment of Health since March, 1949, was
elevated to the position of chief on January 1.
Columbus — Dr. Anthony J. Ruppersburg, Jr.,
was presented the Legion of Merit Award as the
result of his service with the 37th Division of
the Ohio National Guard. He was in command
of the 71st Station Hospital in the Pacific dur-
ing the war. He is now a Colonel and chief
surgeon of the Ohio National Guard.
Covington — Dr. George A. Woodhouse of
Pleasant Hill spoke to members of American
Legion Post 80 on the subject, “Pending Legis-
lation of Socialized Medicine.”
Delaware — Dr. James G. Parker spoke before
the St. Mary’s P.-T. A. on the subject “Medical
Problems of the School Child.”
Fremont — Dr. J. C. Boyce spoke before the
Fremont P.-T. A. on the subject of “Socialized
Medicine.”
Lakewood — Dr. C. Lee Graber, spoke on the
subject of “Socialized Medicine” before the Lake-
wood Business and Professional Women’s Club.
Lima — The Lima Rotary Club honored the
memory of the late Dr. J. R. Tillotson for his
work with crippled children by presentation of
his portrait to the Lima Visiting Nurses Asso-
ciation.
Maholm — Dr. Carl L. Petersilge, Newark,
spoke to the Maholm P.-T. A. on the subject,
“Children’s Health Problems.”
Mansfield — Dr. F. J. Heringhaus spoke to the
Optimist Club on the subject of heart disease.
Marietta — Dr. C. A. S. Williams was named
to the city health board to succeed Dr. J. F.
Weber.
Marietta — Dr. J. F. Weber is the new health
commissioner of Washington County.
New Philadelphia — Dr. George Crile, Jr., Cleve-
land, was guest speaker at an open meeting of
the Tuscarawas County Cancer Society.
Oak Hill — Dr. Brinton J. Allison was reelected
for another term as Jackson County health com-
missioner.
Salem — Dr. Lea A. Cobbs was elected president
of the Columbiana County Health League at its
annual meeting.
Steubenville — Dr. Roy W. Scott, Cleveland, ad-
dressed the Fort Steuben Academy of Medicine.
Steubenville — Dr. Walter A. Cunningham ad-
dressed the Steubenville Junior Chamber of Com-
merce on the subject of socialized medicine.
Xenia — Dr. Paul F. McQuiggan addressed the
Xenia Business and Professional Women’s Club,
stressing the position which American Medicine
has achieved.
Zanesville — Dr. Herman B. Kaufman addressed
the local Kiwanis Club on the subject, “Socialized
Medicine.”
Zanesville — Dr. Margaret O’Neal succeeded Dr.
Beatrice T. Hagen as health commissioner of
Muskingum County.
for March, 1950
267
Medical Care in Small Communities
Problem at National Conference
Constructive recommendations toward provid-
ing medical care to small communities came
out of the fifth annual conference on Rural
Health in Kansas City, Mo., February 3-4, at
which the Ohio State Medical Association was
ably represented.
The conference was sponsored by the Com-
mittee on Rural Health of the American Medical
Association in cooperation with farm organiza-
tions, and was attended by more than 500 medi-
cal and lay leaders.
Among the recommendations for further pro-
gress were the following:
(1) Communities should make every effort
to attract doctors by providing hospital or clini-
cal facilities to enable them to keep abreast
of the times and to make community life attrac-
tive to them and their families.
(2) Wider community participation in secur-
ing necessary facilities is a forward step which
should be pushed with increasing vigor. This
is a phase in which community health councils
can play a leading role.
(3) Existing and proposed facilities should be
coordinated and integrated for an effective and
fully utilized program.
(4) An intensified educational program is
needed to acquaint people with facilities avail-
able to them, with university extension services
an important medium in this education.
(5) Communities must be stimulated to under-
take more realistic and objective measurement
of health and hospital needs,- it having been
pointed out that many of the hospitals built
with Federal aid under the Hill-Burton Act were
being used only to half capacity..
(6) Tax funds should be used to provide medi-
cal care only when it is impossible for an in-
dividual to secure such care without such help.
(7) Progress has been made in enrolling rural
people in prepayment medical care plans but
greater efforts should be made in that direction.
(8) Medical schools should screen applicants
early to eliminate those unqualified to become
doctors, should encourage rejectees to prepare
for related professions, and should incorporate
training in rural practice into the curriculum.
Dr. Ernest E. Irons, president of the A. M. A.,
sounded a keynote in the attitude of the con-
ference toward local problems when he said
that it is “no compliment to rural groups to
assume that they cannot devise plans to meet
their own problems.” In the matter of medical
planning, Dr. Irons added that rural communities,
“know what they want and need better than
any bureau in Washington.”
Dr. Carll S. Mundy, Toledo, attended in a
dual capacity as vice-chairman of the Council
on Rural Health of the A. M. A. and as chair-
man of the Committee on Rural Health of the
Ohio State Medical Association. Other members
of the State Committee who attended are: Dr.
Jonathan Forman, Columbus; Dr. J. Martin
Byers, Greenfield; Dr. E. G. Caskey, Mineral
Ridge. Mr. Hart F. Page of the Headquarters
Office and secretary of the Committee on Rural
Health, also attended.
Medical History Group Offers
Program April 15
All those who are interested in medical his-
tory are most cordially invited to attend the
tenth annual meeting of the Committee on Medi-
cal History and Archives of the Ohio Archaeologi-
cal and Historical Society, at the Ohio State
Museum, Columbus, on April 15, beginning at 9
a. m. Presiding at the meeting will be Dr. Jon-
athan Forman, chairman of the Committee and
lecturer in medical history at Ohio State Univer-
sity.
Included in the program are the following fea-
tures:
“Samuel Hanbury Smith of Cincinnati, Colum-
bus and Hamilton,” Dorothy M. Schullian, cura-
tor of rare books, Cleveland Branch, U. S. Army
Medical Library, Cleveland.
“Ohio Physicians of the Nineteenth Century,
a Statistical Study,” Frederick C. Waite, Ph. D.,
Dover, N. H.; emeritus professor of histology and
embryology, Western Reserve University.
“The Development of Dermatology in Ohio,”
Leon Goldman, M. D., professor of dermatology,
University of Cincinnati.
“The Development of Hygiene and Health
Museums,” with notes on the Western Museum in
Cincinnati and the part that Daniel Drake had
in it, Bruno Gebhard, M. D., director of the Cleve-
land Health Museum.
“Body Snatching in Ohio During the Nineteenth
Century,” Linden Edwards, professor of anatomy
in the Ohio State University.
“James Salisbury, M. D.,” Clyde Cummer, M. D.,
assistant clinical professor of dermatology, West-
ern Reserve University.
“Notes on Early Development in Roentgen-
ology,” Otto Glasser, physicist, Cleveland Clinic.
“Historical Items Related to Ohio in Army
Medical Museum,” Thomas Haviland, chief of
operations, Museums of the U. S. Army Medi-
cal Corps, Washington, D. C.
“The Medical Aspects of the Miami-Erie
Canal,” Louis R. Effler, M. D., Toledo.
At present, only one state (Arizona) has a
tuberculosis death rate of over 60 per 100,000
population. In 1933, when nationwide figures first
became available, 19 states and the District of
Columbia had rates of 60 or higher. — Metro-
politan Life.
268
The Ohio State Medical Journal
Radiopaque diagnostic medium . . .
Original development of Searle research
now
Clear visualization of body cavities — for the roentgen investigation of
pathologic disorders involving sinuses . . . bronchial tree . . . uterus . . .
fallopian tubes . . . fistulas . . . soft tissue sinuses . . . genitourinary tract
. . . empyemic cavities.
Iodochlorol is notably free from irritation, free-flowing, highly stable
and has pronounced radiopaque qualities. It contains the two halogens,
iodine, 27 per cent, and chlorine, 7.5 per cent, organically combined
with a highly refined peanut oil.
Iodochlorol is available in bottles containing 20 cc. of the radiopaque
medium; each one is packed in an individual carton. G. D. Searle &
Co., Chicago 80, Illinois.
RESEARCH IN THE
SERVICE
OF MEDICINE
for March, 1950
269
Parrot Fever . . .
With Mild Outbreak of Psittacosis in Northeast Section of State,
Ohio Public Health Official Issues Warning and Reviews Etiology
RECENT isolation of virus from psittacine
birds and the occurrence of one proven and
“"several suspect cases of psittacosis in hu-
mans have made it necessary for the Ohio De-
partment of Health to issue a warning of the
possible dangers of infection.
One flock known to have been infected was in
a pet shop in Canton. Before the flock was in-
spected many birds had been sold to persons
throughout the state without records of transac-
tions. The proven case of psittacosis in a hu-
man was that of a man in Steubenville who said
he purchased a bird from the Canton shop.
Warnings were issued to persons who recently
have purchased birds of the advisability of con-
sulting veterinarians if birds become ill and their
family physicians if illness occurs in families.
Because of possibility of infection and the fact
that psittacosis is relatively uncommon and easily
confused with atypical pneumonia, Dr. Charles
R. Freebie, Jr., chief of the Division of Com-
municable Diseases of the Ohio Department of
Health, prepared the following review for The
Journal.
SYMPTOMS REVIEWED
Psittacosis, or more correctly ornithosis since
it occurs in orders of the aves class other than
the psittacine, is a specific infectious disease which
is transmissable to man. It is due to a filterable
virus which has been isolated from the nasal
secretions, blood, liver, and spleen of birds and
from nasal secretions and lung tissue of humans.
The disease is highly communicable from bird
to bird and somewhat less so from bird to man.
There is some evidence that the disease is air
borne, and that the portal of entry is the upper
respiratory tract.
Experimental observations indicate that the
incubation period is between eight and fourteen
days. Onset in man is abrupt and accompanied
by chilly sensations, headache, backache, and
fever. Cough is usually absent or nonproduc-
tive at first, but later is present and productive
of extremely viscous light yellow sputum. At
the height of the infection there is marked pros-
tration, restlessness and occasionally delerium.
Epistaxis occurs in about 25 per cent of the
cases. The temperature is quite high and re-
mains so for a period of a week or more, then
declines by lysis. Pulse is usually slow in rela-
tion to the temperature. Albuminuria is almost
constant and the white blood count is normal or
slightly increased with a moderate leukopenia
developing later.
The disease may be transmitted to mice by
intraperitoneal innoculation of blood drawn dur-
ing the first week of illness and causes character-
istic pathologic changes. Sputum is more uni-
formly infectious than the blood, but repeated
trials are often necessary. The serum of recov-
ered cases contains complement-fixing antibodies.
Patients who show a high temperature, slow
pulse, headache, indefinite pneumonic signs with-
out pleural pain, absence of leucocytosis, and
give history of recent association with psittacine
birds should be suspected and have their sputum
tested by the mouse test for psittacosis. Addi-
tional aid is to be derived from complement-
fixation tests on acute and convalescent speci-
mens of the patients’ serum.
Isolation of patients is required during the
acute febrile stages and strict adherence to medi-
cal aseptic technique is strongly advised. Con-
current and terminal disinfection should be prac-
ticed and suspect birds sacrificed and examined.
Contacts should be kept under surveillance for a
period of fourteen days, but placarding is not
practiced. Cases should be reported to local
health authorities in order that the infection may
be traced and necessary precautions taken to
prevent further spread to humans or other bird
flocks.
Prognosis is guarded, with experience showing
a fatality rate of 30-40 per cent in diagnosed
human cases. Experimentally, high doses of peni-
cillin have been found to be effective against the
infection, as has aureomycin, but extensive clini-
cal reports on their use in human psittacosis
have not been published.
ARE YOU AND MEMBERS OF YOUR
FAMILY REGISTERED TO VOTE?
Dr. Papanicolaou To Direct Course
In Exfoliative Cytology
A course in Exfoliative Cytology for physi-
cians will be given under direction of Dr.
George N. Papanicolaou at Cornell Univer-
sity April 17-29. Inquiries may be directed
to Dr. Papanicolaou at Cornell University
Medical College, 13 York Ave., New York 21.
A similar course will be given for laboratory
technicians March 20-April 1, also under direc-
tion of Dr. Papanicolaou. Inquiries about the
technicians’ course should be directed to Miss
Charlotte M. Street at the above address.
Dr. John D. Porterfield,,, director of the
Ohio Department of Health, announced that the
Department will underwrite the expenses of
any Ohio physician or technician accepted by
3 school for the course.
270
The Ohio State Medical Journal
T -w* -*-1 -l /\-n • Comments on Current Economic and Social
XU XXlXX" 131X110X1 • Questions and Professional Problems;
Suggestions Regarding Organized Activities
WHAT ARE YOU DOING
ABOUT IT, DOCTOR?
What did yon think of the recent* “policy”
statement issued by the Republican National Com-
mittee? It was pretty fuzzy and indefinite, in
our opinion. Although protesting state social-
ism in any form, including socialized medicine,
the statement contained an awful lot of “me too”
applesauce on the matter of Federal handouts.
One commentator, after reading it, observed
that Norman Thomas, the perennial Socialist
candidate for President, once remarked that the
American people would never vote for Socialism
as such, but that Socialism was inevitable be-
cause their representatives in Congress would
continue to vote for individual measures which,
in the long run, would add up to Socialism.
Another writer offered the thought-provoking
comment that the Republicans are promising
“liberty” as against “socialism”; the Democrats
cash money, from the public treasury, for special
groups.
Now comes the announcement from the White
House that President Truman plans to invade
Ohio this year to take the stump for candidates
who favor his hand-out, state socialism program.
A recent Gallup poll indicated that a large
proportion of the people are not well informed
about the compulsory sickness insurance issue.
Only 54 per cent of those questioned could name
at least one argument for or against the plan
and only 30 per cent knew how the cost would be
met.
Rather confusing, isn’t it? Looks as if those
who believe 1950 is the year of great decision
have a job cut out for them. Cash money from
the treasury is going to win the race unless
the job of enlightening the voters is stepped up
considerably between now and next November 7.
What are you doing about it, Doctor?
TALK-IT-OVER SESSIONS
WITH THE DRUGGISTS
Editor John W. McPherrin has reprinted many
of the editorials which appeared in The Ameri-
can Druggist in an attractive book entitled
“Where We Stand.” The collection of 62 edi-
torials reflects beyond any question that the
druggists in this country see no good whatsoever
in the government practice of medicine.
“If the patients, doctors and druggists of our
metropolitan areas could know each other better,
we don’t think there would be any more support
for government control of health in the big cities
than in the small towns,” said one editorial,
adding: “Such a situation is difficult to achieve
but it has been done in the small neighborhood
communities of some of our largest cities. When
druggists and doctors express friendly confidence
in each other, they help create faith in private
medicine.”
In our opinion, Mr. McPherrin’s advice is
sound and timely. Talk-it-over sessions for doc-
tors and druggists should become a custom in
every community. Try it in your county.
FACTS, FIGURES AND
FALLACIES
Ohio State Chiropractic Society announces that
it will circulate petitions to initiate a bill for a
separate licensing board at the 1951 session of the
State Legislature . . . giving as its reason the
deep desire of chiropractors to police their own
profession . . . presumably the habitual law-
violators, most of whom can’t pass present
exams or never even try.
Congressman Biemiller, Wisconsin’s gift to the
ranks of the socializers, had Milton Mayer’s
critical article of questionable authenticity about
the A. M. A., “The Dogged Retreat of the Doc-
tors,” which appeared in Harper's Magazine,
inserted in the appendix of the Congressional
Record at a cost to the taxpayers of $410 . . .
another indication of how free some public of-
ficials are with other people’s money.
5-C 5jS
One economist, using Bureau of Labor Sta-
tistics figures, has shown that the 1949 dollar
was worth not quite 46 cents compared with its
value in 1939 in terms of what it will buy . . .
which explains why the present-day working
man scolds his wife because she can’t make both
ends meet on $40 a week wdiereas $20, ten years
ago used to do the job.
^ ^ $
Commenting on Oscar Ewing’s remark before
the National Press Club that he fails to see any
obligation to feed doctors who would refuse to
join his health insurance scheme, George Dixon,
Washington columnist, opined: “Why does any
American listen to Ewing and his kind? Can’t
the simplest intelligence understand he can’t
have the government running his body without
having it running his life?”
5»: Sfc 4s
Branding current Social Security “saving” for
the future as a “fiction,” the Brookings Institu-
tion predicts that the costs of present and
proposed security expansion schemes would cost
the nation $55 billion annually in another 50
for March, 1950
271
years ... In 1949, approximately 341,000 Ohioans
received Federal Social Security benefits of
various kinds, exclusive of general welfare, health
and educational services partially financed from
U. S. funds for all Ohio citizens.
He H* H*
A. P. story says a renewal of the 10-cent tax
on union members for the A.F.L.’s separate politi-
cal education fund is being considered . . . Wasn’t
it Mr. William Green of the A. F. L. who bitterly
denounced the A. M. A. for raising a public edu-
cation campaign fund?
^ ^ ^
During December, 295 local advisory councils
of the Ohio Farm Bureau discussed the ques-
tion of improved health and medical services in
rural areas . . . All took a definite stand against
compulsory health insurance, pointing out that
there are sound ways of solving the health prob-
lems of rural Ohio if the people will pull together.
5fc ^ HJ
Average age at death of the 3,331 physicians
whose obituaries were published in The Journal
of the A. M. A. in 1948 was 67.2 years. . . .
heart disease was the leading cause of death,
41 per cent . . . largest number of deaths oc-
curred between ages 70 and 74.
He * sfs
F. B. I. agents who started checking the files of
the Chicago office of the A. M. A. last October
are still at it, using the Board of Trustees’
room as their workshop.
❖ ❖ ❖
Membership of the A. M. A. on January 1,
1950, was 144,212, a net gain of 4,171 during
1949 . . . gain in Fellows was 2,548 . . . Speak-
ing of the A. M. A., a few doctors protest paying
1950 A. M. A. dues because they think they were
not levied in a democratic manner . . .Provision
for levying of dues has been in the A. M. A.
Constitution and By-Laws for years, but never
used . . . Action was taken by House of Delegates
composed of physician-delegates elected by houses
of delegates of the state societies, in turn com-
posed of delegates elected by the county medical
societies . . . Wherein was this procedure a viola-
tion of democratic principles?
❖ 5^ ❖
According to one weekly news magazine, many
psychiatrists are disturbed because Dr. Carl A.
L. Binger, testifying in the Hiss trial, made an
official diagnosis of Whittaker Chambers with-
out interviewing him . . . They undoubtedly are
correct in their belief that practices like this
will discredit psychiatric testimony ... in fact
medical testimony generally.
^ ^ ^
This month’s prize for under-statement goes
to Truman’s Council of Economic Advisers. . .
In estimating that the cost 25 years hence of
Truman’s welfare schemes will be $25 billion, it
blandly stated: “This is a very large figure.”
MR. CHRISTENSEN
PAYS HIS “DUES”
As a morale builder to those who may have
some doubts as to why the American Medical
Association needs to carry on an aggressive
public education campaign, as well as an active
intra-professional service program, and needs
funds for both, we recommend careful reading
of the following letter received recently by Dr.
Ernest E. Irons, president of the A. M. A., from
Mr. Joseph Christensen, Chicago, restaurant
owner:
“I cannot put M. D. after my name but
I can, at least for a while, still put U. S. A.
As a consequence, please accept the enclosed
check for $25 as a slight token of regard for
my doctor and all his colleagues. These
are my ‘dues’ as a citizen, and I hope they
will help in your fight against socialized medi-
cine.
“A people without guts are soon a nation
without guts, and if it should become neces-
sary to remove any part of mine, I want to
pick my man and pay his charge without a
precinct captain getting his nose in my
anatomy.”
STUDY OF METHODS OF
TEACHING MEDICINE
Action by the Commonwealth Fund in granting
$400,000 to Western Reserve University School of
Medicine for a five-year experimental study of
revisions in the methods of teaching medicine
could become one of the most significant under-
takings of the present decade. A real experi-
ment of this kind is long overdue.
All of the problems confronting our medical
schools are not financial problems. Reappraisal
of curriculum and methods is imperative. Closer
cooperation and a better understanding between
medical educators and educators in charge of pre-
medical training are needed.
The public is more interested in medical edu-
cation today than ever before. For that reason
it is confused, to put it mildly, as a result of the
verbal warfare being waged between groups
which have a part in educating doctors and all
of which, presumably, have one objective, namely,
the production of an adequate number of ade-
quately trained physicians.
It’s high time for a truce during which brains
and energy can be devoted to a real attempt to
find solutions. Readjustments within might even
produce solutions to the financial problem which
is one of major proportions.
It is heartening to know that private philan-
thropy has stepped forward with funds to do
a basic job of this kind. There still may be
hope that the financial problems of the medical
schools can be met in the same manner.
Strangely enough, most of the causes for the
272
The Ohio State Medical Journal
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for March, 1950
present financial predicament of most of the
medical colleges are results of the unsound eco-
nomic policies instigated by a paternalistic gov-
ernment which now is eager to rush to their
rescue. Medical schools would be in a better
position to obtain endowments from private
sources, if the government were to spend less
and reduce taxes, thus giving private agencies
and individuals an opportunity to continue with a
job they have been doing for many decades.
AMVET COLUMNIST WARNS
HIS BUDDIES
One of the best editorials we’ve seen on com-
pulsory health insurance appeared in the January
issue of The Ohio AMVET, monthly publication
of the Ohio Unit of the American Veterans of
World War II. Captioned “Farewell to Free-
dom,” it was written by Fred J. Milligan, Co-
lumbus attorney, former State Commander of the
AMVETS. His column “Post Scripts” is one
of the features of the publication.
Mr. Milligan not only made a clear statement
of the issue and the arguments against it, but
he urged veterans to do something about it.
After pointing out that the AMVETS went on
record against the scheme at their National
Convention last August, he stated:
“So far so good. But now is the time for every
veteran to take his stand and make his voice
heard through his local post to his congressman
and senator. Furthermore, this is an election
year and if we veterans have convictions on this
subject it’s our duty to see that no candidate for
congress is permitted to straddle this important
issue.”
Realizing that the ramifications of the proposal
go away beyond the socialization of medicine, Mr.
Milligan continues:
“The adoption of the proposed compulsory
health insurance program means a farewell to
freedom as you fought for it. It means a ‘Serf
State.’ _ A most valuable attribute of freedom
is the right to choose — your associates, your home,
your job freedom to determine the course of your
life, and to live it as you choose so long as
you do not infringe upon the rights of others.
That is what you fought for. That is what has
made the nation superior to any other — the
supremacy of the individual because he is an
individual. This freedom is guaranteed to all and
can be taken away only if we actively consent
or inactively permit ourselves to be lulled into
bondage under the false guise of greater ‘secu-
rity.’ ”
As an alternative to “political medicine,”
Mr. Milligan suggests:
“Let us expand our hospital facilities.
“Let us increase our medical colleges.
“Let us admit more young people to the medical
profession.
“Let us have more general practitioners. We
need more ‘family’ doctors.
“All of this can be done without violence to
anyone. The people will retain their freedom and
self respect. They will receive more medical care
at less expense. They will be free to choose
their own doctors. They will be free to live
their own lives in their own way. That is the
only way to achieve happiness for the greatest
number of people. And that is the true objective
of government.”
And Mr. Milligan knows something about
government, for he formerly was assistant at-
torney general and later Director of Commerce
for the State of Ohio.
INDUSTRIAL FUMES SHOULD
BE CONCERN OF DOCTORS
The U. S. Public Health Service in the fall
came out with a full report of the Donora (Pa.)
incident in which industrial fumes stabilized by
weather conditions caused the illness of thousands
of persons, many of whom died.
Although acknowledging that a parallel situ-
ation might never again arise, the report states
“that contamination of air in industrial areas can
cause serious acute disabling diseases.”
Since Ohio is one of the leading states in in-
dustry— much of which is concentrated — the re-
port should be of particular interest to the medi-
cal profession here.
Although extensive studies of air pollution
around industrial areas in Ohio have been made,
undoubtedly even more extensive surveys will be
conducted in the future.
Members of the medical profession should be
prepared to offer any constructive aid and co-
operation if or when such studies come up.
ARE YOU AND MEMBERS OF YOUR
FAMILY REGISTERED TO VOTE?
PUBLIC HEALTH IS RECOGNIZED
AS A SPECIALTY
Public health workers can take a great deal of
pride for their part in the achievements of the
first half of the twentieth century, especially in
the field of preventive medicine. Doctors in this
field also can take pride in the growing recog-
nition of their offices as key positions in the
community.
Creation of the American Board of Preventive
Medicine and Public Health, although coming
at a time when further specialization is under
some controversy, sets a milestone in the ad-
vance toward better and more progressive pub-
lic health service.
Public health efforts have been hampered by
the fact that the limited finances allotted by
states, counties and municipalities often do not
offer inducements commensurate with the re-
sponsibilities involved.
Creation of the new board should do much to
convince legislators that health officers can be,
and many are, authorities in their field and,
when they are qualified, deserve remuneration in
keeping with that of others with parallel re-
sponsibilities.
274
The Ohio State Medical Journal
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275
• • •
Do You Know?
Dr. Bruce K. Wiseman, professor of medicine,
Ohio State University College of Medicine, Co-
lumbus, spoke on “Use of Radioactive Isotopes
in the Treatment of Disease,” during the annual
Midwinter Clinics of the Colorado State Medical
Society, Feb. 21-24 at Denver.
^ ^ ^
The death rate for accidents in the United
States was 67.1 deaths per 100,000 popu-
lation in 1948, compared with 69.4 in 1947.
^ ^ ^
The Environmental Investigations Branch of
the Division of Industrial Hygiene of the U. S.
Public Health Service is moving to Cincinnati,
where it will be located in the Environmental
Health Center of the Public Health Service. The
policy of the U. S. P. H. S. is to concentrate in
Cincinnati all its research on water, sewage and
other sanitation problems.
^ ^
A gift of $750,000 has been received by
Northwestern University to establish the Irving
S. Cutter Memorial Professorship in the School
of Medicine. The donor, an alumnus of the
School, wishes to be anonymous.
^ ^ ^
Dr. Robert M. Zollinger, professor of surgery,
Ohio State University College of Medicine, was
one of the guest speakers at the annual assembly
of the American Academy of General Practice,
Feb. 20-24, in St. Louis.
He sfc %
The Clark County Medical Society recently
adopted a resolution in tribute to Dr. D. W.
Hogue, Springfield, and presented him with a
pair of binoculars on the occasion of his retire-
ment after 50 years in the active practice of
medicine. Dr. Hogue was Councilor for the
Second District of the Ohio State Medical Asso-
ciation from 1935 through 1942. His new ad-
dress is Rye, N. Y.
H* H5 H*
About 1,580,000 couples embarked upon matri-
mony in the United States in 1949, according to
the statisticians of the Metropolitan Life In-
surance Company. This is a decline of one-eighth
from 1948 and nearly one-third less than the all-
time peak of 2,291,000 marriages in 1946.
^ ^ ^
Dr. Joseph L. Fetterman, Cleveland, was guest
speaker at a meeting of the Polk County Medi-
cal Society, Des Moines, Iowa, Feb. 15. He spoke
on “A Survey of Psychiatry for the Practitioner
With Particular Reference to the Use of Shock
Therapy.”
H5 ^ 5}1
Enrollment in Ohio Medical Indemnity, “The
Doctors’ Plan” is now approximately 700,000 per-
sons.
Charles S. Nelson, Executive Secretary of the
Ohio State Medical Association, spoke on “Doc-
tors and Politics” at the Second Annual National
Educational Campaign Conference of the Ameri-
can Medical Association, held at Chicago, Feb. 12.
^ ^ ^
An example of achievement in efforts to com-
bine health districts for more efficient administra-
tion is that of the recently organized Crawford-
Wyandot district. Dr. Guy T. Wasson, for many
years health commissioner of Crawford County
now directs the new district.
5jc Sfc 5j!
Dr. Robert M. Hall, newly appointed secretary
of the A. M. A. Council on National Emergency
Medical Service, is enlisting the help of secre-
taries of state medical societies in gathering im-
portant information pertaining to Civil Defense
plans or programs in their areas.
❖ ❖ ❖
Ohio State University’s College of Medicine
may be the first in the Nation to use color tele-
vision in its instruction program. Permanent
installations for the latest in television are be-
ing built into the new medical center building
now nearing completion.
❖ ^
An example of additions to the State’s hos-
pital facilities is that of the Mercy Hospital in
Springfield which opened recently. Addition of
this 319-bed modern structure, built at a cost
of $5,100,000, gives Springfield two modern hos-
pitals.
^ ^ ^
Dr. A. Ashley Weech, medical director of the
Children’s Hospital, Cincinnati, in January went
to Puerto Rico at the request of Puerto Rican
physicians to deliver a series of 12 lectures on
problems of child health.
He H5 sfc
Dr. Morris G. Carmody, Painesville, in Janu-
ary spoke before the Medical Advisory Committee
to the Atomic Energy Commission in Cambridge,
Mass. He is a member of the Committee. Dr.
Carmody spoke on “Chronic Pulmonary Granu-
lomatosis.”
He H* He
Dr. Raymond Hussey, Dean of the School of
Occupational Health, Wayne University, Detroit,
has joined the staff of the Council on Industrial
Health of the A. M. A. as Scientific Director. In
order to take the position, Dr. Hussey has re-
linquished his membership on the Council. He
has been a member since 1941, serving as vice-
chairman for the past several years.
276
The Ohio State Medical Journal
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CITY ZONE STATE
for March, 1950
277
i
• • •
On the Firing Line
Shots at Truman-Ewing Compulsory Sickness Insurance Scheme;
Ammunition For Doctors in Speeches Against Federalized Medicine
“. . . English doctors buy their practice. There-
fore, a doctor sells his practice when he reaches
retirement age, and lives on the proceeds when
he is too old to work. Physicians were forced to
join the compulsory health service because, if
they didn’t, the government would not allow them
to sell their practice.” — Dr. Elizabeth Everard,
formerly of Bournemouth, England, now in
Kingston, Ontario, Canada, interviewed by the
Sidney (O.) Daily News, regarding England’s
health scheme.
“This device (The Welfare State), by taxes,
transfers to government, various social functions
which the individual has taken upon himself. For
instance, the United States actually possesses
the best hospital system in the world, most of it
voluntary, and supported by private charity.
But charity must be measured not only against
earnings but against taxes. As the ability to
give charity is reduced, the voluntary institutions
become increasingly dependent upon the state
which can support them only by increasing taxes.
But a tax is not an instrument of civilization
and does the giver no good. He has no freedom
of choice. In fact, as he pays more taxes, he
becomes himself more dependent. In the end,
he can become a slave.” — George E. Sokolsky.
❖ * ❖
“ ... It is my considered opinion that the
British program has resulted in more medi-
cal care of a lower quality for more people
at a higher cost.” — Harold E. Stassen, Presi-
dent, University of Pennsylvania, in Reader’s
Digest, January, 195 0).
* * *
“Until some of the major defects of the Act
are remedied, grave and unnecessary dangers
will exist for both mother and infant . . .
certain very definite risks to childbirth have been
added by the present medical service.” —
Review of first year’s working of National Health
Service of Great Britain, in The Practitioner.
❖ ❖ ^
“The large majority of American families have
the resources to pay for adequate medical care
if they elect to give it a high priority among
the several objects of expenditure.” — Report of
the Brookings Institution on Medical Care for
the Individual.
“. . . The introduction of the general dental
service has indirectly caused the irreparable
damage to the teeth of hundreds of thousands of
school children . . .” — Review of first year’s
working of the National Health Service of Great
Britain, in The Practitioner.
* * *
“Why does any American listen to Ewing
and his kind? Can’t the simplest intelligence
understand he can’t have the government
running his body without having it running
his life?” — George Dixon in the Columbus
Dispatch).
❖ ❖ ❖
“Do we have in America any movement com-
parable to the Fabian Socialist movement in
England? And if so, what is it doing, how is it
progressing and what are its chances of success
here? The answer, of course, is that we do have
precisely such a movement here, that it is mak-
ing rapid strides, and that unless it is arrested,
and at some very early date, nothing can prevent
its extension here on the British model.” —
John T. Flynn in The Road Ahead.
❖ ❖ *
“I understand that the Medical Fraternity in
the United States are somewhat anxious con-
cerning the possibility of the introduction of a
Health Insurance Scheme on lines similar to our
own. I give you fair warning that if this meas-
ure is adopted, they are likely to be faced with
problems that will have a very adverse effect on
the welfare of the country.” — Letter to Dr. D.
W. Hogue from a London business man.
ARE YOU AND MEMBERS OF YOUR
FAMILY REGISTERED TO VOTE?
“It is a further fact that during the first year
of the operation of the British National Health
Service, from July, 1948, to July, 1949, the death
rate in Britain went up rather sharply! . . .
the additional tombstones in the British ceme-
teries— 72,125 more than in the year before the
National Health Program went into effect —
are grim signposts on which we can read ‘Never
take this road for a National Health Program.’ ”
— Harold E. Stassen, President, Universty of
Pennsylvania, in Reader’s Digest, January, 1950.
CLIP THIS MATERIAL FOR REFERENCE
278
The Ohio State Medical Journal
Jtuaiebk fyine G ad. me tied, and Penjjumed.f
ad. ado-en.tid.ed in p.uldicatiand at tlte
American Medical Ad.d.aciatianr
one didtnilfUted in Ohio- bn:
CARL G. and DOROTHY SMITHSON, Divisional Distributors
252 S. CHESTERFIELD ROAD
PHONE: DOUGLAS 1240 COLUMBUS 9, OHIO
DISTRICT DISTRIBUTORS
DOLORES ADAMS
181 Twelfth Ave.
Columbus 1, Ohio
Phone WAlnut 1654
ESTHER MESSERSMITH
Arbaugh Building
Salem, Ohio
Phone 7290
TILLIE CARR
P. O. Box 415
Steubenville, Ohio
Phone 24826
LEONA McARTOR
1807 Lexington Ave.
Springfield, Ohio
Phone: 22050
ELVAH R. HUNT
519 Oak Street
Ironton, Ohio
Phone 927-R
ALICE SENSENBRENNER
313 E. Mound Street
Circleville, Ohio
Phone: 780 L
ASSISTANT DISTRICT
LOUISE S. DAVIS
379 W. 8th Ave.
Columbus 1, Ohio
Phone UNiversity 1741
ESTA REESE
Portsmouth Road
Gallipolis, Ohio
Phone: 986 W
RUTH STIFF
240 N. Cherry St.
Lancaster, Ohio
Phone: 1914 W
DISTRIBUTORS
VELDA KELTNER
217 E. High Street
Ashley, Ohio
Phone: 2492
LANA POLSTER
80 Brunson Ave.
Columbus 3, Ohio
Phone FAirfax 1632
EVELYN M. SEELIG
2150 Sun crest Dr.
Columbus 4, Ohio
Phone: JOrdan 4711
ANNABELLE O. RICHARDS
1341 Ridge Ave.
Steubenville, Ohio
Phone: 2-7643
ERMA TODD
559 Harding Road
Zanesville, Ohio
Phone 3895
MABEL M. LAMP
89 Riverview Dr.
Newark, Ohio
Phone: 41633
VIRGINIA THOMPSON
265 E. 11th Ave.
Columbus 1, Ohio
Phone: UNiversity' 6277
VIRGINIA E. WEBB
507 E. Madison Ave.
Springfield, Ohio
Phone: 3-729 4
REGINA L. WILLIAMS
433 - 14th Ave.
Columbus 1, Ohio
Phone: UNiversity 1782
HELEN E. SMITHSON, Divisional Distributor
Post Office Box 125, CHAGRIN FALLS, OHIO
ANNE McVICKER
517 C.A.C. Bldg.
Cleveland 15, Ohio
Phone: MAin 9237
RUTH KIRCHNER
285 Circular St.
Tiffin, Ohio
Phone: 3817
ANNE WISEMAN
233 Superior
Youngstown, Ohio
Phone: 32938
DISTRICT DISTRIBUTORS
LAVERNE CARR POWELL
1759 S. Union St.
Alliance, Ohio
Phone: 7038
HELEN A. REIFF
5 Park Ave. West
Mansfield, Ohio
Phone: 46706
LOUISE WYNNE
822 West 14th
Lorain, Ohio
Phone: 61924
MARIE HAZEN
Hotel Portage, Rm. 115
Akron, Ohio
Phone: HEmlock 0515
DONALD RADIKE
Hale Rd.
Painesville, Ohio
Phone: 9036
WILMA PINKLEY
232 East 10th
Ashland, Ohio
Phone: 578 Red
GEORGE AND HELEN YOCUM, Divisional Distributors
ROOMS 203 & 204, 113 WEST BRACKENRIDGE STREET, FORT WAYNE 2, INDIANA
MAILING ADDRESS: POST OFFICE BOX 1017, FORT WAYNE 1, INDIANA
PHONE: HARRISON 1178 and ANTHONY 5360
DISTRIBUTORS
GLADYS SEWARD
424 Irving Street
Toledo, Ohio
Phone GArfield 3613
E. J. & AGNES CURTIS, Divisional Distributors
5921 OAKWOOD AVENUE
Phone: Mulberry 5382 CINCINNATI 24, OHIO
MINNETTA THOMAS
815 Keith Bldg.
Cincinnati, Ohio
Phone: MAin 0360
DISTRICT DISTRIBUTORS
LAVINIA P. GRIMES
2535 Ritchee Ave.
Cincinnati, Ohio
Phone: EAst 3838
RUTH MOSELEY
1627 Warevliet Ave.
Dayton, Ohio
Phone: KEnmore 2744
for March , 1950
279
In Memoriam
• • •
Thomas Adams, M. D., Cleveland; Medical
Faculty of Trinity University, Toronto, 1901;
aged 73; died Nov. 17; member of the Ohio State
Medical Association and the American Medical
Association.
Francis Wayland Davis, M. D., Cincinnati;
Miami Medical College, Cincinnati, 1891; aged
82; died February 4; former member of the Ohio
State Medical Association and the American
Medical Association through 1933.
P. William Haake, M. D., New York; Syracuse
University College of Medicine, 1927; aged 50;
died January 11; former member of the Ohio
State Medical Association through 1941 and
later a member of the New York State Medical
Association; Fellow of the American Medical
Association. Dr. Haake practiced in Zanesville
until about 10 years ago when he left for New
York. Surviving are his widow and two children.
William Edward Lawhead, M. D., Van Wert;
Indiana Medical College, School of Medicine of
Purdue University, Indianapolis, 1907; aged 63;
died December 3; member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association; president of the Van
Wert County Medical Society, 1943-45; delegate,
1943. Dr. Lawhead, retired medical officer of
the U. S. Navy, accepted the position as city
and county health commissioner last fall. Surviv-
ing are his widow and his father.
William Franklin Lehr, M. D., Arlington (Han-
cock County); Eclectic Medical College, Cincin-
nati, 1899; aged 79; died January 13; former
member of the Ohio State Medical Association
and the American Medical Association through
1947. Dr. Lehr had practiced in his community
for more than 50 years. He was honored by the
Hancock County Medical Society in November by
being presented the 50-Year Pin and Certificate
of the Ohio State Medical Association. He was
a director of the Farmers and Merchants Bank
in Arlington and was honorary president of the
Hancock County Chorus. He had been both a
member and president of the Arlington School
Board, and was affiliated with the Odd Fellows
and the Masons. Three children survive.
Eugene Phillips Neitz, M. D., Wellsville; Ohio
State University College of Homeopathic Medi-
cine, 1915; aged 59; died February 7; member
of the Ohio State Medical Association and the
American Medical Association; vice-president of
the Columbiana County Medical Society in 1943.
Dr. Neitz served in the Army Medical Corps
during World War I. He practiced medicine in
Cleveland, Youngstown, Petersburgh and Iron-
dale before moving to Wellsville in 1933. He
was a member of the city council for a year
and was Wellsville’s health commissioner for
several years. Organizations in which he held
memberships included the Masonic Lodge, the
Elks Lodge, the American Legion and the Pres-
byterian Church. Surviving are his widow, a
daughter, two sons and two brothers.
Norman William Neptune, M. D., Loudonville;
Jefferson Medical College of Philadelphia, 1903;
aged 80; died January 16; former member of the
Ohio State Medical Association and Fellow of the
American Medical Association through 1946;
delegate of the Ashland County Medical Society
in 1928. Dr. Neptune began his practice in
Loudonville in 1903. He was a member of the
Masonic Lodge and an officer in the Baptist
Church. A son, Dr. Edgar M. Neptune of Syra-
cuse, N. Y., survives.
Eugene Olin Porter, M. D., Cincinnati; Miami
Medical College, Cincinnati, 1908; aged 75; died
February 5; former member of the Ohio State
Medical Association and the American Medical
Association through 1948. Dr. Porter served his
entire practice in Cincinnati and vicinity, where he
was surgeon for the B. & O. Railroad until two
years ago. He was affiliated with the Masonic
Lodge. Surviving are his widow and a sister.
Clifton Reedy, M. D., Columbus; Starling Medi-
cal College, Columbus, 1897; aged 80; died
January 29. Dr. Reedy retired from active prac-
tice in 1915. Surviving are his widow and two
grandchildren.
Frederick George Stueber, M. D., Lima; Rush
Medical College, University of Chicago, 1882;
aged 89; former member of the Ohio State
Medical Association and the American Medical
Association through 1942; member of the Ameri-
can Academy of Ophthalmology and Oto-
Laryngology. *Dr. Stueber served most of his
practice of nearly 60 years in Lima. Recently he
was presented the Ohio State Medical Associa-
tion’s 50-Year Pin and Certificate. He was a mem-
ber of the Triologic Society, was a charter mem-
ber of the Board of Trustees of the Lima City
Hospital and Memorial Hospital. He was an elder
in the Evangelical and Reformed Church and
served as a trustee of the church’s Children’s
Home in Fort Wayne. Surviving are a daughter
and a son, Dr. Paul J. Stueber, of Lima; also
a grandson, Dr. Paul J. Stueber, Jr., of Cleve-
land.
280
1'be Ohio State Medical Journal
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for March, 1950
281
A
Activities of County Societies . . .
First District
(COUNCILOR: D. W. HEU SINK VELD', M. D.,
CINCINNATI)
HAMILTON
Guest speaker at the Jan. 17 meeting of the
Academy of Medicine of Cincinnati was Dr.
Herrman L. Blumgart, Harvard University Medi-
cal School and physician-in-chief, Beth Israel
Hospital, Boston, who spoke on the subject, “The
Pathogenesis of Angina Pectoris.” Dr. William
T. Collins spoke briefly, giving a progress re-
port on the operation of the Cytologic (Papani-
colau) Laboratory at the Cincinnati General Hos-
pital.
Second District
{COUNCILOR: M. D. PRUGH, M. D., DAYTON)
DARKE
“Anterior Poliomyelitis” was the topic of a dis-
cussion by Dr. Bert C. Wiley, Dayton, at the
Jan. 17 meeting of the Darke County Medical
Society.
MIAMI
Fifty-Year Pins and Certificates of the Ohio
State Medical Association were presented to five
Miami County physicians at the semi-annual
meeting of the Miami County and Shelby County
Medical Societies at the Piqua Country Club on
Jan. 5. Those honored were Dr. George E. Mc-
Cullough, Troy; Dr. Albert J. Bausman, Piqua;
Dr. Charles Baker, West Milton; Dr. E. A. Yates,
formerly of Piqua but now of St. Petersburg,
Fla.; and Dr. James R. Caywood of Piqua. The
award was presented posthumously to Dr. H.
R. Pearson, late of West Milton.
Dr. M. D. Prugh, Dayton, Councilor of the
Second District of the Ohio State Medical Asso-
ciation, made the presentations. Dr. E. 0. Swartz,
Cincinnati, President-Elect of the Ohio State
Medical Association, was principal speaker for
the occasion and spoke on “The Doctor Looks at
Public Relations.”
At the Feb. 3 meeting of the Miami Society,
Dr. Charles R. Freebie, Jr., chief of the Division
of Communicable Diseases of the Ohio Depart-
ment of Public Health, Columbus, spoke on the
subject, “A Discussion of Intensive Treatment
Methods in the Treatment of Syphilis.” This was
a report of the work at the Rapid Treatment
Center in Columbus.
The Society is sponsoring a new series of
radio health broadcasts over Radio Station
WPTW, Piqua, on Saturdays at 10:30 a. m.,
entitled “The Public Comes First.” The follow-
TO BE A GOOD CITIZEN, YOU MUST
BE REGISTERED TO VOTE
ing are topics of weekly programs: “What Con-
stitutes Adequate Medical Care”; “Prepaid Medi-
cal Service Plans”; “Hospital Insurance and How
To Make Use of It”; “What Are Rural Medical
Problems”; “The Cost of Illness”; and “The Pub-
lic Comes First.”
SHELBY
Dr. Russell L. Wiessinger is the new presi-
dent of the Shelby County Medical Society. Other
officers are Dr. C. B. Conover, vice-pres., and
Dr. John H. Kerrigan, secy.-treas. Delegate
and alternate are Dr. Harry E. Grimm and Dr.
V. W. LeMaster, respectively. All are of Sidney.
Third District
(COUNCILOR: J. CRAIG BOWMAN, M.D.,
UPPER SANDUSKY)
MARION
Delegate and alternate, respectively, of the
Marion County Academy of Medicine are Dr.
Alton E. Morrison, Marion, and Dr. Robert T.
Gray, Prospect.
SENECA
Four veteran physicians of the county were
honored on Jan. 11 at a meeting of the Seneca
County Medical Society by being presented the
50-Year Pin and Certificate of the Ohio State
Medical Association. They are Dr. Robert C.
Chamberlain, Dr. William H. Benner and Dr.
George W. Willard, all of Tiffin, and Dr. H. L.
Hinkley of Green Springs. Dr. Chamberlain
was not able to be present because he is in
California on an extended visit. Presentations
were made by Dr. J. Craig Bowman, Upper
Sandusky, Councilor of the Third District.
Fourth District
(COUNCILOR: CARLL S. MUNDY, M. D., TOLEDO)
DEFIANCE
The monthly meeting of the Defiance County
Medical Society was held at the Crosby Grill on
Jan. 17. The following officers were installed:
Dr. Harold J. Wenzinger, pres.; Dr. John U.
Fauster, Sr., pres. -elect, and Dr. G. Frederick
Moench, secy.-treas.; delegate, Dr. D. J. Slosser;
alternate, Dr. Paul B. Newcomb.
A request by the Ohio Society for Crippled
Children for approval of the traveling clinics in
Defiance County for epileptics was granted by
vote.
At a dinner meeting at the Kettering Country
Club in Defiance on Feb. 14, four physicians were
honored with the Fifty-Year Pin and Certificate
of the Ohio State Medical Association. They
are Dr. John U. Fauster, Sr., Dr. Seth DeMuth,
Dr. S. J. Hull and Dr. R. W. Finch. Presentations
282
The Ohio State Medical Journal
were made by Dr. Carll S. Mundy, Toledo, Coun-
cilor of the Fourth District of the Ohio State
Medical Association.
LUCAS
Eighteen Lucas County doctors were honored
by The Academy of Medicine of Toledo and
Lucas County on Jan. 6 at its annual meeting, at
which 50-Year Pins and Certificates of the Ohio
State Medical Association were presented. They
are: Drs. Ralph P. Daniells, R. V. Mateer, Louis
A. Miller, E. W. Doherty P. Bruce Brockway,
Christian Storz, Charles Lukens, H. L. Green,
W. W. Alderdyce, Charles Louy, Paul E. Bethards,
George M. Reinhart, George H. Jones, A. J.
Richie, Burt G. Chollett, J. A. Coleman and
Charles A. Burritt. In addition to the honor be-
stowed by the Association and the Toledo
Academy, the Toledo Blade devoted three pages
in its pictorial supplement of Jan. 1 to them.
Dr. Carll S. Mundy, Councilor of the Fourth
District of the Ohio State Medical Association,
made the presentations. In congratulating the
physicians for their long and faithful service,
Dr. Mundy reviewed the role of free medicine in
the progress of the past half century. Dr. Brock-
way responded in behalf of the 50-year doctors.
Dr. Eugene A. Ockuly, incoming president of
the Academy, gave the principal address of the
evening. His talk was a plea for unification of
medical organization effort in the Toledo area.
PAULDING
Dr. R. H. Mouser, Paulding, has been de-
signated delegate and Dr. G. L. Doster, Paulding,
alternate, for the Paulding County Medical So-
ciety.
SANDUSKY
Delegate and alternate, respectively, of the
Sandusky County Medical Society are Dr. John
J. Gedert, Clyde, and Dr. Edward B. VogeR
Bellevue.
WOOD
Dr. N. P. Dallis, Toledo, addressed the Wood
County Medical Society on “Psychiatry in Gen-
eral Practice” at the regular dinner meeting
at the Midway Restaurant, Perrysburg, Janu-
ary 19.
It has been a number of years since the So-
ciety program has included a paper on psychiatry
and it was warmly welcomed. Dr. Dallis gave
a discussion of the many classifications of mental
disease covering organic disease, the psychoses,
childhood manifestations of mental aberration,
manic depressive types, involutional classes,
paronoid states, melancholia, postpartum psy-
choses, anxiety neurosis and the paretic, the
psychopath, the epileptic, the bromide patient
and many others. Dr. Dallis gave an account
of the malpractice hazards existing in this sector
of medicine which was enlightening and of great
An Observation on the Accuracy of Digitalis Doses
Withering made this penetrating observation in
his classic monograph on digitalis: "The more I
saw of the great powers of this plant, the more it
seemed necessary to bring the doses of it to the
greatest possible accuracy.”1
To achieve the greatest accuracy in dosage and at
the same time to preserve the full activity of the
leaf, the total cardioactive principles must be iso-
lated from the plant in pure crystalline form so
that doses can be based on the actual weight of the
active constituents. This is, in fact, the method by
which Digilanid® is made.
Clinical investigation has proved that Digilanid is
"an effective cardioactive preparation, which has
the advantages of purity, stability and accuracy as
to dosage and therapeutic effect.”2
Average dose for initiating treatment: 2 to 4 tab-
lets of Digilanid daily until the desired therapeutic
level is reached.
Average maintenance dose: 1 tablet daily.
Also available: Drops, Ampuls and Suppositories.
1. Withering, W An account of the Foxglove, London, 1785.
2. Rimmerman, A. B.: Digilanid and the Therapy of Congestive
Heart Disease, Am. J. M. Sc. 209 : 33-41 (Jan.) 1945.
Literature giving further details about Digilanid and Physician’s Trial
Supply are available on request.
Digilanid contains all the initial glycosides from
Digitalis lanata in crystalline form. It thus truly
represents "the great powers of the plant” and
brings "the doses of it to the greatest possible
accuracy”.
Sandoz
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for March , 1950
283
value. Treatment such as can be used by the
general practitioner and also a discussion of
“shock” methods was described in detail as were
the indications for institutionalization of the
mental patient.
After a generous answering of questions with
suggestions of textbooks, the members gave a
rising vote of thanks to Dr. Dallis.
Fifth District
(COUNCILOR: FRED W. DIXON, M. D., CLEVELAND)
ASHTABULA
The monthly meeting of the Ashtabula County
Medical Society was held at the Ashtabula Hotel
following a dinner on Jan. 10. Dr. Fred A.
Dixon, Cleveland, Councilor of the Fifth District
of the Ohio State Medical Association, was first
speaker of the evening and gave a review of
medicine from the early days to the present in
Ohio.
Dr. Lowry M. Guilinger, born 1869, a graduate
of Chicago Homeopathic, 1898, and licensed in
1899; and Dr. Clarence E. Case, born 1870, a
graduate of Western Reserve in 1895 and licensed
in 1896, were presented Fifty-Year Pins and
Certificates of the Ohio State Medical Associa-
tion. Dr. Case spoke of his father who had been
a physician before him and of the early hardships
of physicians.
The Pin and Certificate for Dr. Melvin B.
Todd, born 1866, a graduate of Cleveland Uni-
versity of Medicine & Surgery in 1894, and
licensed in 1896, were forwarded in his absence.
The Pin and Certificate for the late Dr. Lawrence
A. Connell, deceased Sept. 23, 1949, were sent
to his widow.
The Society decided to urge members to sup-
port Senator Robert Taft in his reelection.
Along the line of combatting socialized medi-
cine, members were urged to publicly take a
more active part and a most definite stand re-
garding friendly and unfriendly politicians and
legislation.
Guest speaker for the evening was Dr. Ralph
Bacon, Erie, Pa. He gave an outline of what
doctors in Pennsylvania are doing to acquaint
the public with the cancer problem. He sug-
gested further education of the public regarding
the early symptoms of cancer. Announcement
was made that the annual formal dance would
be held at Hotel Ashtabula on Feb. 25.
Sixth District
((COUNCILOR: PAUL A. DAVIS, M. D„ AKRON)
MAHONING
With the start of 1950, Dr. Gordon G. Nelson
assumed office as president of the Mahoning
County Medical Society. The new president-
elect is Dr. Elmer J. Wenaas, who was named
to the position at the Dec. 20 meeting, Dr. G.
E. DeCicco is the new secretary, and Dr. L. H.
Getty was reelected treasurer.
Dr. Vernon L. Goodwin, retiring secretary, was
elected to a three-year term as delegate to the
Ohio State Medical Association. The other two
delegates whose terms are still in force are:
Dr. William M. Skipp and Dr. Ivan C. Smith,
Alternate delegates for one year terms are:
Dr. Robert E. Odom, Dr. J. Clair Vance and
Dr. Carl A. Gustafson. Dr. H. E. Patrick was re-
elected as the Society’s representative on the
board of directors of the Associated Hospital
Service.
It was reported that the Mahoning Medical
Service Foundation was ready to function and
that the Mahoning County Commissioners were
to arrange for payment for services of hospital-
ized cases.
At the Jan. 17 meeting, Dr. George Crile, Jr.,
Cleveland, spoke on “Some Problems in the
Treatment of Peptic Ulcer.” The Society is now
meeting at the Elks Club.
Dr. William M. Skipp, delegate of the Ohio
State Medical Association to the A. M. A., re-
ported on actions taken at the December meeting
of the A. M. A. in Washington.
SUMMIT
“Socialized Medicine” was the subject of a talk
by Dr. James L. Doenges of Anderson, Ind., at the
Jan. 3 meeting of the Summit County Medical
Society. Members of the dental, nursing and
pharmaceutical professions were guests of the
Society at the meeting.
Seventh District
(COUNCILOR: R. J. FOSTER, M. D., NEW
PHILADELPHIA)
BELMONT
Five physicians were presented 50- Year Pins
and Certificates of the Ohio State Medical Asso-
ciation at the Feb. 16 meeting of the Belmont
County Medical Society at the Belmont Hills
Country Club. They are Dr. D. O. Sheppard,
Barnesville; Dr. R. H. Wilson, Martins Ferry;
Dr. E. W. Turner, Belmont; Dr. Henry F.
Zink, Bellaire; and Dr. Homer S. West, St. Clairs-
ville. Dr. R. J. Foster, New Philadelphia, Coun-
cilor of the Seventh District of the O. S. M. A.,
made the presentations. Scientific speaker for
the occasion was Dr. Edward V. Turner of Co-
lumbus, who discussed phases of pediatrics.
HARRISON
Two Cadiz physicians, Dr. Anna B. Watson and
Dr. John S. Campbell, were honored by being
presented 50-Year Pins and Certificates of the
Ohio State Medical Association. Dr. R. J. Foster,
IF YOU’RE NOT REGISTERED TO VOTE,
VISIT YOUR ELECTION BOARD
284
The Ohio State Medical Journal
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285
New Philadelphia, Councilor of the Seventh Dis-
trict of the Association, made the presentations.
Dr. Campbell began his practice in Cadiz in
1889. Dr. Watson was a medical missionary in
Egypt for the United Presbyterian Church for
15 years. She was active in practice until 1946.
Eighth District
(COUNCILOR: CHESTER P. SWETT, M. D., LANCASTER)
FAIRFIELD
Officers of the Fairfield County Medical Society
for 1950 are: Dr. Wilford D. Nusbaum, pres.; Dr.
Victor N. Kistler, vice-pres.; and Dr. Arthur B.
Van Gundy, secy.-treas., all of Lancaster. Dele-
gate and alternate, respectively, are Dr. L. E.
Stenger, Lancaster, and Dr. William M. Kuntz,
Millersport.
Representative Walter E. Brehm, Logan,
Eleventh Congressional District, was guest speak-
er at a meeting of the December meeting of the
Fairfield County Medical Society in Hotel Lan-
caster. His subject was “Effects Socialized Medi-
cine Would Have in the United States.”
GUERNSEY
The regular meeting of the Guernsey County
Medical Society was held at noon on Jan. 19
at the Berwick Hotel with 11 members present.
Dr. Reo M. Swan, president, presided. Dr.
Thomas S. Tonnous, Pleasant City, was in charge
of the program.
Dr. Thomas W. Frame introduced the speaker
of the day, Dr. James H. McCreary, Ohio State
University College of Medicine, Columbus, whose
subject was “Disseminated Lupus Erythematosis.”
While a rather rare condition, it was the speaker’s
opinion that the condition apparently is being
seen more frequently in recent years. The speak-
er showed kodachrome pictures of typical cases
of the three subdivisions — acute, subacute and
chronic discoid types. A question-and-answer
period followed.
Dr. Henry L. Wells spoke briefly on Board
of Health matters, and suggested that all com-
plaints to the Board of Health be submitted in
writing. Dr. M. C. McCuskey suggested that
members be on the alert for prospects to take
over the newly created office of public health phy-
sician for Cambridge and Guernsey County. It
was announced that the Society’s Public Rela-
tions Committee would meet soon with County
Commissioners to draw up a new contract for the
care of indigent cases.
LICKING
Licking County Medical Society officers for
the current year are Dr. James B. Johnson, Jr.,
pres.; Dr. Charles S. Bishop, vice-pres.; and
Dr. R. Gilbert Mannino, secy.-treas. Dr. George
A. Gressle is delegate and Dr. Johnson, alternate.
All are of Newark.
MORGAN
Officers and representatives of the Morgan
County Medical Society for the year are: Dr.
C. E. Northrup, McConnelsville, pres.; Dr. E.
G. Rex, McConnelsville, secy.-treas.; Dr. Henry
Bachman, Malta, delegate; and Dr. A. A. Coul-
son, McConnelsville, alternate.
WASHINGTON
Dr. Clarence E. Ash of Beverly was elected
president of the Washington County Medical So-
ciety for the year. Other officers and represen-
tatives are the following Marietta physicians:
Dr. Kenneth E. Bennett, vice-pres.; Dr. William
R. Stewart, secy.-treas.; Dr. Donald S. Williams,
delegate, and Dr. Roy M. Meredith, alternate.
ARE YOU REGISTERED TO VOTE?
IF NOT, ACT PROMPTLY
Ninth District
(COUNCILOR: J. PAUL McAFEE, M. D.,
PORTSMOUTH)
The Lawrence County Medical Society will be
host to the Ninth District at a meeting to be held
at the Lawrence County General Hospital, Iron-
ton, on Thursday, April 27. The scientific pro-
gram will be in charge of a team selected by the
Committee on Cancer of the Ohio State Medical
Association. The subject of the present status of
medical public relations will be given a promi-
nent place on the program.
HOCKING
Dr. J. Ward Doering, Logan, was reelected
president of the Hocking County Medical Society.
Other officers are Dr. C. T. Grattidge, Laurel-
ville, vice-pres., and Dr. Owen F. Yaw, Logan,
secy.-treas. Delegate and alternate, respectively,
are Dr. Grattidge and Dr. H. M. Boocks, Logan.
JACKSON
Officers of the Jackson County Medical So-
ciety for 1950 are the following: Dr. David S.
Mack, Jackson, pres.; Dr. William T. Washam,
Jackson, vice-pres., and Dr. Alvis R. Hambrick,
Wellston, secy.-treas. Dr. John L. Frazer and
Dr. Earl J. Levine, both of Jackson, are dele-
gate and alternate, respectively.
LAWRENCE
Six Lawrence County doctors were presented
the Ohio State Medical Association’s 50- Year
Pins and Certificates at a meeting of the Law-
rence County Medical Society on Jan. 25 in
Ironton. Dr. J. P. McAfee, Portsmouth, Coun-
cilor of the Ninth District of the Ohio State
Medical Association, made the presentations to
the following: Dr. William F. Marting, Dr.
Daniel J. Webster, and Dr. Oliver U. O’Neil of
Ironton; Dr. F. D. Campbell of Coal Grove; Dr.
286
The Ohio State Medical Journal
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of Chesapeake.
MEIGS
The Meigs County Medical Society, at its an-
nual meeting on Jan. 26, presented the Ohio
State Medical Association’s 50-Year Pins and
Certificates to five physicians. Dr. S. J. Blazewicz,
president, made the presentations. Those who
received the awards are: Dr. L. G. Gribble, Dr.
W. S. Hart and Dr. S. S. Mart of Pomeroy,
Dr. Wilbur Ellis of Middleport and Dr. John
Philson of Racine.
Officers for the present year are: Dr. Joseph
J. Davis, Middleport, president; Dr. Charles J.
Mullen, Pomeroy, vice-pres., and Dr. William J.
Jeric, Pomeroy, secy.-treas. Members voted to
officially recognized the recently organized
Woman’s Auxiliary.
SCIOTO
At the Jan. 9 meeting of the Hempstead
Academy of Medicine, Dr. Joseph P. Webb and
Dr. S. Werthammer of Huntington, W. Va., dis-
cussed “The Liver-Needle-Biopsy and Its Use
in Diagnosis of Hepatic Disease.”
Tenth District
(COUNCILOR: H. M. CLODFELTER. M. D., COLUMBUS)
FAYETTE
Dr. Joseph M. Herbert is the new president of
the Fayette County Medical Society for the ensu-
ing year. Dr. E. H. McDonald is vice-pres., and
Dr. Newton M. Reiff, secy.-treas. Dr. J. E.
Rose is delegate and Dr. J. H. Persinger, alter-
nate. All are of Washington Court House.
FRANKLIN
Officers of the Columbus Academy of Medicine
who took office on Jan. 1 are Dr. Grant 0.
Graves, president; Dr. E. T. Kirkendall, pres.-
elect, both of Columbus; and Dr. Oscar W. Jep-
sen, Canal Winchester, secy.-treas.
Members of the Council, in addition to the
officers, are: Drs. Gilman D. Kirk, Rollo W.
Bonnell, John M. Lowery, John M. Thomas, James
H. McCreary, Robert E. S. Young, Warren G.
Harding, Horace B. Davidson, Jack S. Silber-
stein, Allan C. Barnes, Frank A. Riebel, Clark
P. Pritchett and Thomas E. Rardin.
Trustees are Drs. Rollo W. Bonnell, Harrison
S. Evans, Thomas E. Rardin and John E. Brown,
Jr.
Delegates are Drs. Charles W. Pavey, Frank-
lin C. Hugenberger, Phillip T. Knies, Richard
L. Meiling, Gilman D. Kirk and Robert E. S.
Young.
Alternates are Drs. Anthony Ruppersberg, Jr.,
George F. Collins, William L. Pritchard, Clark
P. Pritchett, Reuben B. Hoover and Thomas E.
Rardin.
Speaker for the Jan. 16 meeting of the Co-
lumbus Academy of Medicine was Dr. Max M.
Zinninger, University of Cincinnati College of
Medicine, whose subject was “The Diagnosis and
Management of Acute Intra- Abdominal Condi-
tions.”
KNOX
Members of the Knox County Medical Society
elected the following officers and representatives
to serve during 1950: Dr. Robert H. Hoecker,
Mt. Vernon, pres.; Dr. Joseph W. Allman, Center-
burg, vice-pres.; Dr. Charles E. Cassaday, Mt.
Vernon, secy.-treas.; Dr. Henry T. Lapp, Utica,
delegate; and Dr. Raymond S. Lord, Fredericks-
town, alternate.
MORROW
Dr. Lowell Murphy, Cardington, was reelected
president of the Morrow County Medical Society
for 1950; Other officers are Dr. William Deffinger,
Marengo, vice-pres., and Dr. Francis W. Kubbs,
secy.-treas. Delegate and alternate are Dr. J. P.
Ingmire and Dr. C. S. Jackson, both of Mt. Gilead.
Eleventh District
(COUNCILOR: JOHN S. HATTERY, M. D., MANSFIELD)
ASHLAND
Dr. William F. Emery was guest of honor
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The Ohio State Medical Journal
County Medical Society in early January, at
which meeting he was presented the 50-Year
Pin and Certificate of the Ohio State Medical
Association. Dr. C. B. Meuser, colleague of Dr.
Emery’s for 38 years, made the presentation.
Dr. George M. Emery placed the pin on the lapel
of his father. Dr. A. D. Robertson presented
Dr. Emery with an oil painting which had been
painted by his daughter.
LORAIN
Speaker at the Jan. 10 meeting was Dr.
Edmund E. Beard, Western Reserve University
School of Medicine, who spoke on “Endocrinology
in Present-Day Practice.” Dr. Valloyd Adair
delivered a memorial address for the late Dr.
S. V. Burley.
Woman’s Auxiliary ...
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
Auxiliary members, please note: The 1950
Annual Meeting of the Woman’s Auxiliary to the
Ohio State Medical Association will be held con-
currently with the Annual Meeting of the Medi-
cal Association — in Cleveland on May 16, 17, 18.
The Cleveland Hotel will be Auxiliary headquar-
ters. The full official program will appear in the
forthcoming issue of The Ohio Medical Auxiliary
News.
ALLEN
The January meeting of the Auxiliary to the
Lima and Allen County Academy of Medicine
was held at the home of Mrs. R. L. Tecklenberg,
president. Members made 40 pairs of washable
slippers to be given to St. Rita’s and Memorial
Hospitals. Mrs. H. A. Lotzoff gave a review
of the article “Fear” from Hygeia magazine.
Mrs. Charles H. Leech, Mrs. F. M. Flickinger and
Mrs. V. H. Hay of the Program Committee acted
as hostesses and served a lunch to the 28 mem-
bers present.
ARE YOU AND MEMBERS OF YOUR
FAMILY REGISTERED TO VOTE?
ASHTABULA
Miss Amy Parker, director of guidance and
child accounting in the Ashtabula city schools,
was guest speaker at the dinner meeting which
members of the Ashtabula County Auxiliary held
January 10 at the Hotel Ashtabula.
Mrs. Donald Forward was named chairman for
the style show and tea which the group is ar-
ranging for the public in March. Mrs. E. N.
Wright will serve as co-chairman. The January
dinner meeting was arranged by Mrs. A. M.
Mills, chairman; Mrs. Byron Johnson, Mrs. S. A.
Burroughs, and Mrs. H. A. Tagett.
AUGLAIZE
The newly organized auxiliary to the Auglaize
County Medical Society held its second meeting
on January 19. Mrs. George Cooperrider, state
president-elect, was present. There was election
of the president-elect; committee chairmen were
appointed; the constitution was set up; and dues
of five dollars a year were agreed upon. A dele-
gate and alternate to the state convention were
chosen.
BUTLER
Ollie James, chief editorial writer of the Cin-
cinnati Enquirer and author of the humorous
column “The Innocent Bystander,” injected a
brand of wit and humor into the dinner meeting
on January 18 of the Woman’s Auxiliary to the
Butler County Medical Society, that made the
gathering a “howling” success. The husbands of
the auxiliary members were guests at the meet-
ing. Mr. James’ description of his confinement
in the hospital provided a particular touch of
hilarity.
Mrs. Fred Brosius was in charge of the
program and Mrs. W. H. Roehll was in charge
of dinner arrangements. Mrs. W. H. Henry,
president of the Auxiliary, greeted the guests;
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for March, 1950
289
Dr. L. H. Skimming, newly elected president of
Butler County Medical Society, spoke briefly.
Dr. David Heusinkveld, Cincinnati, First District
Councilor, was a special guest. Assisting Mrs.
Roehll were Mrs. John Carter, Mrs. Charles
Buchert, Mrs. L. H. Skimming, Mrs. John Bauer,
and Mrs. E. McCall Morris.
FAIRFIELD
The Fairfield Auxiliary met on January 8 at
the Nurses House of the Lancaster Fairfield
County Hospital. Mrs. F. W. James presided
over the business meeting. The project chairman,
Mrs. W. D. Nusbaum, discussed matters relating
to the various projects. Mrs. C. P. Smith and
Mrs. W. D. Monger were named delegate and al-
ternate respectively to the state convention.
Following the meeting, the group toured the
hospital. Mr. E. J. Milarm, hospital administra-
tor, addressed the women and told about the new
wing which is to be added. Tea was served later,
guests at which included two instructors in the
School of Nursing and the assistant to the ad-
ministrator.
FRANKLIN
The Auxiliary to the Columbus Academy of
Medicine held its January meeting at the home
of Mrs. Phillip T. Knies. Prior to the general
meeting, Mrs. Oscar W. Jepsen, president, pre-
sided over an Executive Board meeting. Guest
speaker for the afternoon was Mr. G. Walter
Burwell who spoke on “The Flower of the
Future.” Chairman of the tea was Mrs. Richard
Zollinger, with Mrs. Frank Donley and Mrs. E.
R. Schumacher as co-chairmen. They were
assisted by Mrs. Joseph Forrester and Mrs.
Ralph Samson.
GREENE
Dr. Robert E. Boswell of Dayton was the guest
speaker at the Christmas dinner party of the
Greene County Auxiliary which was held at
Trebein Manor. Husbands of the members were
guests. Dr. and Mrs. Boswell visited in Europe
last summer and the former spoke of his im-
pressions of the countries in which they travelled.
Dr. and Mrs. H. C. Messenger also gave high-
lights of their trip to Europe, from which they
returned recently. Both spoke of the medical as-
pects which interested them in England and Italy.
The dinner meeting was opened with a short
talk by the Auxiliary’s president, Mrs. H. C.
Schick. There were covers for forty members
and guests.
GUERNSEY
Members of the Guernsey County Auxiliary
met on January 5 for a luncheon and business
session at the home of Mrs. William Mahaffey.
Two new members were introduced: Mrs. J. E.
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Complete cooperation to the attending physician.
For descriptive folder, call or write
M. YOUNG, Business Manager
Telephone FA. 2535 or FA. 4893
813 Bryden Road Columbus, Ohio
290
The Ohio State Medical Journal
Patton and Mrs. Kenneth Frakes. Mrs. F. Gordon
Lawyer, president, presided at the business meet-
ing. The group which, as a Christmas project,
provided a variety of useful gifts for the women
residents at the County Home, voted a donation
to the local tuberculosis association. The mem-
bers spent the remainder of the afternoon count-
ing and tabulating sales tax stamps which will
be redeemed to finance other philanthropic proj-
ects.
Mrs. Stanley Cash, health education instructor
in the Cambridge public schools, gave a very
informative talk at the February meeting of
the Auxiliary which was held at the Coffee Shop.
Mrs. Lawyer, Auxiliary president, presided at
the business meeting following the luncheon.
Members voted to assist financially with the
school’s visual aid program.
JEFFERSON
A benefit card party was sponsored by the
Jefferson County Auxiliary at the Nurses’ Home
of the Ohio Valley Hospital. More than 70
people enjoyed the games, and the refreshments
which were served. Mrs. John Smarrella was
chairman of the committee in charge of arrange-
ments. Assisting her were Mrs. V. B. DiLoreto,
Mrs. D. A. Macedonia, Mrs. John Bevan and
Mrs. John Gallagher.
The Auxiliary held its January meeting at the
home of its president, Mrs. Walter Cunningham.
After discussing plans for future activites, the
business session was followed by a social hour.
KNOX
Mrs. W. W. Brownfield spoke to the Knox
County Auxiliary on January 24 at the home of
Mrs. C. E. Cassaday. Mrs. Brownfield chose
for her subject “Archeology of Palestine,” il-
lustrating her talk with maps, charts and pic-
tures.
The business meeting was in charge of the
president, Mrs. John Baube. Mrs. Julius Sham-
ansky asked members to recruit donors for the
Red Cross bloodmobile which was scheduled to ap-
pear on February 3. Lighted tapers and a center-
piece of red tulips were used on the refreshment
table over which Mrs. Shamansky presided.
Mrs. I. S. Workman and Mrs. 0. W. Rapp were
assistant hostesses.
LAWRENCE
The newly organized Lawrence County Auxi-
liary is extending an invitation to all doctors’
wives in the Ninth District to attend the district
medical meeting with their husbands that is to be
held in Ironton on April 19. These new Auxiliary
members are making elaborate plans to enter-
tain visiting doctors’ wives from the other
counties in the district.
LICKING
The Woman’s Auxiliary to the Licking County
Medical Society met for its January dinner meet-
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for March, 1950
291
ing- at Wagner House, with 26 members present.
Mrs. J. Y. Salzman, president, presided and in-
troduced two new members: Mrs. Gerald Erhard
and Mrs. Jay Wells.
Mrs. Paul Grove announced that work will
start soon on nurse recruitment, one of the main
projects of the Auxiliary. It is planned to
pick a girl from the county and city high
schools, worthy of the scholarship the Auxiliary
gives outright. Appointments of two members
to the budget committee were made. Delegates
to the state convention in May are Mrs. Salz-
man and Mrs. Roland Jones, president-elect.
Mrs. Carl Petersilge gave a resume of the work
being done by the American Medical Association
in its fight against socialized medicine, and what
the Auxiliaries can do to help.
LOGAN
The Auxiliary to the Logan County Medical
Society held its December meeting at the home
of Mrs. O. C. Amstutz, for a Christmas dinner
party with the husbands of members as guests.
Music and canasta were enjoyed during the
evening.
On January 24, Mrs. R. A. Firmin was hostess
to the group when it met at her home. Mrs. F.
Blair Webster, president, presided and introduced
Mrs. M. L. Pratt, secretary of the local Red Cross
chapter. Mrs. Pratt spoke briefly of the blood bank
and its importance to the community, and asked
the Auxiliary to secure a new donor for each mem-
ber on the visits of the blood bank. The mem-
bers agreed to cooperate and have this as a
project for the year. A social hour followed
the business session.
LUCAS
The Lucas County Auxiliary held a luncheon
meeting on January 17 at the Woman’s Club,
with Sergeant E. H. Davey of the State Highway
Patrol as guest speaker. His subject was “The
History, Organization and Purpose of the Ohio
State Patrol.” He also presented the newest
ideas in traffic strategy.
A site has been purchased for the new
Academy building in Toledo and the Auxiliary
has been honored by being asked to have two
members on the planning committee and two on
the fund-raising committee.
About 40 women are attending the Art Ap-
preciation courses sponsored by the Auxiliary
and held each Friday at the Art Museum. Fifty
women attended the study group session on
“Live Issues of Today” held under the leader-
ship of Mrs. Nelson Morris.
MERCER
The Mercer County Auxiliary held its regular
monthly meeting on January 17 at the home of
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The Ohio State Medical Journal
Mrs. Charles P. Adkins, with Mrs. M. G. Harnick
assisting. Luncheon was served, following which
the meeting was called to order by Mrs. W. C.
McNeil, president. A vote of thanks was given
Mrs. McNeil and Mrs. Mcllroy for the very
successful dinner dance held in December for the
doctors of the Mercer County Medical Society.
Mrs. R. Schmidt reported that toys, brought
by the members at a previous meeting, had been
given to the American Legion and placed in
Christmas baskets for needy families. Several
ways were suggested for making money. Social-
ized medicine was also discussed and it was im-
pressed upon each member the duty she has in
helping to prevent Government control of medi-
cine.
MIAMI
Nineteen wives of Miami County physicians met
on January 31 at the Troy Country Club to
organize a Woman’s Auxiliary to the Miami
County Medical Society. Officers were elected
and include: Mrs. George Woodhouse, president;
Mrs. William T. Wilkins, Jr., president-elect;
Mrs. Kenneth F. Lowry, vice-president; Mrs. E.
G. Puterbaugh, secretary; Mrs. William W. Weis,
treasurer.
Present to assist in the organization were
Mrs. George Cooperrider, state president-elect
and Mrs. E. P. Greenawalt, second district direc-
tor. Luncheon was served preliminary to the
business meeting when the two state officials
outlined projects for future activities.
IF YOU’RE NOT REGISTERED TO VOTE,
VISIT YOUR ELECTION BOARD
MORROW
The regular monthly luncheon meeting of the
Auxiliary to the Morrow County Medical Society
was held on February 6. The business session
was presided over by Mrs. Frank Sweeney, presi-
dent. One of the chief projects of the group
at the present time is the making of money
to benefit the proposed County Hospital. Presi-
dent-elect of the Morrow Auxiliary is Mrs.
Lowell Murphy.
OTTAWA
The Auxiliary to the Ottawa County Medical
Society voted at the meeting on January 19
to provide a Valentine treat of cake and ice cream
for the men and women at the Ottawa County
Home. The meeting was held in the home of
Mrs. A. D. Miessner. Mrs. G. R. Ley was ap-
pointed Auxiliary representative to the monthly
meetings of the county cancer control unit. Plans
for a February rummage sale were discussed.
RICHLAND
The Richland County Auxiliary held its Janu-
ary meeting at the Women’s Club, with Mrs.
C. E. Hunter and Mrs. W. H. Buker serving
as hostesses. Forty members were present for
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for March, 1950
293
the luncheon which was served on tables centered
with pink begonias. Mrs. F. J. Heringhaus
presided at the business session, following which
a motion picture film on cancer, “Choose to Live/’
was shown.
Luncheon was served on February 6 at the
Women’s Club to 45 members of the Auxiliary.
Valentine appointments and lighted tapers
decorated the tables. Hostesses were Mrs. Joseph
Bein and Mrs. Joseph Edelstein. Mrs. Hering-
haus presided at the business meeting at which
each member voted her cooperation with the well
baby clinic’s expanding program.
Mrs. Erling Smedal introduced three new mem-
bers: Mrs. Paul Lee, Mrs. Frank Neff, and Mrs.
Bruce Sutton. Following the business session,
bridge was played.
SCIOTO
The doctors of Scioto County were the guests
of honor on February 9 at a banquet given by
the Auxiliary to the Hempstead Academy of
Medicine in the Rafter Room of the Four Keys
Restaurant. Dinner covers were laid for 70
and following the fete, Alfred Schaefer showed
colored motion pictures of his extensive tour of
South America. Cupids, red and white flowers
and candles decorated the tables, and each doctor
was presented with a valentine — each such valen-
tine being delivered in person at the tables by
specially designated “letter carriers.”
The committee in charge of arrangements in-
cluded: Mrs. W. A. Ray, president; Mrs. H. M.
Keil, Mrs. C. L. Ferguson, Mrs. Milton Levine,
Mrs. J. W. Hutchens, Mrs. C. W. Wendelken and
Mrs. J. W. Daehler.
TRUMBULL
A joint dinner meeting was held on January 18
by the Trumbull County Medical Society and its
Auxiliary. Guest speaker was Dr. Schneider,
of the Babies’ and Children’s Hospital in Cleve-
land. The Auxiliary held its own business meet-
ing later in the evening, continuing a discussion
of plans for the Gardenia Ball. It was reported
that six chairs had been purchased to be presented
to the Old Folks Home of Trumbull County.
TUSCARAWAS
Mrs. Harold Wherley reviewed the history of
the Auxiliary to the Tuscarawas Medical Society
when its members met on January 12 at the
home of Mrs. Ruel Foster. It was announced
that 23 patients attended the orthopedic clinic
at the hospital the previous week. Auxiliary
members assist at this clinic. The organization
also placed gift subscriptions of Hygeia in
schools and youth centers, and sent a Christmas
basket to the tuberculosis sanatorium. The
group plans to assist in the heart fund cam-
paign. Three new members of the Auxiliary
are: Mrs. Raymond Crawley, Mrs. R. E. Wolf,
and Mrs. E. L. Miller.
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The Ohio State Medical Journal
Licensed Through Endorsement By
State Medical Board
The Ohio State Medical Board has issued li-
censes to practice medicine and surgery in Ohio
to the following physicians, through endorsement
of their licenses to practice in other states:
October 4, 1949 — Maximilian M. Kafka, Middle-
town, Univ. of Maryland.
December 13, 1949 — Carter M. Ballinger, Parma
Heights, State Univ. of Iowa; George W. Ballou,
Cincinnati, Univ. of Louisville; Beatrice Bam-
berger, Columbus, Univ. of Maryland; Andrew M.
Brenner, Hillsboro, Indiana Univ.; Lovelace B.
Capehart, Jr., Dayton, Columbia Univ.; James L.
Chesnut, III, Columbus, Univ. of Pittsburgh; John
B. Chewning, Cincinnati, Univ. of Penna.; Wm.
A. Collins, Jr., Columbus, Univ. of Tenn.; Rob-
ert L. Copeland, Cleveland, Wayne Univ.
Nathaniel J. Fine, Canton, Laval Univ.; Sidney
C. Foster, Columbus, Syracuse Univ.; S. John
Fung, Columbus, Univ. of Michigan; Robert A.
Furman, Cleveland, Columbia Univ.; Abraham
J. Gabriele, Dayton, Univ. of Vermont; Charles
H. Gallup, Cleveland, Univ. of Rochester; James
Hare, Parma Heights, Hahnemann Med. College;
John R. Huey, Columbus, State Univ. of Iowa;
Roy T. Johnson, Cincinnati, Univ. of Tenn.; Jack
M. Kenyon, Toledo, Univ. of Toronto; John A.
Kirchner, Cincinnati, Univ. of Virginia.
Clinton F. Lavender, Cleveland, Western Re-
serve Univ.;' Louis A. Lorina, Youngstown,
Medical College of Virginia; John E. Lynch, Cin-
cinnati, Indiana Univ.; Benjamin Moorstein,
Akron, Univ. of Michigan; James W. Papez, Co-
lumbus, Univ. of Minnesota; Joseph R. Paradise,
Cleveland, St. Louis Univ.; Norman V. Petersen,
Cleveland, Univ. of Pittsburgh; Fred F. Somma,
Akron, Univ. of Cincinnati; Henry M. Tardif,
Springfield, Univ. of Buffalo; Maurice Tatelman,
Springfield, Univ. of Nebraska; Alfred A. Thur-
low, Jr., Springfield, Washington Univ.; Gerard
F. Wolf, Sidney, New York Univ.
Staff Appointees
Several recent appointments on the Staff
of the Cleveland Clinic Foundation have been
announced. Dr. Stanley 0. Hoerr, formerly
associate professor of surgery at the Ohio State
University College of Medicine, joined the
staff of the Department of Surgery. Dr.
Donald B. Effier is on the staff in the Depart-
ment of Thoracic Surgery. Until 1948, he
was adjunct clinical professor of surgery at
George Washington University. Dr. Robert
A. Hays has been appointed a member of the
staff in the Department of Therapeutic Radi-
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in 1949. Dr. Robert E. Wise has been ap-
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Meiling To Direct Paring of
Military Hospitals
Secretary of Defense Louis Johnson on Febru-
ary 1 directed the inactivation, or change of
status, of 18 military hospitals in continental
United States.
The action marks only the first phase of a
study of the total medical services problem
within the Department of Defense, which is
being made under direction of Dr. Richard L.
Meiling, of Columbus, now director of Medical
Services for the Department.
The program is estimated to effect a reduction
of about 8,000 staffed hospital beds and to
alleviate the acute shortage of physicians by
assigning about 400 physicians to other loca-
tions in the military medical service. It is to
be accomplished over a period of five months so
as not to interfere with medical care of any
patients. The action is expected to effect a
recurring annual savings of approximately
$25,000,000.
The Secretary of Defense also anticipated that
substantial additional savings can be made after
officials analyze smaller medical installations.
Certain of the facilities to be closed are adapt-
able for the needs of Veterans Administration pa-
tients. Dr. Meiling has been authorized to dis-
cuss the problem of hospitalization of V. A. pa-
tients in military hospitals with the Veterans Ad-
ministration and the Bureau of the Budget, and
to make arrangements for the care of V. A. pa-
tients in accordance with provisions made in the
1951 fiscal year budget for hospitalization of
V. A. patients in military hospitals.
Endocrinology
A postgraduate assembly in “Endocrinology
Including Diabetes” will be sponsored by the As-
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and the American Diabetes Association at the
Roney Plaza Hotel, Miami Beach, Fla., April 3-8.
Additional information may be obtained from, or
application made to Dr. Henry H. Turner, secre-
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The Ohio State Medical Journal
Ohio Society for Crippled Children
To Sponsor Easter Seal Drive
In 1949 the Ohio Society for Crippled Chil-
dren grossed $375,833 from Easter Seals. More
than 90 per cent of this amount was retained in
Ohio while 08.3 per cent was sent to the National
Society. Seventy-six per cent of that retained
in the state was expended in local communities
while 15.7 per cent was used by the State Society.
Society officials revealed that actually more
than $392,000 had been expended in Ohio during
the last fiscal year for crip-
pled children’s work. The
additional amount above the
Easter Seal receipts was
made possible by special
donations. Because of the
increased needs and mount-
ing costs of services, Society
officials hope to increase
their budget for the coming
year. The Ohio Society for Crippled Children,
with headquarters at 5 W. Broad St., Colum-
bus 15, acts as an administrative, coordinating
and supervisory organization to more than 60
local county societies for crippled children
throughout the state. County organizations are
administered largely by volunteer workers.
OHIO BOY FEATURED
Six-year old Russell Miller of Columbus has
been singled out as the national Easter Seal
Boy in the annual campaign for crippled chil-
dren, March 9 to April 9.
The child is a cerebral palsy victim who has
been receiving treatment since he was three
years old at the Cerebral Palsy Treatment
Center, 620 E. Town St., Columbus, sponsored
by the Franklin County Society for Crippled
Children.
Russell’s real chance for rehabilitation came
in 1946 when the center, one of the first in the
country, was opened. He has progressed to the
point where he was admitted on February 1 of
•this year to Open Air Elementary School, a
Columbus public school for crippled children.
The National Society was founded by Edgar
F. “Daddy” Allen in Elyria, 29 years ago. Of-
ficers point out that it is guided by a three-
point program for the nation’s handicapped —
education, research and direct services, financed
by Easter Seal campaign. Cerebral palsy claims
nearly 200,000 victims in the United States. It
is estimated that there are 8,000 cerebral palsied
children in Ohio.
Since opening of the Columbus center, similar
centers for pre-school children have been estab-
lished in Cleveland, Dayton and Bowling Green.
Several other communities offer at least one of
the therapies required for restoration of cerebral
palsied children.
IF YOU’RE NOT REGISTERED TO VOTE,
VISIT YOUR ELECTION BOARD
Eye, Ear, Nose and Throat
A Seminar in Otolaryngology-Ophthalmology
will be held April 17-21 at the New York Poly-
clinic Medical School and Hospital, 345 W. 50th
St., New York City 19. Additional information
may be had by writing the Medical Executive
Officer.
A SERVICE OF SUPPLY
Bowman
TO THE MEDICAL ARTS
MEDICAL and SURGICAL
EQUIPMENT and SUPPLIES
PHARMACEUTICALS
BIOLOGSCALS
MEDICAL FURNITURE
SURGICAL and DIAGNOSTIC
INSTRUMENTS
The Bowman Brothers Drug Co.
CANTON, OHIO
CANTON at 7 79 Schroyer Awe., S.W.
AKRON at 370 East Market Street
LIMA at 539 West Market Street
PHARMACEUTICALS
A complete line of laboratory con-
trolled ethical pharmaceuticals. Chemists
to the Medical Profession since 1903.
EMMER
THE ZEMMER CO., PITTSBURGH 13, PA.
OH-3-50
for March, 1950
297
Dr. Curtis Twice Honored
For the Year
Dr. George M. Curtis, chairman of the Depart-
ment of Research Surgery at the Ohio State Uni-
versity College of Medicine, has been twice
honored for outstanding work in his field.
He has been selected as one of two persons
to receive the 1950 recognition award presented
by the Professional
Inter-Fraternity Council
at Ohio State University.
The Council, whose mem-
bership is made up of
12 professional groups
on the campus, yearly
singles out two persons
“who have made marked
contributions to their
fields and have brought
honor to their frater-
nities.” The award was
made at the annual rec-
ognition banquet on February 15. Dr. Curtis
was awarded the recognition certificate by Alpha
Kappa Kappa, medical professional fraternity.
He has been associated with the University
faculty for 18 years. Other recipient of the
award is Bernard V. Christensen, Ph. D., dean
of the College of Pharmacy, 0. S. U.
Dr. Curtis also was chosen for the 1950 honor
award of the Mississippi Valley Medical Society.
This award is given from time to time “to
those who have made distinguished contributions
to clinical medicine.” The award will be presented
at the banquet of the Society in Springfield, 111.,
on September 28. He was recently awarded a
$3,000 research grant by the Ciba Pharmaceutical
Co. to support research studies on hyperthyroid-
ism.
COMING MEETINGS
Ohio State Medical Association, Annual Meet-
ing, Cleveland, May 16-18.
American Medical Association, Annual Session,
San Francisco, June 26-30.
American Association of Industrial Physicians
and Surgeons, 35th Annual Meeting, Sherman
Hotel, Chicago, April 22-29.
American Association for Thoracic Surgery,
Denver, Colo., April 15-19.
American College of Physicians, Boston, April
17-21.
American College of Radiology, San Francisco,
Calif., June 25.
American Goiter Association, Shamrock Hotel,
Houston, Texas, March 9-11.
American Pediatric Society, French Lick, Ind.,
May 8-10.
National Tuberculosis Association, Washing-
ton, D. C., April 25-28.
INDEX TO ADVERTISERS
Abbott Laboratories 220
American Meat Institute — 206
Ames Company, Inc. 216
Ann Arbor School — 288
Ar-Ex Cosmetics, Inc — 299
Ayerst, McKenna & Harrison, Ltd 207
Bell, Kathryn, Inc. 294
Borden Company 224
Bowen, Charles F., M. D 294
Bowman Bros. Drug Company 297
Camel Cigarettes 222
Cincinnati Sanitarium 212
Clinical and Pathological Laboratory 290
Columbus Orthopaedic Appliance Company 292
Cook County Graduate School of Medicine 292
Davies, Rose & Co., Ltd. 205
Eaton Laboratories, Inc. 273
Endo Products, Inc. 221
Fairfield Nursing Home . 291
Fleet, C. B., Company, Inc. 213
Hanger, J. E., Inc. 293
Harding Sanitarium — 210
Holland Rantos Company 281
Ingleside Home, Inc — 287
Lederle Laboratories 219
Lilly, Eli & Company. Insert Between
Pages 224 and 225
Luzier’s Inc 279
McMillen Sanitarium - 212
Mead Johnson & Company Back Cover
Medical Protective Company 295
Mercer Sanitarium 210
Merck & Company, Inc. 217
Miller, W. H., M. D 291
Neil Training School- 299
Nerren Company 296
Nestle’s Company, Inc 287
New York Polyclinic Medical School 285
Num Specialty Company 299
Oak Ridge Sanatorium 211
Parke, Davis & Company. 300 and
Inside Back Cover
Philip Morris & Company 218
Picker X-Ray Corporation 223
Pogue, Mary E., School 289
Quincy X-Ray & Radium Laboratories 296
Radium Emanation Corporation 215
Resthaven 290
Rexair Division 285
Rupp & Bowman Company 293
Sandoz Chemical Works 283
Sawyer Sanatorium 201
Schering Corporation 203
Searle, G. D., & Company 269
Special Formula Corporation 277
Stoneman Press 215
Van Wagner Company 296
Wendt-Bristol Company 295
Wickhaven Sanitarium 210
Windsor Hospital 210
Winthrop-Stearns, Inc— 214
Wyeth, Incorporated — - — 275
Zemmer Company 297
298
The Ohio State Medical Journal
to fee* , V; ' vQ;;: i
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intermediate action: peak effect in 8 to 12 hours, with action continuing
sometimes for 16 or more hours.
GLOBIN INSULIN WITH ZINC SQUIBB
10-cc. vials (40 ir 80 units per cc.)
prolonged action: onset slow; peak effect in 10 to 12 hours, with action
sometimes persisting for 24 or more hours.
PROTAMINE ZINC INSULIN SQUIBB
10-cc. vials (40 ir 80 units per cc.)
Squibb
MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858
for April, 1950
305
*74e PlttfAJcM cumX BaaklUell
By JONATHAN FORMAN, M. D.
Life Among the Doctors, by Paul de Kruif
($4.75. Harcourt, Brace & Co., New York City).
From their beginning we have followed the
writings of Paul de Kruif, sometimes with pleas-
ure, sometimes with irritation, and always with
interest. Bacteriologist made angry, turned
pamphleteer, historian, and finally crusader, de
Kruif has made a greater contribution to the
ultimate health of the nation than most phy-
sicians. He has done this mostly by shorten-
ing the interval between discovery and prac-
tical, everyday application of advances in
medicine. Sometimes he has been altogether
too premature. Carried away with his enthu-
siasm he has, at times, made mistakes, but in
general his writings have been helpful.
In this volume, it becomes quite clear that he
has always wished to be a physician and that
now as he looks back in these pages, he takes
his satisfaction in the wholesale manner in
which he has been allowed to serve Medicine
although he has been unable to serve the in-
dividual sick.
De Kruif never overestimates the amount of
information that his readers possess and he
never underestimates their intelligence. He
marshals the facts that his readers lack the
ability to appeal to their emotions as to their
minds. He writes most effective melodrama.
Virtue after travail and suffering overcomes all
obstacles and triumphs over wickedness, ignor-
ance, and apathy.
In his enthusiasm, de Kruif permits his read-
ers to draw mistaken conclusions. He is a hero
worshiper with strong loyalties and a deep
hatred for what he deems to be ignorance, prej-
udice and injustice blocking the path of his
heroes. Sometimes he is also mistaken in these.
For instance, he allows his concept of the stub-
borness of Morris Fishbein to overlook the
great responsibility to established truth to the
sick that the former Editor of the Journal of
the American Medical Association has. He
dramatizes this responsibility into what he con-
siders the backwardness and reactionary attitude
of all the physicians who belong to the Ameri-
can Medical Association.
At his best, de Kruif has just the right de-
grees of suspense and timing to pull our heart
strings as he describes the fifty-odd living re-
searchers in public health and clinical medicine
as his life among the doctors.
As de Kruif matures, however, we find him
looking up from the struggles of his heroes to
the problems of medical care with a sympathetic
eye for our profession. He knows as well as
we do that the nationalization of Medicine will
only set back its work. Like most laymen and
those physicians who have never practiced
their art, he is oversold on the advantages and
the merits of group practice. This view he
defends with a fierceness born of his loyalty to
Dr. Sidney Garfield. As he studies the current
controversy of socialism by which we shall
share our poverty and our increasingly inadequate
medical facilities, we can rest assured that
de Kruif will be in there fighting for person-
alized ministration by personal physicians.
There is not a dull moment in this whole
book and those of us who are interested in
the use of words as a means of communicating
the meaning of science to laymen, can learn much
from a study of this book.
Fundamentals of Otolaryngology, by Lawrence
R. Boies, M. D., ($6.50. W. B. Saunders, Phila-
delphia, Pennsylvania) , is a new text by the au-
thor and other members of the Staff at the Uni-
versity of Minnesota. It has presented the essen-
tials in a clear and understandable way. If you
have not refreshed yourself about the progress
in this field, it would be wise to avail yourself
of the chance to read this text.
Oral Bacterial Infection: Diagnosis and Treat-
ment, by Lyon P. Strean (Dental Items of Inter-
est Publishing Co., Inc., Brooklyn, New York),
is a well written text for medical and dental stu-
dents and for all who want up-to-date informa-
tion quickly. For this reason, the author has
paid an unusual amount of attention to his
index and the result is a thoroughly workable
manual. The author is a well known worker in
this field.
Hemorrhagic Disorders: A Guide to Diagnosis
and Treatment, by Paul M. Aggeler, M. D., and
S. P. Lucia, M. D., ($10.00. University of Chi-
cago Press, Chicago, Illinois) is a unique book
attempting to present in elaborate charts the
subject of abnormal bleeding in a way that we
can all understand. The pages of the text were
reproduced from an exhibit designed for use
in teaching at the University of California
Medical School. Consequently, the book is
streamlined. In our opinion, we need more
texts like this.
The Psychoanalytic Study of the Child, Volumes
III and IV ($10.00. International Universities
Press, Inc., New York City), contains nine
papers dealing with the problems of psychoan-
alytic theory and of child development; eleven
on clinical problems; two on guidance work; two
306
The Ohio State Medical Journal
on the problems of group psychology. These
are followed by a survey of the literature on
feeding problems of psychogenic origin and an
essay on a historical topic, i. e., Child Psychiatry
in 1830. In all, a worth-while book on the
status quo.
Marriages Are Not Made in Heaven, by Janet
Fowler Nelson (Woman’s Press, 600 Lexington
Avenue, New York City), is a manual on family
relations presented to the public after a thorough
trial by the committee of the Y. W. C. A. It is in-
tended to meet the need of the working girl.
Siam Doctor, by Jacques M. May ($2.75.
Doubleday & Company, New York City), is the
story of this man from October, 1932, to June,
1940, and his experiences in Siam.
Physiology of Thought, by Harold Bailey, M. D.,
($3.75. William-Frederick Press, New York
City), is designed to be a functional study of
the human mind in action. It presents pretty
largely the concepts of the author as they have
been built up without reference to others and,
therefore, tends to be dogmatic; however, the
approach is right. The book, therefore, deserves
critical reading.
Handbook of Medical Management, by Milton
Chatton, M. D., Sheldon Margen, M. D., and H. D.
Brainerd, M. D.., of the staff of the Medical School
of the University of California ($3.00. Univer-
sity Medical Publishers, P. O. Box 761, Palo
Alto, California) , is a 475-page manual of the
size to fit in the pocket of the House Officer —
a real pocketful of information arranged in the
most usable way.
Granulomatous Inflammation, by Wiley D.
Forbus, M. D., ($2.00. C. C. Thomas, Springfield,
Illinois), is publication number one in a series
of American Lectures. These beautiful little
books just by their format bring joy to your
reviewer’s heart. It is hoped that lectures by
equally as authoritative persons may come to
us instead of stuffy, overpadded books which
are that way because we have not found any
way to distribute these smaller and more effici-
ent books.
The Arthropathies, by Alfred A. deLorimier,
M. D., ($7.00. Second Edition. The Year Book
Publishers, Chicago, Illinois), comes six years
after the first edition. There are many new
photographs to make this handbook of Roentgen
Diagnosis worth while to all who see X-ray
pictures of sick joints.
Essentials of Obstetrical and Gynecological
Pathology, by Robert Faulkner, M. D., and
Marion Douglass, M. D., ($8.75. Second Edition.
C. V. Mosby Company, St. Louis), is welcome.
Two of our members of the Staff of the Western
Reserve University Faculty have assembled the
scattered information on pathology to be found
in the clinical literature of this field. There are
inany improvements in this edition. A good book
of reference for the house staff and for those
who are especially interested in the subject.
Birthday Book for the Fiftieth Birthday of
Professor Aarno Turunen, being Supplement
Three to Volume 38 of Annales Chirurgiae et
Gynaecologiae Fenniae. Six hundred pages of
gynecology as practiced in Finland. All done
in honor of a great physician and a great citizen.
Mobilization of the Human Body, by Harvey
E. Billig, Jr., M. D., and Evelyn Loewendahl,
M. A., ($2.00. Stanford University Press, Stan-
ford, California), presents newer concepts on
body mechanics. The work is timely as we
physicians are called upon more and more to
help adapt the human body to meet the demands
of the mechanization of even the simpler tasks.
Progress in Neurology and Psychiatry — An
Annual Review edited by E. A. Spiegel, M. D.,
($10.00. Volume IV. Grune & Stratton, Nevj
York City), is composed of nearly 600 pages of
contributions by a large number of distinguished
workers in the field. This gives a comprehensive
coverage of the year’s progress.
The Origin of Medical Terms, by Henry Alan
Skinner ($7.00. Williams & Wilkins, Baltimore,
Mai-yland) is an attempt by the professor of
anatomy at Western Reserve University to place
in our hands a general reference book of standard
medical terms, particularly those likely to be
encountered as one enters the study of medicine.
In our mixed language, there is room for a book
as well done as this one.
Chemotherapy of Leukemia and Leukosarcoma,
by William Dameshek and his associates at The
New England Medical Center ($4.75. Grune &
Stratton, New York City), is a beautiful re-
production of an exhibit at the American Medi-
cal Association Convention in June, 1949. This
new method of presenting teaching material is
worthy of much recommendation, especially in
these days of LOOK and LIFE level of literacy.
Atlas of Drawing for Chordate Anatomy, by
Samuel Eddy, Professor of Zoology, University
of Minnesota ($3.50. John Wiley & Sons, Inc.,
New York City), is a book of unlabeled draw-
ings of the structures of animals commonly
studied in comparative anatomy. In 1915, your
reviewer introduced the idea of an illustrated
notebook in pathology based upon the same prin-
ciple that has governed the production of this
book, i. e., the average student will spend more
time making mediocre drawings than the results
will justify.
Dental Roentgenology, by LeRoy M. Ennis,
D. D. S. ($10.00. Lea & Febiger, Philadelphia),
makes every effort to correlate the radiograph
with the pathology by giving an explanation of
each.
for April, 1950
307
THE CINCINNATI SANITARIUM
Established 187 3
A PRIVATE HOSPITAL for NERVOUS and MENTAL DISORDERS
D. A. JOHNSTON, M. D., Medical Director W. N. WRIGHT, M. D., Resident Psychiatrist
EMERSON A. NORTH, M. D., and CHARLES KIELY, M. D., Visiting Consultants
HENRY GRUENER, M. D., Resident Physician ELLIOTT OTTE, Business Manager
FOR TERMS APPLY TO THE CINCINNATI SANITARIUM, college hill, CINCINNATI 24, ohio
Licensed by State of
Ohio.
Approved by Amer-
ican College of
Surgeons.
Member —
American Hospital
Association.
Ohio Hospital
Association.
Central Psychiatric
Hosp. Assoc.
TELEPHONE
KIRBY 0135
KIRBY 0106
THE McMILLEN SANITARIUM
COLUMBUS, OHIO
An Active Treatment Hospital
For All Nervous and Mental Disorders including Alcoholism and Drug Addiction
50 Years Continuous Operation
ROBERT A. KIDD, M. D.,
Senior Psychiatrist
SHOCK THERAPY
Consulting Psychiatrists
! NICHOLAS MICHAEL, M. D.
LAWRENCE TURTON, M. D.
HERBERT L. PARISER, M. D.
MILTON PARKER, M. D.
ROBERT S. DARROW, M. D.,
Clinical Director
Telephone: Fa. 1315
308
The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association, a scientific society, non-profit corporation, with a definite
membership, for scientific and educational purposes.
Vol. 46 April, 1950 No. 4
Jonathan Forman, M. D., Editor
Charles S. Nelson,
Managing Editor — Bus. Mgr.
R. Gordon Moore,
Asst. Managing Editor
Arterial Infusion*
DONALD E. HALE, M. D.
The Author
• Dr. Hale, Cleveland, Ohio, is a, graduate of
University of Pennsylvania School of Medicine,
Philadelphia, 1929; fellow, American College
of Surgeons'; memher, American Society of
Anesthetists, Inc.; and head. Department of
Anesthesiology, Cleveland Clinic Hospital.
ARTERIAL infusion is the injection of blood
r-\ or other fluid under controlled pressure into
^an artery. The needle, or cannula, is di-
rected toward the heart so that the fluid passes
up the artery to the aorta instead of in the
ordinary peripheral direction. The fluid injected
should be blood, but in a grave emergency
saline or glucose solutions may be used and are
quite effective for short periods of time. The
procedure is most clearly indicated in severe
cardiovascular collapse as the result of hemor-
rhage.
Arterial infusion performs two vital functions.
The first is that of supplying blood or other
fluid to the patient’s cardiovascular system.
This can also be accomplished by the intravenous
administration of fluids. The second, and more
important, is the building up immediately of
sufficient pressure in the aorta so that blood
flow to the coronary and cerebral arteries is
reestablished. The intravenous route is satis-
factory in patients who have a systolic blood
pressure as low as 50 mm. of mercury inasmuch
as fluid infused into the vein is in the arterial
circulation a few seconds later. But in individuals
in whom there is cardiac arrest or greatly
diminished cardiac output, with indiscernible
pulse and absence of blood pressure, arterial in-
fusion affords a means of taking over temporarily
the function of the heart by supplying blood to
the aorta and thence immediately to the myo-
cardium and the brain.
APPARATUS
The apparatus consists essentially of a Kelly
flask containing the fluid to be administered, the
* Part VI of a Symposium on “Acute Cardiorespiratory
Failure : Requirements for Successful Resuscitation,”
presented at the Annual Meeting of the Ohio State Medical
Association, Columbus, April 19-22, 1949.
means of applying a measured pressure to the
air over the fluid and a tube which delivers the
fluid from the flask to the artery. The mouth of
the Kelly flask is fitted with a rubber stopper
through which a short glass tube connects by
means of a rubber tube to a hand pressure bulb
and aneroid manometer. The commercial blood
flasks which are now generally available can
be adapted to this use by simple modifications.
The small-mouthed commercial flask is modified
by removing the ball valve and replacing it with
a glass tube which reaches from the neck of the
flask to within 1 cm. of the bottom. The wide-
mouthed flask is already equipped with such
a glass tube. In either case, * the pressure is
applied through this glass tube to the volume
of air over the solution. The commercially
available disposable plastic tubing may leak if
pressures of 200 to 300 mm. of mercury are ap-
plied and should, therefore, either be ligated in
place or should be replaced with a rubber tube.
The rubber tube, when used, should have a
fairly thick wall with a small lumen and should
terminate in an adaptor which will fit a 15
gauge needle or cannula.
An ordinary Murphy drip may be interposed
in this tube although it should be pointed out
317
that a danger of this arrangement is the pos-
sibility of forcing small bubbles of air down
through the delivery tube and so into the patient’s
artery. Small quantities of air are ordinarily
well borne by the patient when given intravascu-
larly but in a patient with absent blood pressure
to whom blood is administered rapidly, small air
emboli may be carried up into the aorta and
thence into a coronary or carotid artery with,
perhaps, serious consequences. A Murphy drip
with a bent tip which delivers its stream toward
the side of this apparatus may help to prevent
this occurrence. An even better device is a
modification of the Murphy drip which is manu-
factured in England.* This contains a glass float,
the tip of which is ground to fit the bottom of the
Murphy drip so that with the last of the fluid
the Murphy drip is sealed and no air can enter
the artery. It should be clearly pointed out that
the danger of massive air embolism with the ap-
paratus described is a real possibility and every
precaution should be taken to prevent this oc-
currence.
Another modification of the equipment consists
of a 10 or 20 cc. syringe fitted either with a
double valve or a three-way stopcock. The blood
or fluid is led to the valve or stopcock and is
then conducted by another tube to the artery.
If the syringe becomes sticky and begins to bind
in use it may be replaced by a clean one, or the
plunger of the syringe may be covered by a
loosely fitting Penrose drain, containing a small
quantity of citrate or heparin solution. This
Penrose drain is secured by a silk ligature around
the syringe barrel and also around the neck of
the plunger. This prevents drying and contami-
nation of the plunger, and the solution affords
adequate lubrication. Massive air embolism is
much less likely with the use of this apparatus.
TECHNIQUE
Arterial infusions may be administered
through any available artery. The femoral
artery may be used if it has a pulse which per-
mits accurate identification of its position. The
aorta, when it is present in the operative field,
whether in the chest or abdomen, may be the
site of the needle puncture. The radial artery
is ordinarily employed because of its ready acces-
sibility, its fairly superficial, long, straight course
in the wrist, and because it can ordinarily be
sacrificed without danger at the end of the
procedure. The apparatus is set up, the tubing
is filled with the fluid to be used and the tubing
clamped near the needle or cannula. The artery
is isolated and opened by means of a small in-
cision. The cannula is inserted and secured in
place by means of a ligature. The pressure
above the fluid is now adjusted so that it is
between 100 and 300 mm. of mercury. The
clamp is removed and the fluid allowed to flow.
* Macintosh drip, A. Charles King Co., Ltd., London.
The blood pressure of the patient is checked
frequently either by the conventional means of
stethoscope and inflatable cuff or by reducing the
pressure over the fluid until it just stops flow-
ing. At this point, if the meniscus of the fluid
is level with the patient’s heart the reading on
the manometer dial gives an accurate reading of
the radial systolic pressure.
Inasmuch as the procedure attempts to re-
place the action of the heart temporarily it is
safe to start the infusion of fluid at a pressure
of 300 mm. of mercury. It may be desirable to
use a smaller pressure in arteriosclerotic in-
dividuals. The pressure should be reduced as
soon as a reasonable blood pressure has been
established and at this point the infusion should
be continued slowly at a pressure which is only
10 to 20 mm. of mercury above that of the pa-
tient. Even though fluids are being administered
intravenously at the same time it is well to leave
the cannula in place until the blood pressure has
been reestablished and has reached equilibrium
at a safe level. At the conclusion of the infusion
the radial artery may be ligated and the incision
closed. It is not too difficult a matter, however,
to resuture the incision in the artery using 7-0
silk on an atraumatic needle. If resuture of
the artery is contemplated, the longitudinal in-
cision is the one of choice.
RESULTS
It has been demonstrated experimentally that
opaque medium injected into the brachial artery
of a dog will reach the coronary and carotid
arteries almost immediately. In one such ex-
periment the blood pressure was reduced to 20
mm. of mercury, whereupon 12 cc. of radio-
opaque medium was injected into the brachial
artery. An X-ray taken five seconds after the
beginning of the injection demonstrated clearly
a satisfactory filling of both coronary arteries,
both carotids and vertebrals and all of the
major cerebral vessels. In another experiment,
cardiac activity following two minutes of com-
plete cardiac and respiratory arrest following
blood letting was reestablished by means of
arterial infusion alone.
PRECAUTIONS
It is important, of course, that the blood
given by this method be cross-matched with
that of the patient whenever possible. Although,
in an emergency, type O blood with an agglutinin
titre less than 1 to 64 may be used with safety.
It should be emphasized that the greatest care
must be exercised in the intravascular injection
of fluids under air pressure in order to avoid the
danger of massive air embolism.
CONCLUSION
Arterial infusion affords a valuable emergency
means of reestablishing coronary and carotid
circulation in severe hemorrhagic hypotension.
318
The Ohio State Medical Journal
Sinusitis Due to Bacterial Allergy: Identified by Tissue
Culture and Treated by Specific Desensitization
HERMANN BLATT, M.D., and FRANK A. NANTZ, M.D.
The Authors
O Dr. Blatt, Cincinnati, Ohio, is a graduate
of University of Berlin, 1934; associate fellow,
American College of Allergists; and member
of staff, Jewish Hospital, Cincinnati.
O Dr. Nantz, Cincinnati, Ohio, is a graduate
of University of Cincinnati College of Medi-
cine, 1936; diplomate, American Board of
Ophthalmology; associate fellow, American
College of Allergists; member of staff, Jewish
Hospital and Children’s Hospital, Cincinnati.
CHRONIC sinusitis cases which presented an
obscure etiology or failed to respond to
standard treatments were tested for hyper-
sensitivity to bacteria. Approximately 78 per
cent of those tested were found positive to two
or three strains of bacteria and were given a
course of desensitization. Nearly all of these
responded well (see below).
Because the theoretical basis for testing and
treating these patients for bacterial hypersen-
sitivity had not as yet been fully established,
we were frankly very skeptical at first about
undertaking this program. The patients, how-
ever, having suffered so long from sinusitis,
were willing to “subject themselves” to any
experiment. Now, with almost two years of re-
markably successful experience treating these
cases in this manner, we feel we should com-
municate our experiences in the hope of stimu-
lating further investigations along these lines.
DISTINCTIVE CHARACTERISTICS OF SINUSITIS
DUE TO BACTERIAL HYPERSENSITIVITY
(1) Virtually all these patients said in their
histories that their first attacks followed fall and
winter colds, and were accompanied by a low
grade temperature. These attacks had then be-
come increasingly more frequent, until the pa-
tient suffered from almost constant attacks of
sinusitis even though in the fall and winter
months or on damp days their symptoms were
more marked.
(2) On examination these patients taken as
a whole, had thick yellowish postnasal drips, their
nasal turbinates were markedly congested, not
necessarily livid, and on transillumination, there
was some haziness of the frontal sinuses. Nasal
smears did not necessarily show marked
eosinophilia, in contrast to pollen types of nasal
conditions, such as allergic rhinitis.
(3) All cases were excluded to pollen sensitivity
by skin tests. Many, on the other hand, showed
positive reactions to skin tests for dust. Their
bacterial hypersensitivity findings, however, be-
ing in all cases so marked, it was decided to
desensitize to the bacteria first. In the end, in
fact, after we began our tissue culture studies,
none were ever desensitized to dust, because
their conditions improved sufficiently on a pro-
gram of densenitization to bacteria alone.
(4) All cases had previously been treated for
their sinus conditions over long periods of time,
but had failed to respond to the treatments
Submitted August 8, 1949.
given. According to their histories, they had
been given such therapy as: Commercial stock
respiratory vaccines, antibiotics, antihistaminics,
frequent washings of the sinuses, infra red, and
vitamins. It was interesting to note that in
contrast to other forms of allergic nasal condi-
tions, antihistaminics had given no relief what-
soever.
(5) All these cases at the present moment
are markedly improved. Some of them have
been under treatment for as long as two years.
In consequence, we feel fairly confident that
their improvement is reasonably stable, at least
as long as the maintenance program is carried
out. They all no longer get repeated attacks
of colds in winter. If they do happen to get
a single attack, it is much less severe and of
shorter duration. Most of them no longer have
any postnasal drip and in those that do, the
character has changed to a thin, clear type.
DIFFICULTIES OF THIS TREATMENT
The disadvantages of this method of approach
are that the course of desensitizing is long
drawn out; many patients, when improved, dis-
continue treatments before the end of their
program of desensitization. All patients, at some
time in their early course of treatment, get
focal flare-ups, which discourages some. Clini-
cal signs of improvement, furthermore, are sel-
dom seen before four months’ treatment, so that
it is hard to convince some patients of the
efficacy of this program.
From the physician’s point of view, the dis-
advantage lies in the fact that filtrates can
contain no preservative, since even minute
amounts of preservatives affect the antigens.
This increases the danger of contamination and
for April, 1950
319
frequent sterility tests must be run, so as not
to endanger the patient. Furthermore, a separate
tuberculin syringe must be used for each pa-
tient, and after each use the syringes must be
flushed in triple distilled water. The pyrogens in
double distilled water seem to affect the antigens.
COMMON CHARACTERISTICS OP ALL CASES OF
BACTERIAL HYPERSENSITIVITY
Despite the almost unbelievable number of
different symptoms manifested by people suffer-
ing from hypersensitivity to some one or an-
other strain, there are nonetheless certain char-
acteristics common to all.
(1) Antihistaminic drugs have no, or a
negligable ameliorating effect.
(2) When a patient is positive to one strain
of bacteria, he is invariably sensitive to two or
three others.
(3) The strains to which a patient is posi-
tive are frequently unrelated in a serological
sense. The studies we have done thus far seem
to indicate that the colony form is of more im-
portance.
(4) At some time during the course of desen-
sitization, most patients have some form of mild,
short reaction. Usually there is only one, if the
dosages given are not too large or too strong.
The reaction for any given individual is always
of the same type, regardless of its duration.
(5) These reactions can be induced at will
by raising the strength or the amount of dosage.
In fact, all the original symptoms of the dis-
ease can be reproduced at will at any time,
merely by giving a sufficiently large dose of the
filtrate.
(6) Many patients are never able to tolerate
high dilutions such as 1:10 or full strength.
These should be maintained on dilutions of 1:100
or even 1:1000.
(7) In cases of chronic sinusitis, as well as
other types of bacterial hypersensitivity, we
found that though we took nose and throat cul-
tures in 80 per cent of the cases during an
acute phase and before any therapy had been
started, the tests were never as markedly posi-
tive with the autogenous material as with our
stock filtrates. There was a correlation only
in the sense that the throat cultures would
frequently show organisms related to the ones to
which the patient was positive. The few cases
treated with autogenous filtrates did not re-
spond as well as those treated with stock filtrates.
PROCEDURE FOR MAKING TISSUE CULTURE
SURVEY
Each patient initially is tested on three dif-
ferent occasions to about 100 bacterial filtrates.
Only those patients who come down consistently
positive to the same strains on each occasion
can be termed positive, because of the possibility
of error in reading the slides and the possibility
of false serological reactions.
For each test 9 cc blood are drawn and
poured into 1 cc of 2 per cent sodium citrate solu-
tion. The white cells are separated out and a cell
suspension made in Ringer’s solution.
To test for hypersensitivity to a particular
strain of bacteria, one drop of filtrate, one drop
of the cell suspension, and one drop of full
strength thrombin are put together on an ordi-
nary glass slide and incubated for 18 hours.
At the end of this time, if the patient’s
leucocytes are positively hypersensitive, the cells
have become necrotic, crenated and stippled. If
not hypersensitive, they have remained viable.
This procedure has been described in detail in
the Annals of Allergy1- 2 and other articles still
in publication.
PROCEDURE FOR DESENSITIZATION PROGRAM
To desensitize a patient, we use the same
filtrate to which he was positive. We prepare
dilutions starting with 1:1,000,000 and increasing
the concentrations to 1:100,000, 1:10,000, 1:1,000,
1:100 and sometimes 1:10 and even full strength.
First we skin test the patient to 1/20 cc of the
one to a million dilution. The subcutaneous inoc-
culations are increased by 0.1 cc every three or
four days, so long as there are no reactions. If
a reaction occurs, the dose is repeated until it
is well tolerated.
When the patient is down to 1:100 dilution,
or if he gets reactions and tolerates only 1:1,000,
his tissue culture is repeated for the bacteria to
which he was originally hypersensitive. If the
desensitization program is responsible for his
improvement, his tissue culture will now be nega-
tive or only slightly necrotic.
The following five cases are typical examples
of sinusitis due to bacterial allergy and their
response to treatment.
TYPICAL CHRONIC SINUSITIS WITH FLARE-UPS
AND SECONDARY CHEST INFECTIONS
C. K. B., male, age 32, eleven-year history of
upper respiratory attacks. Each of his frequent
bad colds was followed by a sinus flare-up so
bad the entire face hurt. His entire chest filled
up, he frequently sneezed explosively, had some
discharge from his nose, but was bothered more
by a thick postnasal drip. He said at first these
attacks came only in winter but now came all
year round. His past history was not remarkable
except that in 1942 he had supposedly had an
attack of bronchitis associated with pleurisy.
First seen June 5, 1948, during an attack.
Temperature was 102 F. Frontal sinuses and
both antra showed marked haziness to trans-
illumination. Nasal passages were edematous and
livid with a thick postnasal drip. X-ray of chest
showed increased hilar markings. The white
count was 12,800, polys 73 per cent, eosinophiles
2 per cent. Urine was negative. Serology nega-
tive. Nasal smear showed one eosinophile on
the entire slide, many bacteria. The throat cul-
tured showed staphylococci.
The diagnosis at the time was acute pansinu-
sitis, with possible bronchitis. After the attack
had subsided, tissue culture surveys were made on
320
The Ohio State Medical Journal
three different successive days to approximately
100 different bacterial strains. He came down con-
sistently positive to Strains 6011, 9882, 1039 and
1313, i.e., two strains of Group A hemolytic
streptococci, one staph aureus and one staphy-
lococcus albus strain.
He was put on a program of desensitization
to these strains. When the dose was stepped
up from 1:1,000,000 concentration to 1:100,000
he got a mild flare-up. He had a second flare-up
when changed to 1:1,000 dilution. Eventually
he was able to tolerate a dose of 1 cc. of full
strength dilution.
On July 30, 1949, he was reexamined. At this
time his general physical condition was improved.
“He felt better, wonderful.” This was the first
winter in years that he had had no colds and no
sinus condition. The chest findings were nega-
tive. The nose was no longer edematous or
livid. The nasal smear showed no eosinophiles.
He was retested for hypersensitivity but was
found negative to all bacterial to which he had
originally been positive. Nevertheless, as a pre-
caution, he is being maintained on injections
of full strength dilution once a week.
CASE TREATED BY VACCINES, ANTIHISTAMINICS
AND BACTERIAL FILTRATES
M. C., female, age 44, reported a history of re-
current attacks of sinusitis for years, frequently
associated with a temperature of 101-2° F. The
attacks in the last two years had become so
severe she had had to go to bed and give up
working. She did not remember whether the
attacks had originally started in winter but they
were then all year round. When she was younger
she had had frequent sore throats. In 1944 she
had had pneumonia followed by pleurisy. No
history of any allergies.
When seen October 1944, her nasal turbinates
were very livid, and so markedly congested
that she could hardly breathe through them.
Her temperature was 100. She had a thick,
yellow postnasal drip. The chest X-ray showed
some parenchymatous infiltration and a pleuritic
thickening along the right border of the cardiac
shadow, apparently the result of chronic pleurisy.
The rest of the parenchyma was clear. Dia-
phragmatic excursions on fluroscopy were not
impaired. The chest was clear to auscultation
and percussion. Her nose and throat cultures
showed: Hemolytic streptococcus, non-hemolytic
streptococcus, green streptococcus, staphylococcus
albus, hemolytic staphylococcus aureus, staphy-
lococcus citrus. The white count was 5,600 dif-
ferential: Polymorphonuclear neutrophiles 58,
lymphocytes 34, large mononuclears 6, eosino-
philes 2.
At the time this patient first came to us
we had not yet begun our tissue culture studies
for bacterial hypersensitivity. In consequence,
we naturally gave the patient skin tests for
cereals, epidermals, molds, grass pollens, ' tree
pollens, cottonseed, flaxseed, dust (stock and from
home), kapok, orris root, pyrethum, and tobacco.
With the exception of a marked positive re-
action to both forms of house dust, she was
negative to all. She received a desensitization
program with dust and autogenous vaccine, with
no results. When the antihistaminics appeared,
she was given a trial therapy with benadryl and
later pyribenzamine, again with no results.
By December, 1947, we were satisfied enough
by our findings to survey her for bacterial hyper-
sensitivity to all the strains we had at that
time. On four successive occasions she came
down consistently positive to two strains of
Group A hemolytic streptococci. A program of
desensitization was begun. At first she got such
marked focal flare-ups after each injection that
she quit coming, and had to be convinced to re-
sume treatments.
By the fall of 1948 the patient was almost
asymptomatic. On January 25, 1949, she had
a slight cold and a very mild sinus attack. Since
then she has been entirely free of any colds or
sinus flare-ups. Her tissue culture survey, re-
peated March 3, 1949, was entirely negative. As
of June, 1949- she still has a slight postnasal
drip, but it was of a thin, clear character. Her
turbinates were no longer edematous or livid.
She is being maintained once a week on a full
strength dilution.
SEVERAL FLARE-UPS DURING DESENSITIZATION
W. R., male, age 30, had had recurrent attacks
of sinusitis for years. These originally came only
in winter, but now were all year round. They
were accompanied by frontal headaches, a bor-
ing sensation in the eyes, ocular vertigo and a
feeling of pressure in the ears. He “wheezed”
at times whenever the attack was associated with
general upper respiratory infections. The rest
of his medical history was not remarkable. He
had no allergies.
On July 22, 1947, there was a cloudiness of the
right frontal sinus on transillumination. This
was later confirmed by X-ray. The nasal tur-
binates were congested. The pharynx was angry-
red. He had a very thick yellowish postnasal
drip. The ear drums showed a poor light re-
flex, the hearing, however, was normal. There
was pressure tenderness over both foramens
supraorbitalis.
The patient made roughened breath sounds.
The X-ray of the chest showed some increased
hilar markings. Red blood count was normal, white
count (taken during an acute attack) was 13,550,
polymorphonuclear seg. 70, polymorphonuclear
non seg. 6, lymphs 25, eosinophiles 4, monocytes
2. The urine was negative. The corrected sedi-
mentation rate was 10. The nasal smear showed
no eosinophiles. Skin tests to pollens proved
negative, but to dust slightly positive.
Tissue culture surveys were done on three dif-
ferent occasions. He was found positive each time
to two Group A hemolytic streptococci and
one mold. (Skin tests to molds had all been
negative.)
He was put on a program of desensitization
with these filtrates. Two hours after being
given 0.4 cc of the 1:1,000,000 dilution, he had
a marked focal flare-up; his nose was congested;
he had a sinus headache and a slight temper-
ature. The same dose had to be repeated five
times. Each time until the last time, the reac-
tion occurred in the same manner. When the
patient received 0.4 cc of 1:100,000 dilution,
the same phenomena occurred and the dose had
to be repeated twice. When the patient re-
ceived 0.1 cc of 1:1,000 dilution, he had a
slight reaction. After that he had no more.
On February 25, 1949, his examination showed
no postnasal drip. His chest was clear and the
patient stated it was the first time in years
that he had had no sinus flare-ups during the
winter. He was at that time on 0.5 cc of
1:100 dilution.
May, 1949, the patient refused further treat-
ment. He claimed he had been free of attacks
for months and could not see the rationale of
continuing treatments without any symptoms.
for April, 1950
321
FIRST INJECTIONS FOLLOWED BY FLARE-UPS
B. S., female, age 22, gave a history of re-
current attacks of sinusitis since the age of 16.
These were often followed by bronchitis, asso-
ciated with fever and a loss of weight. No
wheezing. The balance of the history was not
remarkable. She had had no atopic allergies,
however, the sister had hay fever and asthma
and the mother had hay fever and migraine
headaches.
On September 27, 1946, her left frontal sinus
was cloudy. The nasal turbinates were markedly
congested, not livid in color. She had a thick
yellowish postnasal drip,' and her pharynx was red
and angry looking. Serology negative. Complete
blood count normal (no eosinophiles). Urine neg-
ative. The sputum was negative for acid fast. The
nasal smear showed no eosinophiles. X-ray of
the chest was negative. Other physical find-
ings were all negative. The nose culture revealed
staphylococcus aureus in pure culture. The
throat had streptococcus viridans and staphylo-
coccus aureus. She was negative to all skin
tests.
She was treated with autogenuous material
with no results. Her sinus attacks became more
frequent and during the winter of 1947 she had
two fairly severe attacks of bronchitis following
sinus attacks. Antihistaminics gave no relief.
In the fall of 1947 tissue culture studies were
done on three successive occasions. She was
positive on each occasion to one Group A
hemolytic streptococcus and one staphylococcus
aureus strain. No tissue culture study was
made using autogenous material. It may be
possible that the staphylococcus aureus strain
found in her throat was the same as that found
in the tissue culture studies.
A program of desensitization was begun. In
the beginning she got marked flare-ups a few
hours after her injection so that she had to be
kept on the minimal dose of 0.1 cc of 1:1,000,000
dilution for quite a while. After several injec-
tions with this dose the flare-ups disappeared
and her condition became steadily better.
January, 1949, her tissue culture survey was
repeated and she was found negative to all
bacteria. June, 1949, she was reexamined. She
had had no attacks for months and her physical
findings were entirely negative. She, however,
still did not tolerate full strength filtrate (her
arm gets red and sore) and so is maintained on
1:10 dilution.
PICTURE OBSCURE BECAUSE OF MECHANICAL
OBSTRUCTION
G. B., male, age 41, had a history sinusitis for
the past eight years. His first attacks had come
in winter, but now were all year round on
damp or rainy days. The attacks had become
so severe that the patient was often incapacitated
from work and had to go to bed. When having
attacks, the coffee beans (where he worked)
made them worse. Location did not seem to
play a role for he had tried other climates
with no result. The only factor which seemed
to affect him was the weather. Food, drugs,
temperature, smoke and excitement all seemed
to play no role. The attacks were not associated
with sneezing and relief following them was
complete. He had a thick nasal discharge dur-
ing attacks and severe frontal headaches,
frequently nausea. He had no history of atopic
allergies but had had active tuberculosis 14
years before. When 15 he had broken his nose.
November 16, 1948, his sinuses were slightly
hazy to transillumination, the septum markedly
deviated to the left. The nose was so flattened
that almost no air could pass through the left
nasal nare. The nasal turbinates on both sides
were markedly congested and very livid. The
pharynx was slightly reddened and there was a
thick postnasal drip. The larnyx was negative.
All other physical findings were essentially
negative. The complete blood count was within
normal limits, eosinophiles 2 per cent. The
urine was negative, the serology negative. The
X-ray of the chest showed an apparently
healed tuberculous lesion. The corrected sedi-
mentation rate was 8. The nasal smear showed
many pus cells and one eosinophile cell on the
entire slide.
The patient was skin-tested to the pollens,
epidermals, dust (stock and from home and
place of work), kapok, orris root, pyrethrum,
tobacco and coffee. He was positive to dust
and kapok. All other tests were negative.
Tissue culture surveys were made on three
different occasions. He came down positive, each
time to a Group A hemolytic strep, strain and
type 7 Pneumococcus. He was negative to
autogenous material from his nose and throat.
It was our belief, however, that no therapeutic
result could be obtained without his mechanical
obstruction being attended to first. He was
advised to submit to surgery. This he refused
to do, so he was experimentally put on a pro-
gram of desensitization with the filtrates to
which he had been found positive. He got a
mild focal reaction on his first dose and when
he started with the 1:100,000 and 1:10,000 dilu-
tions.
Since April 1949 the patient has had no com-
plaints and no sinus attacks. The yellowish
discharge has disappeared entirely, and the tur-
binates are no longer congested. Of course the
obstruction persists, and we doubt whether he
can breathe much through the left nostril, but
he insists he is more comfortable than he has
been in years. His last examination was August
6, 1949.
CONCLUSION
The above cases amply illustrate the type of
cases that are suitable for this method of ap-
proach and can be expected to respond to treat-
ment by desensitization.
What we cannot say as yet is how long the
desensitization program must be continued for
permanent results. In all our cases where we
have discharged the patient, we are repeating
their tissue culture survey every six months to
determine whether they have again become
hypersensitive. So far none have, but this is
inconclusive because sufficient time has not yet
elapsed.
There have been some investigators who
maintained that when bacterial hypersensitivity
was present in chronic sinusitis cases, it was on
a secondary basis. This contention is no longer
tenable as proved by cases such as these, where
the symptoms disappeared completely when
treated solely by bacterial desensitization.
BIBLIOGRAPHY
1. Nantz, F. A., and Blatt, H. : Ann. Allergy, 5:554,
1947.
2. Blatt, H., Nantz, F. A., and Rehm, Jeanne M. : Ann.
Allergy, 7:170, 1949.
322
The Ohio State Medical Journal
Psychiatric Aspects of Medicine
KENNETH E. APPEL, M.D.
The Author
• Dr. Appel, Philadelphia, Pennsylvania, is
a graduate of Harvard Medical School, 1924;
member, American Board of Psychiatry and
Neurology; director of Clinic for Functional
Diseases, Hospital of University of Pennsyl-
vania; and prof, of psychiatry, Medical School,
University of Pennsylvania.
THE triumphs of modern medicine are based
chiefly on the vision and pioneering work
of Lavoisier, Virchow, Pasteur, and their
successors — on chemistry, physiology, cellular
pathology and bacteriology. The body has been
conceived of as a machine built of cells and
differentiated cells grouped as organs. Dam-
age to cells impaired function, and symptoms
and disease resulted. Medicine has been pre-
occupied, as science in general, with things seen,
felt, heard and touched. With technological
refinements, measurements and quantities have
been emphasied. Laboratory medicine has in-
creased our penetration into the mysteries of
disease and immeasurably enhanced our ther-
apeutic techniques and effectiveness.
However, man, the biological organism con-
sidered merely as a series of organs or systems
functioning according to certain chemical and
physiological principles of organization, leaves out
of account certain factors of activation and in-
tegration that must be considered if we are to
understand behavior more adequately. There
are certain drives, urges or motivations, which
appear as activities of the total organism func-
tioning as a unit, not as a function of any parti-
cular set of organs or systems. These forces
which drive and motivate us, subjectively per-
ceived, are the emotions — and the three basic
feelings are love, hate and fear. The life of
the individual personality consists in express-
ing and satisfying these urges or forces in ac-
cordance with one’s social training or condition-
ing, which appears as another guiding system
within us in the form of conscience and ideals.
Conflicts between the instinctive-emotional forces
and the social forces produce stresses or ten-
sions. The expression of these tensions whether
in the physiology, the thought processes or in
overt social behavior is the province of psy-
chiatric study.
Freud spoke of the area of the emotional forces
as the id, and that of the social forces as the
super-ego. The ego may be thought of as
the conscious, perceptive, intellectual functions
which help in the conscious adjustment to the
environment. This division of the personality
into three guiding sets of functions is helpful
from the point of view of the etiology of so-
called psychiatric disorders and also for ther-
apy. If the chief sources of tensions are con-
flicts between the feelings and social training
Presented before the General Session of the Annual Meet-
ing of the Ohio State Medical Association, Columbus, April
19-22, 1949.
(the guiding principles, attitudes or expecta-
tions absorbed unwittingly from our parents in
the early years of life), then these tensions arise
automatically, involuntarily or unconsciously,
as the result of forces within us. The tensions
(or symptoms) are not deliberately willed by
our conscious reasoning. Therefore, the area
of responsibility is markedly limited, and blam-
ing the patient, reasoning and arguing with him
have little effect therapeutically. The areas of
primary disturbance is not in the intellect and
ideas, but in the feelings.
PHYSIOLOGY AND PSYCHIATRY
Modern psychiatry rests to a great extent on
the work of three men: Cannon, Pavlov, Freud.
The importance of the emotions and their effect
on the physiology of the organism was bril-
liantly elucidated by Walter Cannon. The organ-
ization of responses and the conditions of learn-
ing were ingeniously worked out by Pavlov in
his studies on the conditioned reflex. The effects
of conditioning or training, both parental and
social, on the development of the human per-
sonality were the contribution of Freud. In
therapy one studies the origin, development and
effects of emotional relationships to people, the
exaggerations, displacements, ramifications, and
handicaps of intense emotions, the defenses
against them, and one tries to release the pa-
tient from their crippling effects.
Cannon really formed the bridge between
physiology, medicine and psychiatry. He showed
that emotions disturb the physiology in definite,
measurable ways. Psychiatry is studying the
effect not of transitory emotions, but the effect
of intense, persistent, chronic emotions which
disturb not only the physiological homeostasis,
but the intellectual and behavioral equilibrium
of the individual. Persistent, intense emotions
certainly produce symptoms, probably some medi-
cal diseases, delay healing, prolong convales-
for April , 1950
323
cence in medical conditions, and certainly cause
well-definied psychiatric disorders. Feelings,
emotions, drives, with their associated impulses,
thoughts, phantasies, influence the function of
the body in certain types of illness. The changes
produced, the dysfunctions, are in some in-
stances the disease. Thus psychiatry deals pri-
marily with feelings, which are tension or
energies seeking outlet.
PSYCHIATRIC TERMINOLOGY
Psychiatric terminology and classification are
needlessly difficult and esoteric. Their semantics
create mystery. They can and should develop a
homespun terminology. A psychoneurosis is an
emotional condition which interferes with ef-
fectiveness, satisfaction and happiness. A psy-
chosis is an emotional condition of an in-
tensity which makes it impossible to work and
get along with others. In psychoneurosis the
Social Forces in the personality have difficulty
in controlling the emotional intensities. In psy-
chosis the Emotional Forces — the savage brute
instinctive forces — overwhelm the Social Forces.
The chief areas of manifestation or outlet for
the emotional forces can be used as a basis
of practical classification. Physiological tension
states can adequately include hysteria, neur-
asthenia, and psychosomatic conditions. Hyper-
emotional tension states include anxiety states,
manic-depressive conditions and involutional
states. Distorted emotional tension states, where
emotions are inappropriate, distorted, misplaced,
projected, comprehend the schizophrenias.
Oppressive-sensitive tension states include the
paranoid conditions, where people are easily
hurt, feel imposed on, are jealous, misinterpret
aggression, feel persecuted. Obsessive-phobic
tension states include those conditons where
repetitive processes predominate, where there
are substitutions and displacements, reaction
formations, compulsions, rituals and phobias.
Tension states with organic disease include the
confusions due to physical disease. Sociological
tension states include the tension states asso-
ciated with difficulties in social conformity.
Psychopathic personality belongs here; also delin-
quency in children. Effort or adjustment ten-
sion states comprehend the character neuroses
where the personality does not have adequate
resources to meet problems and situations ef-
fectively— for example, the passive, dependent
personality or the chronic aggressive personality.
Situational tension states include tensions re-
active to unusually difficult or trying environ-
mental stresses. The use of such a terminology
indicates the practical down-to-earth basic na-
ture of psychiatry, helps to make its concepts
understandable to the man in the street and to
one’s medical colleagues, and helps dissipate
much of the mystery and fear that attaches
needlessly to psychiatry as a result of its dif-
ficult and Greek terminology.
THE CAUSES OF DISEASE
Medicine broadly is the study of the nature
of disease and its treatment. Disease is dis-
ease, disability, disorder, dysfunction — whether
in the body or mind or in their inter-relations.
The causes of disease in medicine and surgery
are: heredity, defective structure or develop-
ment, physical-chemical-toxic agents, trauma,
infection, exhaustion, tumor or degeneration. In
psychiatry etiological factors are: situations,
stresses, experiences, disordered personalities,
difficulties in inter-personal relationships, feel-
ings or emotions.
Emotions can (functionally and sometimes
structionally or psychosomatically) disorganize,
dissociate, disintegrate bodily function with
trembling, in-coordination, hyperactivity, weak-
ness, paralysis and pain. Emotions can disor-
ganize activity of the mind or personality with
excessive, persistent anxiety and fear; resent-
ment or hostility, discouragement and depres-
sion; suspicion, jealousy and hate; dependency,
lack of initiative and apathy; and amnesias,
delusions and hallucinations.
One of the difficulties with psychiatry, one of
its handicaps, is that emotions can cause the
same symptoms and disorders as physical, medi-
cal, structural disease — as infection, tumor,
trauma or degenerative disease. Doctors have
been trained to look for what they can touch,
see, hear, weigh and measure. They have often
overlooked factors just as real — the feelings,
desires, personal relationships or social feelings,
which can be apprehended not by the five senses
but by understanding. Thus often doctors have
attributed pains, weakness, heart discomforts,
worry about ulcers, cancer and brain tumors,
to the imagination rather than to the real causes
in the stresses and pains of the personality —
the unconscious anxieties, hostilities, guilts, de-
pendencies, resentments and thwarted love, drives
and ambitions. Benjamin Franklin said, pain
is pain and pleasure is pleasure, whether real
or imaginary. Fortunately the recent study of
psychosomatic medicine is dissipating the im-
agination as a supposed cause of many worries
and illnesses, by extending research into the
ramification and conversion of emotion into
physiological disturbances.
Restlessness, irritability, loss of concentration,
ineffective work can be caused on the one hand
by arteriosclerosis, renal disease, hypertension,
multiple sclerosis; or by financial worry, frustrated
ambition, the aggressiveness of the spoiled child,
or melancholia. Weakness and paralysis can
be caused by tumor and multiple sclerosis, or
by discouragement, disappointment, worry and
fear. Headache and vomiting can be caused
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The Ohio State Medical Journal
"by tumor, encephalitis, hypertension, or by
strain, frustration, depression. A girl was sent
to the Psychiatric Clinic for headache and vomit-
ing. This followed an abortion for an illegiti-
mate pregnancy. The shame and remorse were
supposed to be causing the physiological symp-
toms. In three weeks she was dead, of a tumor
of the brain stem. This shows the difficulty of
•differential diagnosis at times.
Temper tantrums, enuresis, lying, mistakes
In arithmetic, are not brain disease in children.
They are ineffective responses to environmental
situations, defective development of the per-
sonality, unsatisfactory training or conditioning.
Thus many, probably the majority of psychoneu-
Toses and many psychoses are not brain disease
or disease of the nervous system. They are
the results of unfortunate, often chance, un-
conscious unwholesome conditioning, with the
development of exaggerated, intense emotional
habits, which hinder effective functioning and
living.
Psychiatric therapy in the past has been
chiefly expectant or custodial, interminable or
exorbitant in time and money. Modern ther-
apy is dynamic and often effective, rather than
expectant. It requires work with the individual
patient and takes time. That is one of the
great handicaps of psychiatric therapy. But
time is an important factor in conditioning which
lies at the source of psychiatric conditions. If
it takes fifteen, twenty or thirty years of con-
ditioning to produce the disability, it is not
surprising that it requires weeks, months or sev-
eral years to supply the corrective emotional
experiences or reconditioning that constitute
psychiatric therapy — conditioning requires time.
EXPERIMENTAL NEUROSES
The production of experimental neuroses in
animals and experimental physiology have formed
the background of much of our psychiatric and
psychosomatic knowledge. Time is required for
conditioning. Liddell found that if electric
stimulation was given to a sheep’s foot, with a
metronome beating as a conditioning stimulus,
the animal could perform satisfactorily at in-
tervals up to thirty seconds. It stood quietly
before and after the shock was delivered. If
however, the interval was thirty seconds or more
a. profound disturbance resulted. The animal
became tense and restless. It moved its leg
when the metronome didn’t beat; when the
metronome did beat it often flexed its leg with
each beat. It resisted going to the pen. It was
restless in the pen. It was withdrawn and
often cowered. It was submissive in attack. The
pulse was rapid and often irregular. It suf-
fered from a neurosis as a result of training.
Kept in the laboratory for one and one-half years
the condition improved, but if tests were then
resumed, the neurosis returned. In one instance
the neurosis remained till death after thirteen
years.
Time and experience are thus conditions in the
development of neurosis and must be taken into
account in treatment. It took a young doctor
one and one-half years to recognize his tendency
to be dependent. It required seven years for a
patient to be able to utter the words pregnancy
or baby, she was so afraid of them. It took
a salesman three years to be in any way critical
of his father, he had so much guilt as a result
of his hostility toward him.
A normal, friendly, cooperative chimpanzee
can be made emotionally upset by complicating
a food testing situation so that she develops
temper tantrums, rolls on the floor in anger (as
an Army colonel did when his daughter became
engaged to a man of whom he disapproved) re-
fused to go into the cage, beat the gate in
anger, frequently defecated and urinated, which
are signs of diffuse sympathetic discharge. After
removal of both frontal lobes, in the test situ-
ation the animal is not upset, not emotional
no matter how many mistakes are made.
After the removal of the frontal lobes for
a tumor in a 40-year-old man, his character
changed from a quiet, submissive person to a
facetious, euphoric, childish one, with frequent
outbursts of anger.
Stimulaton of the sympathetic or parasym-
pathetic nervous systems produce characteristic
physiologic changes, which similarly are often
seen in the neuroses. Alexander in his studies
on the relationships between emotions and
physiology believes that aggressive emotional
impulses tend to find outlet chiefly through the
sympathetic pathways, as in hypertension, while
regressive impulses tend to discharge through
the parasympathetics, as when strong dependency
feelings and longings affect the stomach.
The relation of metabolism to feelings is well
known. In myxoedema there is a drop of per-
formance; feelings of inadequacy, dullness and
depression are not infrequent. In hyperthyroid-
ism there is emotional lability, with frequent
feelings of irritability, anxiety and guilt. When
medical students were exposed to an atmosphere
of diminished oxygen tension there was impair-
ment of emotional control with elation and
flightiness. Psychoneurotics similarly exposed
behaved like hypomanics, with marked lack of
emotional control, great increase in self-esteem
and sexual preoccupation.
The hypothalamus plays an important role
in vegetative innervation and regulation. Path-
ology in the hypothalamus not only affects the
physiology of the body but the emotional reac-
tions, for example, aggressiveness. Stimulation
of the anterior nuclei innervates the parasym-
pathetic, while stimulation of the posterior
for April, 1950
325
nuclei stimulates sympathetic discharge. Tumors
stimulating the anterior nuclei have been reported
as producing excitement and flight of ideas,
while those stimulating the posterior nuclei lead
to indifference, depression and lethargy.
If the brain is sectioned above the hypo-
thalamus in cats, spasms of ragelike behavior
ensue. Rubbing the cat will produce arching
of the back, clawing, lashing of the tail, snarling,
increased breathing, salivation, and dilation of
the pupils.
PSYCHOSOMATIC MEDICINE
Cushing long ago made observations of im-
portance for psychosomatic medicine when he
found gastric ulcers appearing after certain
brain operations.
Wolff has shown that anger produces engorge-
ment of the blood vessels of the stomach, while
fear produces palor of the mucosa. He has
also demonstrated a drop of 13 degrees C in
the finger temperatures when patients were
discussing unpleasant emotional subjects. This
is important etiologically because if such dis-
turbed circulation can result from emotion, it
is not difficult to conceive of permanent nutri-
tional and structural alterations arising from
prolonged emotional tensions over the course of
years. These observations afford hints as to
therapy, namely affording release of these emo-
tional tensions in an atmosphere of patient,
sympathetic, understanding, accepting, consider-
ation and discussion of the patient’s feelings.
The work of Cushing, Cannon, Bard, Gant,
Fulton and Liddell thus formed the physiological
background for psychosomatic medicine. Alex-
ander and his co-workers, following Freud and
Pavlov, have carried this work further and in-
vestigated the emotions and feelings involved
or related to certain clinical medical conditions.
This is the meaning of psychosomatic medi-
cine, the investigation of the interaction and
interdependence of emotion and bodily function.
Psychosomatic medicine is not something en-
tirely new, for the intelligent general practitioner
has always considered the feelings and back-
ground of his patients in making the diagnosis
and planning treatment. Psychosomatic medi-
cine merely aims at discovering and making
more precise the nature of these relationships.
Psychosomatic medicine is better thought of not
as a new specialty but as a psychosomatic ap-
proach to the problems encountered in all medi-
cal specialties (Dunbar).
What are some of these emotional correlations?
— whether casual or contributing, remains to be
worked out. From birth, eating is related to emo-
tions. Feeding is closely associated with love and
maternal care. Receiving food may become as-
sociated with taking and wanting other things
and may lead to impulses of greed and posses-
siveness. Biting may become an expression of
hostility. If hostility is strong, guilt may appear
and motivate eating disturbances, as is fre-
quently seen in melancholia. Hostility and guilt
may manifest themselves in anorexia, unwilling-
ness or inability to eat. Eating may be a
substitute satisfaction for the desire for at-
tention, support, consideration and love. Bulimia
and obesity frequently seem to have such origins.
In anorexia nervosa certain hostile feelings may
be rejected because of shame and guilt and be-
cause they are so closely associated with eat-
ing, food cannot be taken. Repulsion against
food is not infrequently seen as a substitution
for repulsion toward sex. Hostile impulses
may become associated with eating and biting.
They become inhibited because of guilt and
shame, and food is refused. Fasting is a tra-
ditional mode of atonement and hunger-strikes
express hostility.
Emotional disturbances cause loss of appetite
and vomiting. Rejection of certain feelings and
impulses because of fear and guilt often lead
to these reactions. Emotional tension causes
the familiar lump in the throat and cardiospasm.
Peptic ulcers occur in the driving, ambitious,
worrying men of ability. They have persistent
drives to overcome obstacles. Alexander has
found in these people strong cravings for emo-
tional support, care, dependence and love. These
feelings and desires are closely associated with
stomach functions, so that they stimulate the
stomach to hypersecretion and hypermotility
(as the desire for food does) when these feelings
are continually frustrated. They act as con-
stant stimuli to the gastric mucosa, which finally
breaks down with the formation of an ulcer.
Elimination early in life becomes associated
with emotions. This function early becomes
associated with feelings of pride and power,
accomplishment, giving and yielding, or with
resistance to training and authority, and the
development of hostility. Diarrhea is frequently
associated with fear. When pregnancy is feared,
diarrhea may appear as an emotional substitute.
Colitis is often associated with feelings of re-
sentment and hostility. The emotional attitude
is expressed by the bowel. A young lady of
thirty-five had to move away from her parents
and home environment when her husband changed
his work. Her anger and hostility were ex-
pressed in a prolonged severe case of colitis.
The heart has long been called the organ
of anxiety. It has been held by romanticists
to be the seat of the emotions. It leaps for joy
and is broken by grief. It palpitates for love
and stops in terror. Fear drives it into the
mouth and depression into the feet. It throbs
in sympathy, flutters in modesty, beats strongly
in courage. It is of gold in honesty. It aches
326
The Ohio State Medical Journal
and pains in anger and frustration. Where there
is lack of sympathy, we say, one has no heart or
heart is cold.
Chest pains and heart pains are reported in
patients when there are strongly repressed
hostile and aggressive impulses. Palpitation
and extra-systoles have been observed when
strongly aggressive and competitive impulses
have been mobilized. Cardiac neuroses are ap-
parently increasing, which is attributed to the
added stress of modern living. In hypertension
hostility and aggression are intense and chronic
but inhibited. The anger is often rebelliousness
against domination and protest against authority
and responsibility.
In asthma there is fear of separation or es-
trangement from a mother or mother substitute.
The personality traits of asthmatics often show
over-anxiety, lack of self-confidence, or a cling-
ing dependence on parents or parental substitutes,
which is often a result of parental over-solicitude.
Temptations and threats to security and de-
pendence seem to precipitate attacks. There is
a relationship to anxiety and crying — weeping
changing to wheezing. Dreams and phantasies
show wishes to be secure and protected, not
as in gastro-intestinal cases where the wishes
are to be fed. Threatened by too sudden fear
of separation or estrangement the cry as a child
for its mother is repressed and replaced by an
asthmatic attack.
Laryngitis may occur when hostile verbal
attacks are inhibited. There may be an emo-
tional factor in the common cold. Saul found
a frustration of wishes for love, protection and
dependence, with repression of the consequent
anger and hostility, at the time colds developed.
Many skin diseases appear to be related to
pent up anger and rage. People are “burnt-up”
over some situation and this expresses itself in
the disturbed physiology and eruptions of the
skin.
Emotions are important in arthritis and
neuralgia. A woman of 35 was disabled with
pain in the back and asthenia for eight years.
She had two operations and had worn a brace
for months. She had been a bed patient for
one and one-half years. Physical and laboratory
studies were negative except for mild arthritic
changes in the spine. The usual medical and
orthopedic procedures were of no avail. The pa-
tient was seen in interviews of thirty minutes
each, five times a week. The physician in the
main was passive in the therapeutic conferences.
The patient was encouraged to talk of anything
that came to mind and to express herself freely.
Stimulating questions were asked, to bring re-
levant considerations and feelings to conscious-
ness and expression. Direction, reassurance and
suggestions were given as sparingly as possible.
Gradually over the course of months, emotions
of anger and resentment came to the fore and
assumed unusual proportions. They were often
expressed violently in words, gestures and dra-
matizations. There were acts of destructive-
ness. It became clear that the emotions of re-
sentment and hate toward a rejecting, neglecting,
unfaithful father and a driving, restricting,
meticulous, rigid mother, in childhood, repressed
over the course of years, and the hostility to-
ward her husband, had permeated into her bodily
system and with their tensions had caused her
pains and weakness. With the release of these
emotions by verbalization, gestures and dramatic
expression, the weakness and pain disappeared,
health and normal social life returned. This
case shows some important points in psy-
chotherapy and treatment. There was little
authoritative direction. There was no exhorta-
tion and no reasoning. When the malignant
emotional tensions were released, recovery took
place, and reason and self-direction spontaneously
reasserted themselves. It was the attitude of
the physician toward the patient, what he al-
lowed and encouraged to go on in the therapeutic
experience, that was important. This case
illustrates another point — the things a patient
does not talk about at first are often more
important than what he talks - about. Thus
time and patience are required until the violent
emotional tensions press forward and become
verbalized.
PSYCHOTHERAPY
This brings us to the therapy of psychiatric
conditions. Psychotherapy is not an intellectual
exercise. It is not a transference of ideas from
doctor to patient. It is not merely the develop-
ment of insight. It is not an argument. It is
not exhortation or a lesson in morality. It is
not a battle of wills. It is not an opportunity
for the doctor with his superior wisdom to impose
his ideas on the patient, make him feel inferior
or humiliated. It is not an occasion for the
doctor to express his anger at the patient be-
cause of his own frustration in treating the
patient successfully.
Psychotherapy is an experience, and as such
it is a process of conditioning and growth. Like
growth much of it goes on unconsciously and
automatically. An automatic readjustment of
the emotional and social forces (which have been
conflicting and in tension) takes place. Psy-
chotherapy is a social experience, that is, a
relationship with a doctor who wants to help his
patient. It is an experience, again I repeat,
not an intellectual exercise, in which the doc-
tor’s attitudes toward his patient are the most
important levers of therapy. The doctor should
bear in mind certain needs of all people: the
need for new experience; for security; for respect
and a feeling of individuality; and for respon-
for April, 1950
327
siveness and understanding from another human
being.
Security is given by accepting the patient
for treatment, by giving him the support and
protection implied by a regular plan of ap-
pointments—something to look forward to. The
physician is not critical, contradicting, and is
not trying to force the patient to change. He
shows interest, patience and consideration.
Respect is given by affording the patient a
feeling of individuality and worth. He accepts
the patient for what he is, with all his annoy-
ances and immaturities. He allows freedom of
expression without condemnation or criticism.
He is tolerant and permissive. He recognizes
areas of responsibility and lack of responsibility
(due to chance, training, past experience) in
the origin of the patient’s condition.
The physician shows responsiveness to the
patient, and makes efforts to understand what
forces are at work in his patient. These efforts
to understand are often more important therapeu-
tically than actual understanding. Therefore,
general practitioners can do good psychotherapy
without a profound knowledge of psychopath-
ology. This responsiveness plus the other at-
titudes enable the patient to share his thoughts
and feelings. This affords an experience of
participation and togetherness which is important
in therapy.
With the exhibition of such attitudes the
patient will gradually identify with the doctor.
The doctor has a scientific, objective approach
to overwhelming situations and conditions. He
is not overwhelmed. He knows what to do.
He has plans of attack, through asking rel-
evant questions and exhibiting certain attitudes.
The patient absorbs this point of view through
identification with the doctor, and gradually
learns to meet problems and difficulties by ask-
ing himself the same questions, and using the
trial and error approach, with repetition and
practice.
The doctor sets the stage where his attitudes
permit the release of malignant emotional ten-
sions. When understanding of the complexities
of the human organism is so much beyond our
ken, there is place for humility.
But getting well is more important than com-
plete understanding of all the causes of the
illness. In this connection, may I close with
a quotation from Lord Grey: “Nothing so
predisposes men to understand as making them
feel they are understood.”
BIBLIOGRAPHY
1. Saul, E. J. : Physiological Effects of Emotional Ten-
sion. Chapter VIII, in Personality and the Behavior Dis-
orders, edited by J. McV. Hunt, The Ronald Press, New
York, 1944.
2. Polatin, P., and Philtine, E. A. : Psychosomatic Medi-
cine and Treatment. Chapter V, in How Psychiatry Helps,
Harper and Brothers Publishers, New York, 1949.
3. Noyes, Arthur P. : Psychiatry and General Medicine.
328
Chapter XXI, in Modern Clinical Psychiatry, W. B. Saun-
ders Company, Philadelphia, 1949.
4. Cobb, Stanley: Personality as Affected by Lesions of
the Brain. Chapter XVIII in Personality and the Behavior
Disorders, edited by J. McV. Hunt, the Ronald Press, New
York, 1944.
5. Jelliffe, S. E. : Psychoanalysis and Internal Medicine
in Psychoanalysis Today, edited by S. Lorand, International
University Press, New York, 1944.
6. English, O. S. : Therapeutic Approach to Psychoso-
matic Problems, in Psychoanalysis Today, edited by S.
Lorand, International University Press, New York, 1944.
7. Dunbar, F. : Psychosomatic Medicine, in Psychoanalysis
Today, edited by S. Lorand, International University Press,.
New York, 1944.
8. Weiss, Edward, and English O. S. : Psychosomatic Medi-
cine. W. B. Saunders Company, Philadelphia, 1943.
9. Alexander, Franz, and French, T. M. : Studies in
Psychosomatic Medicine. The Ronald Press Company, New
York, 1948.
10. Dunbar, F. : Mind and Body. Random House, New
York, 1947.
11. Appel, Kenneth E. : Psychoanalysis. Annals of In-
ternal Medicine, Vol. 29, No. 4, October, 1948.
The Story Behind The Word:
Some Interesting Origins of Medical Terms
Esophagus — A contraction and simplification
of the Greek word “oesophagus” or the gullet.
It is derived from the Greek words “oiso,” I
shall bear or carry for another, and “phagein”
to eat.
Intestine — From the Latin word “intestinus”
meaning inward or hidden which in turn comes
from the Latin “intus” or within.
Jejunum — This name comes from the Latin
word “jejunus” meaning fasting, empty or dry.
This portion of the small intestine was so named
by the early anatomists because it was always
found empty and hence they literally named it
the “empty intestine.”
Ileum — The ileum or “twisted intestine” derives
its name from the Greek term meaning to “roll”
and was so called from its peristaltic movements.
Cell — Robert Hook (1665) a botanist first used
this term to designate the minute cavities he
observed in the microscopic structure of cork.
The word cell is from the Latin “cella” and
Hook used the name because of the fancied re-
semblance of the cork structure to the monastic
cells or cubicles used by the monks in mon-
astaries.
Dropsy — This term is a shortening or corrup-
tion of the old French term “hydropisie” which
in turn comes from the Greek word “hydropikos”
or relating to water — from the Greek “hudor”
or “hydro” meaning water.
Rash — This term is derived from the German
word “rasch,” meaning quick or impetuous and
also the Danish word “rask,” meaning quick.
Hence used medically to designate a rushing or
sudden breaking out of an eruption on the skin.
Anatomy — Literally “a cutting up.” This term
is derived from the Greek “anatome” or dissec-
tion, which in turn is composed of the Greek
words “ana” or up and “tome” a cutting.
— Harry Wain, M. D., Mansfield, Ohio.
The Ohio State Medical Journal
The Fourth International Neurological Congress*
JOSEPH L. FETTERMAN, M.D.
The Author
• Dr. Fetterman, Cleveland, Ohio, is a grad-
uate of Western Reserve University School of
Medicine, Cleveland, 1921; diplomate, Ameri-
can Board of Neurology and Psychiatry; Di-
rector, Fetterman Clinic; author, “Practical
Lessons in Psychiatry”; and consulting neuro-
psychiatrist, Glenville Hospital and Woman’s
Hospital, Cleveland.
THE Fourth International Neurological Con-
gress was held in Paris, France, Septem-
ber 5 to September 10, 1949. The meet-
ing provided a scientific core surrounded by
social events and the historic sights of this
famous city.
Paris is a place of living beauty enhanced
by the footprints and handiwork of history. In
its center is the River Seine crossed by thirty-
two bridges whose design and form invite see-
ing as well as crossing. For here is a river
whose banks have individual names and upon
whose banks are attached rectangular wooden
shelves, the popular and famous book stalls.
Readers and traders of books and magazines
and pictures come to browse, to chat, to carry
on a miniature exchange in literature. It seems
as though Frenchmen do not discard books and
magazines which they have read, they turn
them in for others to enjoy. Etchings and
lithographs and paintings add attraction and
interest to the wares of the book stalls. Here
are the outlets for many painters who work
along the Seine, sketching the ancient Notre
Dame Cathedral and the bridges nearby.
IDEAL LOCALE
Extending parallel to the river or arching
like spokes in different directions are wide,
spacious boulevards. There is ample room for
vehicles, as well as for rows of trees, then broad
sidewalks and numerous shops. In the endless
succession of attractive shop windows are per-
fumes and linens, jewels and dresses, and pic-
tures and statues. On the corners are the
cafes whose tables fan out upon the sidewalks,
tables where Frenchmen sit and sip black coffee
and chat as they leisurely wratch the world go
by. It seemed as though Frenchmen have three
common escapes: reading, painting, and sitting
at sidewalk cafes discussing life, liberty, and
the pursuit of sexual happiness.
Boulevards and avenues join each other in
large, beautiful squares. These are referred
to as “Place” and are often named after an
event, person, or building. For example, the
Place de L’ Opera is a rectangular area extend-
ing from the beautiful National Opera House
and at which some six famous streets join. The
Place de La Concorde is a more tremendous cir-
cular area in whose center are an obelisk and
a gorgeous fountain while marble banisters, at-
tractive bridges, and gardens surround this
square. Its name means place of peace, a term
that may represent a compensation for its use
during the French Revolution as a site for the
*A Reportorial Review by Dr. Fetterman, Cleveland, Ohio.
Submitted November 4, 1949.
bloody spectacle of the guillotine. For in this
now beautiful and peaceful square thousands of
Parisians gloated and shivered when the deli-
cate Marie Antoinette and her Louis XVI lost
their heads as did thousands of less royal fol-
lowers.
ARCHITECTURE TRIUMPHS
Paris is full of buildings which combine
beauty, utility, and history. In the outskirts
of the city is the palace of Versailles where
Louis XIV spent his childhood and then dur-
ing his long and famous rule told the world,
“L’Etat C’est moi.” (I am the state.) In this
beautiful building the Versailles Treaty was
signed, later to be ignored and trampled upon.
In the center of Paris at the Place de L’Etoile is
the famous Arch of Triumph at whose base lies
the remains of the Unknown Soldier for whom
a flame burns constantly. Nearby is the
Louvre, an immense ex-palace now housing art
treasures of the world. Here among other paint-
ings the Mona Lisa hangs demurely and pen-
sively, not at all jealous because more visitors
seek the statue of Venus de Milo. The crowds
study the face and form and drapes of Venus,
some with open admiration and others with
such jealous phrases as “she is a little too
well developed in certain parts.” Venus stands
unruffled, armless, with unrivaled dignity and
beauty.
Across the Seine from the Louvre is the 980
foot Eifel Tower, a tapering, steel structure, con-
spicuous because of its unique design and be-
cause there are no other relatively tall build-
ings. Visitors gape and arch their necks to see
this unusual building which now serves use-
fully as a radio transmitting station and as
a guide to aviators. Close by is the vast
Hotel des Invalides, built by Louis XIV as a
home for disabled veterans. It is so large and
extensive that it once housed seven thousand
men. Then in the 1830’s the remains of
Napoleon was placed in a beautiful section
of this building, known as the Tomb of Napoleon.
In this atmosphere of beauty and culture were
for April, 1950
329
many schools and hospitals including the Sor-
bonne University, the historically famous Hotel
Dieu and of course the Ecole de Medicine. This
School of Medicine consists of two large and
beautiful buildings, each on one side of a small
street, once famous as the hotbed of the French
Revolution. Today these buildings are devoted
to the welfare of mankind. On one side are
the lecture halls named after some famous
French doctor, such as Amphitheatre Vulpian
and Salle Pasteur. The other building, in the
center of which is a lovely courtyard with a
fountain and shrubbery and trees, contains the
laboratories of the school.
OHIOANS PRESENT
In the two buildings of the Ecole de Medicine
were held the meetings of the Congress. The
attendance was large and included neurologists
from practically every country in the world. A
list of the speakers and their countries resem-
bles the roster of the United Nations. It is
interesting to mention that several represen-
tatives from Soviet Russia were listed on the
program but none appeared in the meeting. The
United States had the largest representation,
180 members; Great Britain was well represented
as were the Scandinavian countries, Holland,
Belgium, Germany, Portugal, Spain, India, Israel,
South Africa, and the countries in North and
South America. Of local interest, we may
mention that three Ohioans were present, Dr.
I. Mark Scheinker of Cincinnati; Dr. Laurence
M. Weinberger of Akron; and the author.
The program was divided into general meet-
ings held in the mornings and many smaller
limited sessions in the afternoons. Each morning
session dealt with one assigned topic to which
selected, eminent speakers and discussants con-
tributed. There was ample time for a rather
complete presentation. The subject matter,
which was covered in the several morning ses-
sions, included Electroencephalography, Ana-
tomy and Physiology of the Thalamus, Virus Dis-
eases of the Central Nervous System, and the
Neurosurgery of Pain. Wilder Penfield and
Herbert Jasper (Canada) took a leading role in
the Electroencephalography session. W. E. Le
Gros Clark (England) and W. R. Hess (Switzer-
land), Ludo Van Bogaert (Belgium), and J. L.
Hermitte presented the papers dealing with the
Anatomy and Physiology of the Thalamus. The
subject of Virus Diseases was formally presented
by A. B. Sabin (U. S. A.) and W. McD. Hammon
(U. S. A.), Sven Gard (Sweden), and P. Lepine
(France). The discussion on Surgery of Pain
was introduced by O. Sjoquist (Sweden), H.
Krayenbuhl, and W. Stoll (Switzerland), R.
Leriche (France), and G. F. Rowbotham (Eng-
land). These formal presentations were fol-
lowed by ample discussion from the floor. The
papers were delivered in the language of the
speaker. The listener who did not understand
the language was helped by an abstract of the
paper in the printed program and at some
sessions by translation.
DIVERSIFIED PRESENTATIONS
The afternoon sessions were held simultan-
eously in seven different halls. Each speaker
was allowed but ten minutes to deliver his
“communication.” Speakers were allowed to
choose their own subjects and as a rule presented
material which was a condensed review of
years of study. Generally, topics were grouped
according to one major theme but at some
sessions the lectures dealt with widely diversi-
fied material. In all, there were over one hun-
dred and fifty papers at these sessions. This
rich assortment of neurologic material was not
presented without some confusion and difficulty.
At times the program was not accurately fol-
lowed and a visitor might hasten from one hall
to another only to find that the lecture which
he desired to hear had already been given.
There was, of course, the problem of language
comprehension and occasionally repetition of sub-
ject matter.
The papers covered such subjects as Central
Nervous System Lues, Epilepsy, Multiple Scler-
osis, Traumatic Disorders, Diagnostic Procedures,
and Therapeutic Techniques. The material was
of a highly scientific order and of considerable
clinical interest. However, most of the audience
did not bring home new therapeutic measures
of great value.
EXHIBITS
In addition to the scientific papers there were
several fine exhibits. I was particularly im-
pressed by the exhibit dealing with the History
of Neurology presented by Webb Haymaker
under the auspices of the Army Institute of
Pathology and the Army Medical Library. This
exhibit consisted of the photographs of the
leading neurologists of the world, living and dead,
and copies of the original material such as
articles and books which they had published.
It is planned to gather this most interesting
exhibit into a book form. I am confident that
neurologists throughout the world will be eager
for the publication of this project.
Although the major interest of this meeting
was scientific there were several social functions.
The Paris Neurologic Society was the host at
a large reception for all the guests. Later the
visitors received a warm welcome from Pierre
De Gaulle in the ancient but still elegant and
beautiful Hotel De Ville (City Hall) and an
elaborate banquet was also held — outstanding
because there were practically no speeches. Sev-
eral sight-seeing tours were arranged.
We who attended the meetings found in the
science of the sessions, the sights of Paris
and the socialization from fellow-neurologists
from all over the world a reward which more
than justified our visit to Europe.
330
The Ohio State Medical Journal
Failures in Electroshock Therapy
CHARLES LANDIS ANDERSON, M. D.
The Author
• Dr. Anderson, Worthington, Ohio, is a
graduate of College of Medical Evangelists,
1940; diplomate, American Board of Psychiatry
and Neurology; member, American Psychiatric
Assn.; clinical director, Harding Sanitarium:
and clinical instructor, dept, of neurology and
psychiatry. College of Medicine, Ohio State Uni-
versity.
ELEVEN years have elapsed since Cerletti
and Bini first gave to psychiatry a new
technique of electrically induced convul-
sive therapy for the treatment of mental disease.
It has been nine years since this form of treat-
ment was first used in the United States.
Electroshock has become an accepted form of
treatment for certain mental diseases, and its
usefulness in those conditions is seldom seriously
challenged. Whereas a few years ago it took
considerable salesmanship on the part of the
psychiatrist to persuade relatives that it was
safe and therapeutically effective to treat a
typical depression with electroshock, now we
often encounter patients and their relatives
asking for electroshock as a treatment for al-
most any type of nervous disorder. With such
wide acceptance of this treatment by the medi-
cal profession and the general public, there has
arisen a greater need for discrimination in the
selection of cases to be treated by electroshock.
The purpose of this article is to record cer-
tain clinical impressions gained while treating
1,200 patients with 16,000 electroshocks during
the past eight years at the Harding Sanitarium,
and to invite the comments and sugges ions
of our colleagues who are dealing with the
same problems. Emphasis will be placed upon
failures with the hope that further study may
reduce their incidence.
The following brief classification will be used
as an outline for discussion:
1. Conditions in which electroshock is the
treatment of choice.
2. Conditions in which electroshock is of
no value and should not be used.
3. Conditions in which there is disagree-
ment regarding the value of electroshock.
4. Inadequately treated cases.
5. Cases in which shock is indicated, but
which fail to respond in spite of adequate
treatment.
In this article, failure is considered to include
cases which responded only slightly or not at
all, and cases which responded but soon re-
lapsed. Those who obtained a remission from
their illness and more than a year later again
became ill are not counted as failures.
CONDITIONS IN WHICH ELECTROSHOCK IS
INDICATED
The affective disorders are generally con-
sidered to respond particularly well to electro-
Presented before the Section on Nervous and Mental Dis-
eases at the Annual Meeting of the Ohio State Medical
Association, Columbus, April 21, 1949.
shock. This is especially true of the typical
depressions, both of the manic-depressive and
involutional melancholia types. Failures in -his
group are relatively infrequent. Cases of agi-
tated depression often respond well, but failure
is somewhat more likely. Gross somatic and
nihilistic delusions make the prognosis poorer.
A number of other conditions, such as manic
states and involutional paranoid reactions, prob-
ably should be placed here, but as there is some
difference of opinion about them, they will be
discussed below.
CONDITIONS IN WHICH ELECTROSHOCK
IS NOT INDICATED
Among the psychoneurotic reactions are many
difficult cases that respond poorly to all forms
of therapy, often because the patient has little
to gain from abandoning his illness. To the
overworked physician and the harried family,
a “short-cut”4 treatment, in which the patient is
not required to be an active participant, may
offer promise of welcome relief. But shock
applied to such conditions is almost always
doomed to failure. Anxiety state does not
respond well to electroshock; obsessive-
compulsive, hypochondriasis, and neurasthenia
are not benefited. All these conditions may seem
better temporarily while confusion and euphoria
resulting from the treatment becloud the pic-
ture, but within a few weeks at most it will
become apparent that nothing has been accom-
plished. The patient may be even worse than
before, perhaps because his hopes for an easy
cure failed to materialize.
Electroshock when employed to treat various
psychosomatic manifestations, such as hyper-
tension, neurodermatitis, asthma, peptic ulcer,
etc., is unlikely to accomplish any good. How-
ever, if hypertension is part of the picture of
an agitated depression, the pressure will fall,
often to normal, as the depression is relieved
for April, 1950
331
by treatment. In our experience psychosomatic
problems not associated with psychoses have not
been benefited by electroshock.
Other conditions which will result in failure
if treated with shock therapy include chronic
alcoholism, psychopathic personality, and homo-
sexuality.
CONDITIONS IN WHICH THE VALUE OF
ELECTROSHOCK IS NOT SETTLED
Some authorities have expressed the opinion
that electroshock is not indicated in the treat-
ment of manic-depressive, manic states.1 In our
experience this seems to be true regarding
hypomanic cases, who can absorb a large number
of treatments without showing any appreciable
improvement. Fortunately, in the more highly
disturbed cases, where it is imperative to quiet
the patient to save him from exhaustion, electro-
shock is very useful. It is necessary, however,
to give a large number of shocks within a
short time, as many as four or more shocks a
■day for the first few days, and daily for some
time thereafter. Under such intensive treat-
ment we have obtained about as good results
with manics as with depressed cases. During the
past year we have used coramine with electro-
shock as described by Fabing,2 and in the small
number thus treated our experience has paral-
leled his.
The treatment of the circular and mixed
types of manic-depressive psychosis has, in our
experience, proved disappointing. While not to
be considered a failure of treatment, electro-
shock in bringing about a remission of a parti-
cular attack has not prevented subsequent at-
tacks. Recently reported work by Geoghegan
and Stevenson3 indicates that in manic-depressive
cases, subsequent attacks can be prevented for
an apparently indefinite period by administering
prophylactically one shock a month.
Reactive depression, though classed as a
psychoneurotic reaction, often responds well to
electroshock,6 especially when the personality
had previously been adequate and the precipitat-
ing factor was strong. A frequent example
during the war was the reaction of a mother or
a wife to news of the death of a serviceman.
Electroshock is useful as a means of initiating
the treatment of conversion hysteria, somewhat
as intravenous barbiturates are used. This
should be followed up with psychotherapy after
the immediate symptoms have been relieved and
some confidence in the physician established.
Where the conversion symptoms involved the
function of locomotion, we were able with shock
therapy to demonstrate to the patient his ability
to walk better than we could with intravenous
barbiturates, which made the patient dizzy and
thereby sometimes unable to walk. It should be
emphasized that the use of shock treatments
alone will end in failure.5
Postpartum psychoses are said by some not
to be benefited by electroshock.1 The follow-
ing case summary is typical of our experience.
A 30-year-old white female, following the birth
of her second child, developed an acute schizo-
phrenic excitement. She was delusional, hallu-
cinated, destructive, noisy, and not eating or
sleeping. After a few days she became mute
and immobile. After eleven shocks she was
so improved that her family considered her
recovered. However, within a few days she
began to relapse. Further treatment was given
according to her clinical condition. Most of
the time she was able to be at home and come
in for shocks at fairly regular intervals. Over
a period of six months she received 41 electro-
shocks. For the past four years she has re-
mained well. While shock therapy apparently
does not greatly shorten the period of illness,
it does aid materially in the management of
the patient, so that she can often remain at
home rather than spend several months con-
tinuously in a mental institution.
Certain patients suffering from a psychotic
depression, and ill enough to make suicide a
definite hazard, fail to respond more than
temporarily to adequate courses of electroshock.
Often it will be found that such individuals
had been suffering from neurotic complaints
for years before the depression set in. They
were basically anxious, dependent people, often
with much guilt and unconscious hostility. In-
somnia may have been present for years. The
depression seemed to be secondary to the long-
continued neurosis. For example, we have had
under our care off and on for the past five
years a 60-year-old married woman who de-
veloped an anxiety neurosis about four weeks
following a hysterectomy. The persistent anxiety
with the associated physical phenomena caused
her such distress and so restricted her life
that she became depressed, emotional, and
suicidal. We have given her four courses of
shock treatment, totaling 46 in all. The tem-
porary improvement was always followed by
a relapse characterized by a return of her
anxiety, discomfort, and then depression. She
remains in the same condition today.
Involutional paranoid reactions do not re-
spond as well to electroshock as do involutional
depressions. However, with little else to offer
these psychotic cases, it would seem that this
form of therapy should be given an intensive
trial. Those paranoids who do recover need a
longer series of shocks than do the depressed
involutionals.
Such a case is a 50-year-old single business-
woman. She had always been of a rigid, perfec-
tionistic make-up, had not married because she
332
The Ohio State Medical Journal
couldn’t find the man that suited her. Her
work was always highly satisfactory. She
carried much heavier responsibilities than her
position or salary would warrant; in fact, the
president of the organization was dependent upon
her to make out all financial reports. She
resented the lack of recognition, though she
liked the work. She had little to interest her
outside of her work, she didn’t make friends
easily, and she was secretive about her personal
affairs. More prominent than her depression
were her suspiciousness and paranoid delusions,
which had been present several weeks upon ad-
mission. Twelve electroshocks apparently re-
sulted in recovery, but after a few weeks she
relapsed, her paranoid delusions being more
systematized than before. She received another
20 treatments and made an excellent recovery.
After several months of convalescence she was
able to return to work and has remained well
for three years.
SCHIZOPHRENIA
Schizophrenia is responsible for more failures
of electroshock therapy than any other psy-
chiatric condition.4 Cases with a history of a
poor prepsychotic adjustment to their environ-
ment, with insidious onset of illness, long dura-
tion of symptoms, and without strong precipitat-
ing factors are almost certain to remain ill-
in spite of treatment. On the other hand, the
schizophrenic who had made a mature psy-
chosexual and occupational adjustment, who was
reacting to strong environmental factors, and
whose illness was of sudden onset, had a good
chance of recovery, even before the introduction
of electroshock. Such cases account for many
of the dramatic recoveries seen in military life
during wartime. The simple and hebephrenic
cases, which usually never did make a mature
adjustment to their environment and who be-
came ill early in life get little benefit from
such therapy. The majority of them in our
experience have failed to recover by means of
electroshock. While catatonics often respond
well to shock, they tend to relapse. The paranoid
often forgets his delusions only during the period
of treatment. However, enough catatonics and
paranoids make a recovery to justify using elec-
troshock on those with fairly normal past
histories who haven’t been ill more than six
months to a year, and who exhibit considerable
affect.
The following case history illustrates the
persistent treatment of a catatonic schizophrenic
with eventual successful outcome, an eventuality
that was not anticipated by her physicians. A
white female, now 45 years of age, showed the
first signs of mental illness in 1928. At that
time she spent nine months in a private institu-
tion. For the following two or three years
she appeared to be well, but in 1933 she again
became mentally ill. She was continuously in
a psychiatric institution from 1933 to 1942.
Between April and November, 1938, she received
151 insulin coma treatments with only temporary
improvement. During 1940 and 1941 she had
five hypothermia treatments, each lasting from
one to three days. Between July, 1941, and
September, 1942, she received 60 electroshocks.
After a few treatments she would appear nearly
normal but relapsed a few days later. She
went through recurring cycles of treatment, im-
provement, and relapse.
After she was transferred to the Harding Sani-
tarium in October, 1942, we gave her electro-
shocks with similar results. During the first
year of treatment she had 51 shocks. In Octo-
ber, 1943, she became an outpatient, traveling
from her home for treatments when necessary.
In the spring of 1946, after she had had about
170 shocks, she began working in an office and
has continued in that position until the present
time. At the first sign of a relapse she was
returned to the Sanitarium for another out-
patient treatment. Thus she missed very little
time from work. By April, 1948, she had re-
ceived 267 electroshocks. During the past year
she has remained apparently well without any
treatment whatever. Early in our experience
with this case we allowed her to relapse com-
pletely before resuming treatment. At such
time she would lie on the floor nude, mute, in
the fetal position, and refusing to eat or release
her sphincters. Later, this picture was not seen,
as we treated her upon the first sign of relapse.
This patient received in all 327 electroshocks,
plus 151 insulin comas, making a total of 478
shock treatments, both insulin and electric. If
all schizophrenics were treated as intensively
as this patient, perhaps many more of them would
recover. This is in line with the claim of Wilcox
that schizophrenics treated early and intensively
respond as well to electroshock as to insulin
coma.6 Practical limitations of time, personnel
and money often make such a routine as we
have outlined impossible, however.
INADEQUATELY TREATED CASES
What constitutes adequate electroshock ther-
apy? The number usually necessary to effect a
recovery varies with the different conditions
treated. Most cases would probably fall within
the following range: Depression (manic-
depressive or involutional), 4 to 10 shocks; manic
state, 10 to 20; postpartum psychosis (which is
usually a schizophrenic reaction), 20 to 40; in-
volutional paranoid, 20 to 40; schizophrenia, 20
to 40 and more.
Oftentimes a patient is treated inadequately
through no fault of the physician, but because
the family is uncooperative, or the patient re-
fuses to take more treatments. Inability to
pay for a long series of treatments together
for April , 1950
333
with an unwillingness to accept state hospital
care may also be responsible for inadequate
treatment in private practice.
FAILURE IN SPITE OF ADEQUATE TREATMENT
Not infrequently a case will fail to improve
or will quickly relapse in spite of the fact that
experience indicates it is the type of case that
should respond readily. Sometimes the patient
must return to an intolerable environment, which
neutralizes all therapeutic efforts. It may be
possible to educate the family to the needs of the
patient, thus making the environment more at-
tractive. The importance of adequate follow-up
supervision, either by the psychiatrist or the
family physician, should be kept in mind. In
a questionnaire we sent to about 200 of our
former electroshock patients several years ago,
we learned that most of them didn’t feel they had
fully recovered from their mental illness until
about three months after they were discharged.
That three-month period of adjustment we feel
is a crucial time for the patient.
Another reason for failures may be that our
diagnostic acumen is still faulty and that we
are giving shock to patients who should have
other forms of therapy. The usual custom of
trying electroshock first on schizophrenics, and
if that fails using insulin coma, might be re-
versed, especially in the simple and hebephrenic
types, where electroshock has little to offer.
And then after all possible causes for failure
have been explored, there will still remain a
certain number who fail to respond. But such
is the experience of medicine in the employment
of all forms of treatment.
DISCUSSION
In order to stimulate further discussion of
the problem of failures in electroshock therapy,
I would like to suggest the following points:
(1) A careful evaluation of each patient before
electroshock is begun. In some cases, such as
a typical manic-depressive depression, the diag-
nosis can be made readily and treatment begun
at once. However, in cases where there is
some doubt about the diagnosis, where the
symptom picture is not exactly typical, it would
be wise to have a clinical psychologist examine
the patient with a battery of tests and where
practicable, have the patient examined by a
staff of one’s psychiatric colleagues. Some pa-
tients, though cooperative, need to be hospitalized
for more accurate diagnosis before treatment is
instituted. (2) After a diagnosis has been ar-
rived at and electroshock is started one should
be careful to give a sufficient number of treat-
ments, continuing to 20, 40, or even more
shocks, if necessary. (3) Certain cases make
more rapid progress if psychotherapy is com-
bined with electroshock. Agreeing with Fetter-
man, et al.,7 we feel that the two are not antag-
onistic procedures. Sometimes the psychother-
apy is given on alternating days between shocks
or it may be more effectively employed following
the termination of electroshock. (4) Analytically
oriented psychotherapy should be employed in-
stead of electroshock in those confused symptom
pictures where anxiety, guilt, and obsessive-
compulsive symptoms are prominent. In the
more difficult cases of this type the general
psychiatrist should refer them to a properly
qualified psychoanalyst. (5) In many instances
the electroshock does its work, but the chance
for permanent improvement is destroyed be-
cause the patient has to return to an unsatisfac-
tory environment. It is the duty of the psy-
chiatrist to continue to follow the patient, if
possible, after he has been discharged from
hospital or office treatment and assist him in
creating a better environment when this is
needed. There has been valid criticism of the
practice of a few psychiatrists of giving the
patient his shocks, taking his money, and turn-
ing him loose. (6) We must expect some failures
when our chief consideration is the welfare of
the patient and not the assembling of impressive
statistics. Knowing this, we should continue
to treat involutional paranoids, schizophrenics
and the atypical manic-depressive cases because
at present we have no better single form of
treatment to offer them. (7) It is well for us
to examine critically the results of our own
labor, admit failure where it has occurred, and
continue to strive for improved techniques and
results. (8) The group that has failed to
obtain permanent benefits from electroshock
should, in selected cases, have insulin coma
therapy or prefrontal lobotomy.
BIBLIOGRAPHY
1. Rickies, N. K., and Polan, C. G. : Causes of Failure in
Treatment with Electric Shock: Analysis of 38 Cases. Arch.
Neurol, and Psychiat., 59 :337-346, March, 1948.
2. Fabing, H. D. : Combined Coramine-Electroshock Ther-
apy in the Treatment of Psychotic Excitement. Am. Jour.
Psychiat., 105 :435-438, Dec., 1948.
3. Geoghegan, J. J., and Stevenson, G. H. : Prophylactic
Electric Shock. Presented at Ann. Meeting of Am. Psychiat.
Assoc., Washington, D. C., May 20, 1948, (awaiting publica-
tion).
4. Kalinowsky, L. B. : Failures with Electroshock Therapy.
Chapter XI of “Failures in Psychiatric Treatment.” Grune
& Stratton, New York, 1948. Discussion : W. A. Horowitz.
5. Kalinowsky, L. B., and Hock, P. H. : The Convulsive
Therapies, Chapter III of “Shock Treatments and Other
Somatic Procedures in Psychiatry.” Grune & Stratton, New
York, 1946.
6. Wilcox, Paul H. : Electroshock Therapy, a Review of
Over 23,000 Treatments Using Unidirectional Currents. Am.
Jour. Psychiat., 104 :100-112, August, 1947.
7. Fetterman, J. L., Victoroff, V. M., and Bregman, E. :
Electro-Coma Therapy : a Six-year Follow-up of a Series of
Private Psychotic Patients Treated wtih Electro-Coma Ther-
apy. O. S. M. J., 45:229-236, March, 1949.
Rehabilitation of the physically handicapped
has become one of the most vital problems of
the present time. The enormous acceleration of
modern industry with its accidents is responsible
for disabling of large numbers of workers. Each
day traffic accidents, disease, congential deformity
and recently the war add their toll. — E. M. Fine-
silver, M. D., Conn. State Med. Jour., Feb., 1950.
334
The Ohio State Medical Journal
Case Report of Tetanus*
DOROTHY STANNARD ALT.EN, M. D.
The Author
• Dr. Allen, Lawrence, Kansas, is a graduate
of University of Wisconsin Medical School,
1948; and at present is associated with Dr.
Marc Lamy in Grenoble, France.
THIS is the case of a 58-year-old male who
entered Mercy Hospital, Janesville, Wiscon-
sin, in a wheelchair on September 20, 1947.
His chief complaint was “stiffness of the right
leg.” Five days prior to his admission, the pa-
tient developed a sore throat and a swelling in
the right gluteal region. At that time he had
the sensation of muscles contracting in the neck,
back, thighs, and legs. Two days prior to ad-
mission the patient noted increasing difficulty
in opening his jaws and swallowing. In addition
he felt pain in the posterior neck muscles. On
the day of admission, there was soreness in
the thoracic spinal muscles as well as in the
posterior neck. He had had no fever and had
lost his appetite. He was able to walk but
rather haltingly because of stiffness in his right
hip. Sitting or changing position was difficult.
His past medical history included the usual
childhood diseases. He alleged addiction to
morphine for the past 32 years and had used
morphine in doses of six grains daily for a
number of years. This is on record in the of-
fice of the Federal Narcotic Agent. The pa-
tient confessed that when he first began using
the drug, he cleaned his hypodermic needles in
alcohol, but through the years he became care-
less and dispensed with sanitary precaution.
The patient is married and before his illness
came in contact daily in his work with soil.
His family history was negative.
He was a stocky, debilitated male who ap-
peared his stated age of 58 and was in acute
distress. He was apprehensive and agitated.
His speech was labored but he was able to swal-
low. Tissue turgor was poor. There were multi-
ple hypodermic scars on the lateral surfaces of
the right and left thighs and along the brachial
veins of both arms. Some of the recent sites
of injection showed pyogenic infection. Pupils
were small and contracted and extra-ocular
movements were normal. On retinal examination
there was no edema of the discs. The jaws
opened only slightly and the pharynx was not
visualized. The neck was stiff on attempted
active or passive flexion. The lungs were clear
and heart tones were distant. The spine was
hyperextended. The cremasteric reflex was posi-
tive. Superficial abdominal reflexes absent.
Flexion ancf abduction of the right hip were
limited with muscle spasm of the right thigh.
The knee jerk on the right was three plus and
on the left, two plus. The achilles jerk was
unsatisfactory on both right and left. Ankle
clonus was positive on the left and the Babinski
* This case report is published both because of the les-
son it teaches and in the belief that we should stimulate
clinical contributions from interns, residents, and the younger
practitioners.
was questionably positive on the right. The
rest of the physical examination was negative.
PROGRESS NOTES
Beginning on September 20, 1947, the progress
notes show that at first the patient was isolated
because he was suspected of having poliomyelitis.
Morphine was administered — four doses of two
grains each in the first twenty-four hours, to-
gether with ten grains of aspirin every three
hours around the clock, and 40,000 units of peni-
cillin every three hours.
Second day: the residence, Dr. Nuzum, made
a tentative diagnosis of tetanus. The sensitivity
tests for serum allergy were negative and 61,500
units of antitoxin serum was given intramuscu-
larly.
Third day: Jaws became rigid and the pa-
tient was unable to talk and could swallow water
with the greatest difficulty. Treatment: Tetanus
antitoxin 20,000 units every four hours. Amigen
1,000 cc. intravenously followed by 1,000 cc.
of five per cent glucose in saline. Paraldehyde
6 cc. intramuscularly. Aspirin stopped.
Fourth day: Jaws are set and thighs stiff.
Involuntary urination and defecation. Respira-
tion is irregular and of Cheyne Stokes variety.
Tongue blade and pharyngeal airway inserted
and suction used to keep it clear. Back arched
three times and several convulsions lasted 20
minutes each. Treatment same. By far, the
worst day.
Fifth day: Four generalized convulsions during
the day. Muscle spasms fewer and less severe.
Able to open jaws and neck less rigid. Penicillin
stopped. Antitoxin ordered.
Sixth day: Delirious at times. Swallowing still
impossible. Tetanus alum-precipitated toxoid
1 cc. intradermally ordered.* Antitoxin reduced
to 10,000 units daily.
Seventh day: Definitely improved; coughing,
wheezing and expectorating clear mucus. Sodium
Amytal grains three by mouth as the nurse sees
fit. Toxoid repeated.
Clinical Progress after September 27, 1947 :
Definite uphill progress. Patient went on a soft
diet of cereals, bananas, etc. Sedations continued.
Occasional purposeless movements of the legs,
and, a few generalized convulsions until Octo-
ber 8, after which, there were no more convul-
sions or spasms. He slept for increasingly longer
periods. Adrenalin and calamine lotion were
given for a urticaria which developed on the hip
and buttocks on October 2. Tetanus antitoxin
stopped September 28. The patient displays in-
creasing irrationality — he often states that he
* The purpose of this was to stimulate active immunity,
but the question might well be raised, in the face of the
fairly large and frequent doses of antitoxin, was not this
toxoid also being neutralized by the antitoxin ?
for April, 1950
335
isn’t sick and claims that the hospital is holding
him — he insists on going to Beloit, Wisconsin.
He worries frequently and expresses morbid fear
of being left alone in his room. He was allowed
up in a chair and was given bathroom privileges.
After a hospital stay of 49 days he was dis-
charged November 8, 1947, in an improved anr
bulatory condition. The final diagnosis by the
attending physician. Dr. 0. V. Overton, was
tetanus and morphine addiction. The patient
was discharged on a daily dosage of morphine
of 6 grains. This is the same amount which he
had been alloted by the Federal Narcotic agent
before the admission of the patient to the hos-
pital.
Totaling of Units of Antitoxin Used:
Sept.
21—
61,500
U.
Sept.
22—
100,000
U.
Sept.
23—
100,000
U.
Sept.
24—
60,000
U.
Sept.
25—
20,000
U.
Sept.
26—
30,000
U.
Sept.
27—
10,000
U.
381,500
U.
COMMENTS
This case is of marked interest because of the
patient’s complicating morphinism added to the
rare appearance of tetanus.* It was impossible
in this instance to determine the incubation
period since the addict exhibited multiple scars
and abscesses due to repeated infections. These
scars were distributed over anterior skin sur-
faces to which the patient had access for the
narcotic was self-injected. According to his
own admission, and in keeping with an addict’s
fundamental personality defect, he soon became
lax in observance of sterile hypodermic technic.
This, together with his daylong work in the
fertilized soil of a greenhouse and nursery, af-
forded an ideal milieu for the contraction of
tetanus. But it cannot be proved whether
tetanus spores contaminated his needle and skin
or whether spores were dusted into the many
neglected and secondarily infected skin abscesses
around the needle punctures.
But one thing is certain, the patient was not
seen by a doctor until five days after the onset
of the first symptoms which were: A sensation
of muscles contracting in the neck, back, thighs,
and legs; a deep, painful swelling in the right
gluteal region, and a sore throat. Two days be-
fore he sought medical aid, he developed dif-
ficulty in opening his jaws and in swallowing,
pain in the posterior neck and thoracic spinal
muscles and stiffness of the right hip joint.
A working diagnosis was reached fairly
promptly within sixteen hours after the patient’s
admission to the hospital. Since the patient was
brought into the hospital during the waning of
* A review of the journal literature compiled by the
Index Medicus from the years 1908 through and including
1946 disclosed only one listing of a case report of tetanus
in a morphine addict per se, and that article was in a
German journal of psychiatry (1930). Swerbejew, N. T.. :
Tetanus in a Morphine Addict, Case. Archives fur Psy-
chiatrie. 90 :590-594, 1930.
the season of poliomyelitis, the consideration
of that disease was in the foreground for the
first sixteen hours before the working diagnosis
of tetanus was assumed. That explains the at-
tempted but unsuccessful spinal tap and also the
enforced isolation of the patient which was
salubrious in view of the final diagnosis of
tetanus.
The general condition of the patient when he
came to the hospital was poor. He was weak,
dehydrated, apprehensive, and could not walk
for any distance because of acute muscle pain
which persisted also at rest. On his third hos-
pital day he developed generalized convulsions
which did not disappear entirely until his
seventeenth hospital day. Acute respiratory
embarrassment did not appear until the fourth
day in the hospital. The patient had an elevated
fever which remained at 100 degrees or above
for nineteen days and ranged from 98 to 103
degrees F. The highest recorded leucocytosis
of 14,350 occurred on September 29, 1947.*
No attempt at isolation of the tetanus bacillus
was made. Since there were probably upward of
forty scars and infected needle punctures, it
would have been an uncertain task of sampling
pus from the wound or wounds which gave rise
to bacilli. Fildes pointed out that for successful
isolation, tissue of the wound should be excised
and placed in a tube of meat infusion. He
considered material taken on swabs or pipets
to be unsatisfactory.
The early management, the writer believes to
have been sufficient, insofar as 61,500 units of
tetanus antitoxin were given intramuscularly on
the second hospital day. Sedatives and ample
intravenous fluids were prescribed, oral nourish-
ment being encouraged throughout. The com-
plication of morphine addiction had to be handled
early. He received 6 grains of morphine daily,
the same amount that he had consumed before
his illness. In addition to morphine he received
the following sedatives to reduce his response
to stimuli; paraldehyde, sodium amytal, aspirin,
and phenobarbital.
It is believed that the completeness of the
patient’s recovery testifies in this particular case
to the adequacy of the treatment. Fairly heroic
doses of antitoxin were given totaling 381,500
units over a period of seven days. Although
he ran a stormy course, there were no complica-
tions of tetanus nor residual paralysis.
The discharge of the patient raised the ques-
tion of sending him to a hospital specialized in
the care of narcotic addicts for withdrawal ther-
apy. However, evaluation of the patient’s age,
his confirmed addiction, and lack of inclination
to be treated rated him as a poor risk for a
successful cure without relapse; therefore, he
was dismissed to his home.
* While several urinalyses and blood counts along with
blood Wassermann were taken, all were negative and, there-
fore, not relevant to the discussion.
336
The Ohio State Medical Journal
The Clinical Use of the Thematic Apperception Test
J. M. WITTENBROOK, M. D., R. T. SID WELL, M. A., A. J. KANDIK, M. A.
IN the diagnosis and treatment of emotional
disorders and other mental disturbances a
great variety of tests are used. The most
important of these are the various personality
tests. Personality tests consist of two main
types, the atomistic and the global. The atom-
istic test attempts to evaluate single properties
of personality while the global test gives a
more general picture of the personality and is
for that reason a much more useful test. The
global test is the more useful test because it
allows greater projection by the individual. By
this is meant that the social-stimulus situation
is sufficiently ambiguous to allow the person to
interpret the material in light of his own psy-
chological structure. We know that simple per-
ception is not the result of purely physiological
functioning of brain and eye, but perception is
actually “conditioned” by the emotional make-up,
needs, and drives of the individual. A recent
publication by Jerome Bruner and Cecile C.
Goodman4 at Harvard University gives in the
bibliography some 36 references to other work
on perception which nicely demonstrates that the
perceiving subject’s response to an object-
stimulus is conditioned by the conflicts, motives,
attitudes and strivings of the individual.
Probably the best known “projective technique”
is the Rorschach Test. In this test ten cards
with both chromatic and achromatic ink blots
are presented to the patient and he is asked
to give his impression of each card. With this
test we are more concerned with discovering
the structural or formal aspects of personality.
The Thematic Apperception Test is a convenient
adjunct to the Rorschach in that it is structured
to exhibit what might be called the “content
analysis” of personality; the particular strivings,
attitudes, and motives of the person which have
been developed in the course of individual experi-
ence. The Thematic Apperception Test is analo-
gous to a picture of personality while the
Rorschach is analogous to an X-ray of the per-
sonality.
THE TEST
The Thematic Apperception Test requires the
patient to develop a story around the picture
visually presented to him. The task is delineated
to one form of response-verbal communication
of a story about the picture which is recordable.
This necessary structurization of the situation
makes comparison of interpersonal relationships
Presented before the Section on Nervous and Mental
Diseases at the Annual Meeting of the Ohio State Medical
Association, Columbus, April 21, 1949.
The Authors
• Dr. Wittenbrook, Cleveland, Ohio, is a
graduate of Western Reserve University School
of Medicine, 1936; member, American Psy-
chiatric Association; instructor in psychiatry.
Graduate School of Nursing, Western Reserve
University; and instructor in psychology, Fenn
College, Cleveland.
• Mr. Sidwell, Cleveland, Ohio, received his
M.A. in Psychology from Western Reserve
University in 1949; and is chief psychologist
at Children’s Aid Society, Cleveland,
• Mr. Kandik, Cleveland, received his M.A.
in Psychology from Western Reserve University
in 1949; and worked on the paper while a
student psychologist at Children’s Aid Society,
Cleveland.
easier and also is supportive to the patient in
that the presence of the picture facilitates his
efforts at production. The aim of this test then
is to confront the individual with a number of
stimulus situations analogous to situations which
may occur in everyday life, and thereby deter-
mine his mode of approach to these situations.
His mode of approach, of course, is determined
by his personality make-up and his vicarious
identification with figures in the cards and what
happens to them give valuable indices of his
own dynamics.
We see, then, that the test is based on the
well-recognized psychologic principle that a
person will interpret an ambiguous social situa-
tion in light of his own personality make-up,
thereby exposing his personality indirectly in
analyzing the phenomenon to which he is at-
tending. In his attempt to explain what seems
an objective occurrence he becomes naively less
conscious of himself and of the scrutiny of the
examiner and thereby less defensively vigilant.
To an examiner psychologically or psychiatrically
oriented interpretation of the double meanings
of wrhat he is saying, discloses many inner
fears, tendencies, wishes, and strivings of the
patient. This is often referred to as the dynamic
content of the story. By this we mean the human
situations and human motives the patient has
expressed which were prompted by the stories.
The revised form of the Thematic Appercep-
tion Test (TAT) which is now commonly used,
is composed of 29 pictures and one blank card.
for April, 1950
337
There is one series of ten cards common to
both sexes and two series of ten cards used
with either male or female patients. The
clinician trained in the use of projective tech-
niques quickly finds, however, that no sharp
delineation by sex is necessary and will prob-
ably devise a battery of ten or more cards which
he finds most efficacious to the type of patient he
most commonly treats. As we have already noted
the test enables the patient to either identify
with or make general identifications of the
figures presented and thereby reveal his idea-
tional contents and attitudes relevant to that
area of ideation. Thus we see there are pic-
tures commonly referring to aggression, danger,
fear, sexuality, suicide, and parent-child relation-
ships. With the adolescent and child, omission
is usually made of those pictures, for example,
that have a more obvious sexual connotation.
The number of stories to be obtained may be
shortened if one is satisfied that the number
of stories already obtained is conclusive, but the
practice of shortening or limiting the series
may be dangerous in that unsuspected con-
flicts may not be elicited and an over-
simplification of the dynamics of the case may
result. It is, therefore, inadvisable to use only
those cards on which the examiner expects —
on the basis of previous knowledge about the
patient — to obtain decisive ideational content be-
cause, first, the most conclusive material may be
given on cards least suspected to reveal this
material, and secondly, the configuration and
form of the narratives elicited on the various
cards may give us a baseline by which to
evaluate unusually brief, elaborate, or other dis-
proportionate stories.
INSTRUCTIONS
There is no formal or stylized instruction for
the test. The important point is that the pa-
tient understand what is expected of him, and,
therefore, the instruction becomes only as elabo-
rate as necessary for understanding on the
part of the patient. A sample of an instruction
given might be as follows: “I am going to
show you a series of pictures and I want you to
make up a story around each one. I want you
to tell me what the situation is in the picture,
what the events were that led up to it, and
what the outcome will be. Describe the thoughts
and feelings of the characters. I want a plot
not an elaborate story. I shall write what you
say as you go along.” For the blank card
additional instruction is necessary, and one might
say this: “For this card, I want you to imagine
a picture, describe it to me, and then tell me
a story about it as you have done for the
other cards.” Good rapport with the patient
is desirable, but good stories may be obtained
as long as the patient is not showing active
distaste or negativism toward the test situation.
Actually, the test is used in many instances as
a means of establishing better rapport with the
patient and the time consumed in establishment
of rapport is reduced. This particular point will
be elaborated on later in the paper.
ADMINISTRATION
The test may be administered in one or two
sessions. It is usually not advisable to give
more than ten or twelve cards in one session
as there is a certain fatigue element which
enters in at this point. Many methods of record-
ing the TAT protocols have been devised, some
quite elaborate, but the two methods which
seem most profitable are manual recording by
the examiner or some type of tape or wire
recording machine. Most clinicians do not have
the physical arrangement of office space or the
availability of stenographic help whereby a
stenographer may sit behind a screen and take
down the stories given as recommended by
Murray. The obvious limitations of longhand
recording by the examiner are that the patient
must be slowed down in presentation of the
story (which gives him greater intellectual con-
trol than in a more spontaneous situation),
and it makes it most difficult to observe the
patient during administration as the examiner
is too busy getting the material down. Machine
recording seems to be better as the testing can
be more spontaneous and on playback voice in-
flection and obvious pauses and blockings can
be detected. Again, there is a disadvantage to
this recording method in that the material must
be transcribed for evaluation, and a verbatim
record may not be necessary and may be too
time-consuming. Further, actual “mike fright”
is sometimes encountered when the means of
recording is made too obvious. One should devise
some means, however, despite the method of
recording used, to take additional behavior notes.
This is most revealing at times when correlated
with known case history material and story
content presented.
All stories are timed and a total time and a
reaction time are obtained for each story. This is
helpful from the standpoint of giving valuable
leads as the amount of “shock” or delay en-
countered by emotion-arousing pictures and their
particular significance for that individual.
The test is composed of the actual administra-
tion of the picture cards and recording of pro-
tocols and an inquiry. There are two ways in
which the inquiry of the stories elicited may be
made. The examiner can make an inquiry while
the patient is telling the story or right after
he has finished telling it to learn more of the
dynamics of the story. Secondly, the inquiry
can be saved until all the protocols are obtained
and then return to those stories about which
338
The Ohio State Medical Journal
he desires more information. It is also valuable
in the final inquiry to ask the source of each
of the patient’s stories, whether he got them
from life, books, or movies.
The role of the examiner while the patient
tells the story is essentially neutral. The ex-
aminer must indicate to the patient that he is
interested in everything said, but must not show
or express his own feelings over the material
elicited from the patient.
INTERPRETATION
Because the problem of interpretation of the
TAT has not been satisfactorily solved, one
finds a diversity of methods of interpretation
utilized. These methods differ with various
clinicians according to their own requirements
and experience. Classically, interpretation has
been divided into formal and content analysis
of the protocols obtained. Most clinicians
devise some method which is an incorporation
or combination of these two approaches. Prob-
ably, the most widely publicized method is
that developed by Murray and Morgan, the test
creators, and their co-workers at Harvard Uni-
versity. Their content analysis determines the
major themes of each story and from these
they ascertain the important needs, presses and
attitudes of the patient. Morgan and Murray
define the theme as the dynamic structure or
plot of the story. These themes usually dem-
onstrate the psychological pressures affecting
the patient and indicate the needs which are the
directional tensions in the patient’s behavior. San-
ford used the exhaustive analysis approach, which
avoids seeking major themes of each story and
concentrates on the sentence by sentence and
phrase by phrase analysis of the needs and
presses. The most common method, however, of
content analysis utilizes the major theme without
employing a strict objective method and listing of
needs and presses. Commonly, we study the char-
acters with whom the patient identifies and the
many and various situations built around these
characters from which the examiner infers the
strivings of the patient and his attitudes and
areas of conflict. The formal analysis usually
consists of an analysis of the patient’s approach
to the test situation, the amount of “shock” or
blocking produced by various cards (as indicated
by reaction and total story time), the structuriza-
tion, style, predominate mood, and the adequacy
of his perception.
ADVANTAGES AND DISADVANTAGES
The advantages and the disadvantages of the
test are many, but the writers feel that the
following are probably the more important in
light of having worked with the test over a
period of time. The TAT itself does not give
any material that could not be obtained by
other methods but does obtain it in a more effici-
ent manner. The fact that the material may be
obtained by other means such as several months
of treatment interviews, permits us to check the
accuracy of the test. The greatest advantage
of the test is that it gives important informa-
tion about the personality of the patient in one
or at the most two interviews. The time saved
by this method, therefore, permits the clinician
to do therapy more effectively and more eco-
nomically. There is the further advantage that
the test indicates not only the nature of the
conflict but also the probable origin of it. The
greatest disadvantage of the test is that it is
a verbal test. Children who do not express
themselves well in language or adults who tend
to be uncommunicative do not produce stories
which are suitable for interpretation. A further
disadvantage is that the test requires that inter-
pretation be made by an experienced or sophisti-
cated clinician, otherwise the inexperienced
clinician might possibly project his own subjec-
tive feelings into the interpretation.
USE IN DIAGNOSIS
With adults we are able to make a dynamic
diagnosis based on knowledge of his psychopath-
ology rather than a purely descriptive one. It
also affords us an opportunity to obtain mental
content from those who have reason to conceal
their thinking. Two examples of such a use
may be seen in the intelligent paranoid and the
adult delinquent. Further, it can be likened to
a laboratory procedure which can be used to
check a clinical opinion.
It has been found, however, that the great-
est use of the test has been in child psychiatry.
This is to be expected since the child seldom
comes for a diagnostic evaluation of his own
volition. He is often frightened and is afraid
that what he may say may be held against him
and be the cause of punishment. This is especially
true of the delinquent child who is obviously
aware that the evaluation of his condition will
determine what will be done with him. Many
children, not delinquents, are fearful of adults
and will refuse to answer ordinary questions
but will enter into a situation showing some
characteristic of a game. It is nearly always
necessary to have the type of information this
test gives in making recommendations for treat-
ment. It is obvious in the delinquent child that
one must learn as much as possible about the
child in a very short time and to be able to
use the information in determining where the
child will be placed and what type of treatment
he should have. Where we are dealing with the
emotionally disturbed child we have a somewhat
different situation. It is necessary to decide the
seriousness of his disturbance and the need for
further observation and care. In many instances
for April, 1950
339
the child’s emotional upset is comparatively mild
and is secondary to that of the parents. In
such a case the parents would be reassured to
relieve their anxiety or the treatment would be
concentrated on them. If the child shows a
considerable amount of disturbance, the test re-
sults can be used to plan the length and depth
of the treatment. In the more severe cases the
results may indicate a need for resident therapy
away from the home.
USE IN THERAPY
The Thematic Apperception Test can be a
means of establishing rapport. It provides the
patient with a formal means of entering into
conversation with the therapist in the early
stages of his treatment when he still feels some
reluctance to discuss his problem. The test is a
more desirable method of establishing rapport
than casual conversation because it simulta-
neously obtains material directly relating to the
patient’s problem.
As a therapeutic procedure the test is useful
in uncovering unconscious material. A patient is
neurotic in part because of the emotionally trau-
matic situations he has experienced. Many of
these situations have been apparently forgotten
but have in reality been repressed into the un-
conscious mind. In the unconscious mind they
remain active influencing the patient’s feeling,
thinking and perception. If through the use of
this test we can bring these repressed memories
from the unconscious to the conscious mind, the
patient can then deal with them in an adequate
and realistic manner so that his behavior becomes
appropriate to the situation and ceases to be
neurotic.
In spite of the fact that the patient may
present himself for treatment, travel some dis-
tance for treatment, and personally meet the
cost of the treatment, we cannot assume that
there is a willingness to be treated. The pa-
tient may wish for a relief from the discomfort
of his neurosis but still be unwilling to change.
It is desirable to be able to assess this attitude
in advance and be prepared to meet it. Card 12
which shows a young man on a couch with an-
other man leaning over him is particularly
useful for this purpose.
The test also provides a simple means of
mental catharsis for the patient who is reluctant
to discuss his conscious thoughts because of em-
barrassment or concern over the therapist’s
possible attitude to his thoughts once they are
revealed. These thoughts can be presented in
an “as if” or third person form which simulta-
neously permits ventilation of the problem and
a testing of the therapist’s attitudes by the
patient. Once the patient feels safe in revealing
his hidden thoughts to the therapist he can then
abandon pretext and present remaining material
in a more open fashion. The authors have seen
material revealed by the test which in other
patients with other forms of therapy required a
year to obtain.
There are various therapeutic situations in
which for various reasons prolonged or deep
therapy is not desirable. Often this results from
time limitation placed on therapy by the patient
himself. By using information obtained from the
TAT we can determine the patient’s more urgent
problems. These can at times be improved by em-
ploying suggestion, explanation and reassurance.
These methods, of course, have their limitations
but may afford sufficient relief to justify their
use. The test is of further use in this type
of therapy by giving us a clear indication of the
seriousness of the problem so that we may know
if we are justified in using a shortened therapy.
SUMMARY
This paper dealt with a projective technique
known as the Thematic Apperception Test. This
test presents a series of pictures to the examinee
who then is asked to tell a brief story about
each picture. It is most useful in bringing to
light what might be called the content of per-
sonality, the particular conflicts, strivings, and
attitudes which have been developed in the
course of individual experience. The test is
based upon the well-recognized principle that
when a person interprets an ambiguous social
situation he is apt to expose his own personality
as much as the phenomenon to which he is
attending.
The TAT has been found useful in any com-
prehensive study of personality, and in the
diagnosis of behavior disorders, psychosomatic
illnesses, neuroses and psychoses. The technique
is especially recommended as a preface to a
series of psychotherapeutic interviews or to a
short psychoanalysis.
BIBLIOGRAPHY
1. Tomkins, S. The Thematic Apperception Test: Tech-
nique of Interpretation, New York, Grune & Stratton,
1947.
2. Rapaport, D. Diagnostic Psychological Testing, Vol.
II. Chicago: Yearbook Publishers, 1946.
3. Stein, M. I. The Thematic Apperception Test. Cam-
bridge: Addison-Wesley Press, 1948.
4. Bruner, J. S., Goodman, Cecile C. : Value and Need
as Organizing Factors in Perception, Jrnl. of Abnormal
and Social Psychology, 42, 1, 1947, p. 33-44.
Dihydrogenated Alkaloids of Ergot
The dihydrogenated ergot alkaloids appear to
act by adrenergic blockade resulting in a reduc-
tion of sympathetic tone with relaxation of the
vessel wall. Regardless of the mode of action,
an enlarged peripheral arterial and capillary
bed was demonstrated in many of the patients
showing favorable clinical response. The peri-
pheral vessels in a normal individual are in a
constant state of vasoconstriction necessary for
the maintenance of body temperature. — Popkin,
Calif. Medicine, Feb., 1950.
340
The Ohio State Medical Journal
James E. Bauman’s Service to the State of Ohio
ROBERT G. PATERSON, Ph.D.
PART II
(Concluded from March Issue)
WHEN I first met Jim it was a “time of
trouble,” to use Arnold Toynbee’s phrase,
for Dr. Probst, Jim and the State Board
of Health. While the temptation is urgent to be-
come caustic about this “time of trouble” I believe
it best to use the temperate and kindly language
of Dr. Probst who wrote about it some twenty-
five years after it occurred. He says:
“I must not say too much as to why I left,
but some explanation is due my friends
who may see this. From the creation of
the State Board of Health, in 1886, to the
time of my resignation in 1911, politics had
never been considered except, perhaps, in
the selection of some of its members. After
their appointment it was never mentioned.
I was given a free hand in the selection
of its growing personnel but I always asked
the Board’s approval before heads of de-
partments and their chief assistants were
appointed. I made the appointments as the
Board agreed that I would have better con-
trol of the employees if they knew they
owed their position to me. This was all
changed in 1911. An executive committee
of two was appointed in that year. Without
warning, nine positions were vacated, in-
cluding the head of the laboratory. (The
head of the Engineering Department re-
signed in disgust.) These vacancies were
filled by the executive committee.
“My removal was sought by this com-
mittee by asking an opinion of the At-
torney-General as to whether I was an of-
ficer or an employee of the State. The
Constitution of the State provided that an
officer of the State must serve for a definite
term. I had been appointed to serve during
my good behavior and to be dismissed for
cause only, and after a hearing. The At-
torney-General, Mr. Timothy Hogan, a good
friend, who knew the ins and outs of all
this, declared that I was an employee; and
further, that political affiliations (I was a
Republican, the administration was Democra-
tic) would not be considered a cause for re-
moval.
“At a meeting of the Board on August 10,
1911, at Toledo, unexpected by any member
of the Board, except my dear old friend
Mr. Hartzel, I handed in my resignation to
be effective on the first of the following
October. On that date my wife and I left
for Vienna where, after a month in Davos,
the greatest tuberculosis center in the world,
I spent four months in postgraduate work.”
The Greeks had a word for describing such
a situation but unfortunately I cannot use it
here!
At the time Dr. Probst resigned, his salary
was $3,000 per annum; the annual appropria-
tion was $45,182; and the personnel had in-
creased to twenty-four, about equally divided
between technical and clerical employees.
NAMED ACTING SECRETARY
Caught unaware, the State Board of Health
appointed Jim as acting secretary and began
looking around for a successor to Dr. Probst.
This maneuver was to be repeated five additional
times in Jim’s long career. Jim served in this
capacity for a period of nine months. Then Dr.
E. F. McCampbell was appointed secretary on
January 17, 1912, but did not begin his service
until June 1, 1912. At the January meeting
Jim was appointed assistant secretary.
Dr. McCampbell came from Marysville, had
studied and taught bacteriology at The Ohio
State University and received both his Bachelor
of Science (1906) and Ph.D. (1910) at the Uni-
versity of Chicago and his M. D. degree from
Rush Medical College in 1912. He was thirty-
two years of age when he came to the State
Board of Health. Dr. McCampbell was dy-
namic, realistic and had little reverence for the
traditions that had been developing during
Dr. Probst’s regime.
Again Jim had a “time of trouble” in ad-
for April, 1950
341
justing1 himself to the constant changes that
were put into effect by Dr. McCampbell. It
was a time of expansion and the pace was quite
rapid. Bill Groeniger came in as State In-
spector of plumbing on February 19, 1911; Frank
G. Boudreau was appointed epidemiologist on
July 1, 1911; and Bill Dittoe was appointed chief
engineer December 1, 1911.
i DIVISIONS NEEDED
By 1912, the staff had expanded to such a
size that a more definite organization into
divisions was desirable. Accordingly there were
set up divisions of administration of which Jim
was the chief; engineering, hygiene, laboratories,
communicable diseases and plumbing inspection.
This year also saw the convening of the fourth
Ohio Constitutional Convention that kept the
people of the State in a constant ferment over
the debates that went on concerning the 340
proposals made during the period from January
9 to June 7, 1912.
James M. Cox, of Dayton, was elected Governor
of Ohio in 1912 and took office in January, 1913.
The Ohio Society for the Prevention of Tuber-
culosis had worked out a program in 1912 that
called for an appropriation by the General As-
sembly of $25,000 a year for the establishment
of a Division of Tuberculosis in the State Board
of Health.
When the proposal was put before him,
Governor Cox, who was a man of decisive char-
acter, agreed in less than ten minutes to urge
the General Assembly to make the necessary
appropriation. From March 23 to 27, 1913, oc-
curred the great flood in Ohio and large emer-
gency appropriations by the state had to be made
to meet the disaster. In spite of this Governor
Cox only reduced the amount for tuberculosis
work from $25,000 to $20,000 per annum for the
biennium, which passed the General Assembly.
On May 1, 1913, the Executive Secretary of
the Ohio Society for the Prevention of Tubercu-
losis was loaned to the State Board of Health
to organize the newly created Division of
Tuberculosis. On May 15, 1913, Emery R. Hay-
hurst was brought into the Board to head the
newly created Division of Industrial Hygiene and
on October 1, 1915, Dr. Francis M. Hollingshead
was appointed chief of the Division of Hygiene.
Growth in personnel and program continued
until Dr. McCampbell resigned May 1, 1916, to
become Dean of the Medical College of the Ohio
State University. Again Jim was made acting
secretary and on February 22, 1917, he became
secretary of the Board. In the interim James
M. Cox was elected Governor for the second
time and a law was passed with his whole-
hearted approval abolishing the Ohio State
Board of Health and transferring its powers
and duties to a State Department of Health con-
sisting of a Public Health Council of four mem-
bers and a Commissioner of Health. The four
members of the Council were appointed by the
Governor for staggered terms, the first of whom
was Dr. Charles O. Probst who served until his
death. Thus were the old ties between Jim and
Dr. Probst restored. The Commissioner of
Health was appointed by the Council for a
term of five years. After the passage of this
act Jim was appointed to act as temporary secre-
tary until a Commissioner of Health could be
appointed.
PERIOD III. 1917-1921
Dr. Allen W. Freeman, of Cincinnati, was ap-
pointed Commissioner of Health August 28, 1917,
and assumed office October 1, 1917. On that date
Dr. Freeman appointed Jim as Deputy Com-
missioner. Dr. Freeman was thirty-six years
of age and held an M. D. from Johns Hopkins
University and practically all his professional
life had been spent in public health work. At
the time of his appointment he was epidemiologist
with the United States Public Health Service
stationed at Cincinnati.
Dr. Freeman has written about some of his
experiences, among others, as Commissioner of
Health of Ohio in his book entitled ‘‘Five Mil-
lion Patients — The Professional Life of a Health
Officer” published in 1946. This is what he has
to say about the organization when he took
charge:
“The organization which the Commissioner
found in operation was far better than he
had hoped. The last secretary of the old
board had evidently been a good judge of
men and had made his appointments without
political interference. He had been out of
office a full year when the new law took
effect on July 1, 1917, and since his resigna-
tion the work of the department had been
carried on by Mr. Bauman who served as
acting secretary.
“Mr. Bauman was unique. He had come
into the department many years before as
a junior clerk and had later taken a degree
in law and qualified for the bar without in-
terrupting his work in the department.
Through the thirty years of his service he
had come to be the stabilizing personality of
the organization, who had carried on during
all the changes that had taken place. His
knowledge of the state and its government
was amazing.
“The technical staff of the department in-
cluded an unusual proportion of men of
ability, though some of the best were already
in military service and others were pre-
paring to follow them. The subordinate
staff had been appointed under Civil Service
procedures and was also of a quality above
the average.
“The department’s program was good.
The State had been a pioneer in the con-
trol of water supplies and the prevention of
stream pollution, and the engineering di-
vision was probably the best in the country.
342
The Ohio State Medical Journal
The rest of the organization was fully
abreast of the time and in some things well
in advance.”
HUGHES-GRISWOLD ACT
While it was recognized that the weak link
in the health organization of Ohio was in the
local areas and several attempts were made to
provide corrective legislation, nothing happened
until the devastating epidemic of influenza swept
through the United States in 1918-19. The
township and village health organization in
Ohio collapsed completely. Governor Cox was
still the dominant figure in the State and was
quick to sense the need for a reorganization of
the local health machinery. The present Hughes-
Griswold Act of 1919-20 was passed. It abolished
all township and village boards of health and
created two main types of organization — (1)
General health districts comprising all the ter-
ritory in a county outside of municipalities;
and (2) city health districts comprising popu-
lations of 5,000 or more. As a result of this
legislation the number of local health authorities
was reduced from 2,150 to 88 general and 80
city health districts, each with a board of health
and each required to employ a health com-
missioner.
In January, 1921, the bureau of local health
organization was established in the division of
communicable diseases and in 1925 it was trans-
ferred to the division of administration of which
Jim was chief. At long last Ohio was on its
way toward meeting a fundamental problem that
had been troubling the State Board of Health
since 1886.
I believe I am right in saying that with the
advent of Dr. Freeman, Jim entered into a
period of four years of happy service, comparable
with those he enjoyed under Dr. Probst. It
was a welcome relief after the six years of
stress and strain through which he had gone.
He and Allen Freeman worked together as a
good team.
PERIOD IV. 1921-1949
In 1921, Harry L. Davis of Cleveland was
elected Governor of Ohio, and one of his plat-
form pledges was a reorganization of the State
Government. The bill to - accomplish this be-
came known as the Administrative Code and
was patterned after the Federal plan of organ-
ization to provide departments, with the heads
of departments constituting the Governor’s
Cabinet.
The main changes in the organization of the
State Department of Health were: (1) The of-
ficial title was changed to “Department of
Health”; (2) the Commissioner of Health was
replaced by a Director of Health to be ap-
pointed by the Governor and to serve at his
pleasure; (3) the authority to create divisions
was given to the Director, subject to the ap-
proval of the Governor; (4) the Director of
Health was designated as chairman of the Pub-
lic Health Council; (5) The Bureau of Vital
Statistics was transferred to the Department of
Health from the Secretary of State’s office and
was designated the “division of vital statistics.”
Everyone interested in public health in Ohio
protested against the change, insisting that the
health department was not and should not be in
politics and that the bill would inevitably make
the director of health a political official.
FREEMAN RESIGNS
Dr. Freeman, being a Virginia Democrat andf
sensing that Republican Governor Davis had
absolute control of the government, decided to
accept an offer from Johns Hopkins to become
Resident Lecturer in Public Health Administra-
tion in the School of Hygiene and Public Health.
He resigned June 10, 1921, effective June 30,
1921. Then in quick succession as Director of
Health were:
Dr. Harry H. Snively, appointed in 1921.
Dr. John E. Monger, appointed in 1923.
Dr. Charles A. Neal, appointed in 1929.
Dr. H. G. Southard, appointed in 1931.
Dr. Walter H. Hartung, appointed in 1935.
Dr. Roll H. Markwith, appointed in 1939.
James E. Bauman, acting Director of Health,
1944-5.
Dr. Roger Heering, appointed in 1945.
James E. Bauman, acting Director of Health,
June 1, 1947, to August 1, 1947.
Dr. John D. Porterfield, appointed August 1,
1947.
No relaxation of the protests against this situ-
ation was permitted throughout the terms of the
various Governors — Donahey, Cooper, White, and
Davey — but to no avail.
In 1935, Martin L. Davey, of Kent, a Democrat,
became Governor of Ohio. He appointed Dr.
Walter H. Hartung, of Toledo, as Director of
Health and it was not long before Governor
Davey began his pressure to oust Jim from the
Department. Jim was listed as a Republican.
Dr. Hartung knowing how valuable Jim was to
the work, resisted this pressure until it became
a question who should go — Jim or Dr. Hartung.
At this point Jim resigned and secured a posi-
tion in the Engineering Department of Franklin
County.
RESTORED TO POSITION
In 1939 John W. Bricker of Columbus, a Repub-
lican, was elected Governor and he was thoroughly
informed about the situation, having served as
Counsel to the Ohio Public Health Association
since 1929. He appointed Dr. Roll H. Markwith,
of Akron, as Director of Health but insisted that
Jim should be restored to his former position in
the Department. This was done in March, 1939.
In May of 1939 with the cordial support and
backing of Governor Bricker, an act was passed
by the General Assembly whereby the Public
Health Council was increased from four to six
members and the Director of Health was to be
for April, 1950
343
appointed by the Governor for a term of five
years from a list of six names submitted to the
Governor by the Public Health Council.
Upon the re-election of Governor Bricker in
1944, he appointed Dr. Roger E. Heering as
Director of Health. Like Freeman before him,
Dr. Heering was a member of the United States
Public Health Service staff and well versed in pub-
lice health administration. When Dr. Heering re-
signed in 1947 to enter the private practice of
medicine in Columbus, Governor Herbert ap-
pointed another trained United States Public
Health Service man as Director of Health —
Dr. John D. Porterfield.
RETIREMENT
*
Jim retired on June 30, 1949, after 57 years
of service to the people of Ohio. Happily he
is still among us in good health and spirits after
all the buffeting he has weathered in the De-
partment. As one reads the record one is con-
scious of the fact that the early history of the
public health movement in Ohio is well recorded.
In 1915 the General Assembly decreed that de-
partmental reports were no longer to be pub-
lished by each department. After that date the
State published a volume called “Ohio General
Statistics” which was thought to furnish all
the information the public required and thus the
State of Ohio could save money. But this ven-
ture never met the needs of those who were in-
terested in the details of a particular department.
In 1929 Dr. C. A. Neal, with the approval of
Governor Cooper, had prepared a volume that
covered the period from 1915 to 1929. Since
1929 we have no published reports so that there
is an hiatus in the record of twenty years. It
appears vital to some of us interested in the
historical aspects of the public health movement
in Ohio that this gap be filled up as soon as
possible. We would urge Dr. Porterfield and the
Public Health Council to lay plans for such an
undertaking and to make use of Jim’s amazing
knowledge of the work.
I close this brief and inadequate recounting
of Jim’s life work with a thought from Shake-
speare’s Othello:
“I have done the state some service and they
know’t.”
Gallia County History
After reading the “History of Medicine in
Gallia County” in the February issue of
The Journal, a member wrote: “No history of
the county is complete without the mention of
Captain John N. Carnes, U. S. Army, killed in
service while based at Hawaii in 1943. John,
a graduate of Ohio State, 1940, was one of the
best loved young men in the community and,
to my knowledge, the only Gallia County physi-
cian who lost his life in service.”
Dr. James Craven Wood 1859-1948
At the time of the division of the Cleveland
Homeopathetic College in 1890, the new “Cleve-
land Medical College” could not find anyone to
fill the professorship of Gynecology still held by
Dr. Biggar in the old college. After a nation-
wide search for the right man, Dr. J. C. Wood
who taught the subject for eight years at the
University of Michigan was chosen. He came
to Cleveland in 1894 where he rounded out thirty-
two years of teaching in medical colleges. It
was natural that these two leaders should be
rivals — and they were. Each was outstanding
among scores of other homeopathic leaders in
Cleveland in the last century who were equally
great and who also served, but these men were
especially prominent and beloved by their stu-
dents and patients.
Dr. Wood found in Dr. Biggar a strong
antagonist and rival. But the . Huron Road group
grew tired of the fray and accepted Dr. Biggar’s
resignation after four or five years, upon which
the two colleges reunited under the name of the
Cleveland Homeopathic Medical College, which
graduated its first class in 1898.
Dr. Wood was born of fine family stock
near Bowling Green, Ohio, in 1859. His father
was General Henry L. Wood, a prosperous farmer
of Wood County and his son had the industrious
outlook of a farm boy. He graduated at Ohio
Wesleyan University, taught country school, went
to business college, and graduated in the home-
opathic department of the University of Michigan
at Ann Arbor.
Dr. Wood was a man of notable qualities;
great refinement and culture with a splendid edu-
cation and an attractive personality. He was a
man of rare judgment, a writer of note, a
nationally known and highly regarded surgeon
and gynecologist and a tower of strength to
the Cleveland homeopathic hospital and college.
When Dr. Biggar resigned, the two colleges
united, and Dr. Wood was in sole charge of
gynecology in the College and in Huron Road
Hospital.
Among his many achievements in the medical
world were presidency of the American Institute
of Homeopathy in 1902, fellowship in the Ameri-
can Association, founding membership in the
American College of Surgeons and membership
on its board of governors for twenty years,
membership in the International Congress of
Gynecology and Obstetrics and presidency of the
Belgian session in 1892, and past presidency of
the Michigan and the Ohio Homeopathic Medical
Societies.
After a brilliant career in medicine and sur-
gery spanning sixty-nine years, he passed away
in August, 1948, at the age of ninety with his
mind unimpaired. — Lucy S. Hertzog, M. D.,
Chardon, Ohio.
344
The Ohio State Medical Journal
1950 ANNUAL MEETING
OHIO STATE MEDICAL ASSOCIATION
CLEVELAND
- May 16, 17, and 18, 1950 =:
ON this and the following pages will be found detailed information on the program
and schedule of events for the 1950 Annual Meeting of the Ohio State Medical
Association. This year’s is a streamlined calendar, concentrated to give doctors
the best in postgraduate sessions within conservative time limits.
TIME AND PLACE: Tuesday, Wednesday and Thursday, May 16, 17 and 18,
1950. Note that the new streamlined time schedule calls for the scientific program
to begin at 1 p. m., Tuesday, and end at 3 :45 p. m. on Thursday. Scientific programs
and exhibits will be in the Cleveland Public Auditorium, only a short walk from
downtown hotels. The House of Delegates will meet in
the Hotel Cleveland — the first session Tuesday begin-
ning at 10 a. m. Specialty groups will meet as an-
nounced in the following pages.
REGISTRATION : Registration Headquarters will
be in the Main Entrance Lobby of the Cleveland Pub-
lic Auditorium — open from 8 a. m. to 6 p. m. on Tues-
day and Wednesday and from 8 a. m. to 4 p. m. on
Thursday. There is no registration charge. Admis-
sion to all sessions will be by badge secured at Regis-
tration Headquarters. Those eligible to register are:
Members of the Ohio State Medical Association (who
should have 1950 Membership Cards for presentation
at time of registration) ; physicians from other states who are members of their respec-
tive state medical societies ; residents, interns, medical students, nurses, health workers,
and others who are presented at Registration Headquarters by members. The Woman’s
for April, 1950
345
Auxiliary will provide registration facilities for its members and others eligible for
membership.
SCIENTIFIC SESSIONS : All scientific, clinical and instructional sessions sched-
uled by the Ohio State Medical Association will be held in the Cleveland Public Audi-
torium. For the General Sessions, scientific programs are being sponsored by the
Specialty Sections to the interest of physicians in all branches
of medicine. See detailed program in the following pages for
exact place and time. Some specialty societies will hold ses-
sions as listed in the detailed program.
HOUSE OF DELEGATES : Two sessions of the House
of Delegates will be held, both in the Hotel Cleveland. The
first session will be on Tuesday, May 16, beginning at 10 a. m.
and followed by luncheon. The second session is scheduled
for Thursday, May 18, beginning with a luncheon at 12 noon.
MEDICAL TOPICS OF THE DAY: Six of these panel
discussion sessions will be held — three on Tuesday and three
on Wednesday, from 1 to 2 :30 p. m. Doctors will have a
choice of attending any one of the three sessions on two
successive days. These programs are conducted on a slightly
more formal basis than the Instructional Courses, but get away from the scientific
paper presentation procedure. See Tuesday and Wednesday schedules for details.
INSTRUCTIONAL COURSES: Fourteen of these informal discussion sessions
have been scheduled. They are especially designed to provide members with practical in-
struction on handling of clinical problems aris-
ing in everyday practice — especially in the
general practice of medicine. Procedure fol-
lows the line of panel discussions, with ques-
tions from the audience playing a large part
in the formal presentations.
A review of the detailed program in the fol-
lowing pages will convince members that out-
standing clinicians in their respective fields have
been selected as moderators and discussants.
Attendance to the Instructional Courses
will be by tickets only. Experience during previous meetings has shown that these
courses are very popular, while seating capacity necessarily is limited. Those who plan
to attend, therefore, should apply for tickets in advance of the meeting.
A special folder on the Instructional
Courses and other Annual Meeting events will
be mailed to each member in the near future.
This folder should be read carefully because it
will give information on how to secure Instruc-
tional Course tickets. There is no charge for
the tickets; the procedure is for the purpose
of making reservations only.
The discussions will be held during three
separate periods so that a doctor may sched-
ule three complete Instructional Courses.
The first of the series will be held from
9 to 10:30 a. m. on Wednesday, May 17. The second series will be from 9 to 10 :30 a.m.
on Thursday, May 18, and the third series from 10 :30 a. m. to 12 noon on Thursday.
346
The Ohio State Medical journal
See Wednesday and Thursday programs on the following pages for topics, discussants
and other details.
SPECIALTY SOCIETIES: Several societies of medical specialists have an-
nounced programs during the Annual Meeting of the Ohio State Medical Association.
These include: Ohio Academy of General Practice, annual meeting, Tuesday, May 16,
7:30 p. m., Hotel Cleveland; Cleveland Society of Neurology and Psychiatry, social
hour for members of Section on Nervous and Mental Diseases of the Ohio State
Medical Association, Tuesday, May 16, 5 p. m., Hollenden Hotel; Ohio State Radiological
Society, annual meeting, Wednesday, May 17, 9 a. m., Statler Hotel; and the Ohio
Chapter, American College of Chest Physicians, annual meeting, noon luncheon,
Wednesday, May 17, Hotel Statler. See following pages for details.
NATIONAL AFFAIRS: Two outstanding guest speakers are scheduled to
appear on the program for the purpose of discussing national affairs. The Hon-
orable Robert A. Taft of Ohio, member of the U. S. Senate, will talk on pending
legislative proposals and vital national problems. Dr. George F. Lull, Chicago,
secretary and general manager of the American Medical Association, will discuss
the National Educational Program and other activities of the A. M. A. They will
speak at a general session on Wednesday morning, May 17.
SCIENTIFIC EXHIBITS: These educational features will emphasize the latest
developments in medical research and investigation. Displayed studies will offer mem-
bers an opportunity to discuss results with persons directly responsible for their develop-
ment. Recess periods throughout the session will give members ample time to browse
through these exhibits and study those in which they
may be specially interested. The exhibits will be in
the Main Floor Arena of the Public Auditorium.
TECHNICAL EXHIBITS : These commercial dis-
plays offer opportunity for doctors to view the latest
developments in pharmaceutical products, surgical in-
struments, therapeutic equipment and the like with re-
spective promoters. Technical as well as scientific ex-
hibits will be in the Main Arena. Ample time will be
provided between sessions for inspecting this feature.
Physicians always find that commercial projects add considerable to the educational
material displayed at the Annual Meeting.
AUXILIARY : The Woman’s Auxiliary of the Ohio
State Medical Association will hold its annual meeting
concurrently with the Annual Meeting of the Association.
Auxiliary meetings will be held in the Hotel Cleveland.
Detailed program will be found elsewhere in this issue.
ANNUAL BANQUET: This main social function
of the Annual Meeting will be held on Wednesday evening,
May 17, on the Mezzanine Floor of the Hotel Cleveland.
The banquet will be followed by an evening of entertain-
ment and dancing. No formal program. Because this
primarily is a social function, a nominal fee of $5.50
each will be charged those who wish to attend. To in-
sure reservations, tickets should be ordered in advance of the meeting. Instructions
for making reservations will be contained in the special folder which will be mailed
to each member.
for April, 1950
347
1950— ANNUAL
OHIO STATE MEDICAL ASSOCIATION
TUESDAY, MAY 16
TIME
10:00 A. M.
to
12:00 Noon
HOUSE OF DELEGATES BUSINESS SESSION AND
1:00 P. M.
to
2:30 P.M.
MEDICAL TOPICS OF THE DAY
RISK FACTORS IN ANESTHESIA
Room B — North Wing
Third Floor
R. J. WHITACRE, M. D.
East Cleveland, Moderator
( See following pages for details)
NEPHRITIS AND NEPHROSIS
Room A — South Wing
Second Floor
J. M. HAYMAN, JR., M. D.
Cleveland, Moderator
(See following pages for details)
2:30 P.M.
to
3:00 P. Ml
RECESS FOR VISITING THE EXHIBITS
3:00 P. Ml
to
3:45 P. M.
PSYCHIATRY IN GENERAL PRACTICE
MAURICE LEVINE, M. D.
Cincinnati
3:55 P. M.
to
4:25 P. M.
PRESENT-DAY PRACTICE IN OBSTETRIC ANALGESIA
GEORGE J. ANDROS, M. D.
Ann Arbor, Mich.
4:25 P. M.
to
4:55 P. M.
MODERN CONCEPTS OF ANESTHETIC MANAGEMENT FOR
GYNECOLOGICAL AND OBSTETRICAL PATIENTS
RALPH M. TOVELL, M. D.
Hartford, Conn.
4:55 P.M.
to
5:25 P. M.
RESUSCITATION OF THE NEWBORN
J. J. JACOBY, M. D.
Columbus
348
The Ohio State Medical Journal
I
MEETING— 1950
CLEVELAND PUBLIC AUDITORIUM
TUESDAY, MAY 16
LUNCHEON, BALLROOM, MEZZANINE FLOOR, HOTEL CLEVELAND
|
MEDICAL TOPICS OF THE DAY
NEUROSES AND EARLY PSYCHOSES IN GENERAL PRACTICE
Ballroom — North Wing — Fourth Floor
CALVIN L. BAKER, M. D.
Columbus, Moderator
( See following pages for details)
F »
RECESS FOR VISITING THE EXHIBITS
\
GENERAL SESSION
BALLROOM, NORTH WING, FOURTH FLOOR
for April, 1950
34S>
1950 — ANNUAL
OHIO STATE MEDICAL ASSOCIATION
WEDNESDAY, MAY 17
TIME
9:00 A. M.
to
10:30 A. M.
Instructional Course 1
Ballroom — North Wing
. Fourth Floor
TREATMENT OF HEART
DISEASE
A. CARLTON ERNSTENE, M. D.
Cleveland, Moderator
( See following pages for details)
Instructional Course 2
Room C — South Wing
Fourth Floor
OFFICE ANESTHESIA
k. c. McCarthy, m. d.
Toledo, Moderator
(See following pages for details)
9:00 A. M.
to
12:00 Noon
ANNUAL MEETING OF THE OHIO STATE RADIOLOGICAL SOCIETY,
10:30 A. M.
to
12:00 Noon
THE HONORABLE ROBERT A. TAFT, of Ohio, Member of the United States Senate
and
GEORGE F. LULL, M. D., Chicago, 111., Secretary and General Manager of the
American Medical Association
1 :00 P. M.
to
2:30 P. M.
MEDICAL TOPICS OF THE DAY
CONVULSIVE DISORDERS: RECOGNITION AND TREATMENT
Room A — South Wing — Second Floor
MAX T. SCHNITKER, M. D.
Toledo, Moderator
(See following pages for details)
2:30 P. M.
to
3:00 P.M.
RECESS FOR VISITING THE EXHIBITS
3:00 P.M.
to
3:15 P.M.
DIABETIC KETOSIS
CECIL STRIKER, M. D
Cincinnati
3:15 P M.
to
3:30 P. Mi.
URINARY BLADDER EMERGENCIES
EUGENE A. OCKULY, M. D.
Toledo
3:30 P.M.
to
3:45 P.M.
IMMEDIATE MANAGEMENT OF HEAD INJURIES
JOSEPH P. EVANS, M. D.
Cincinnati
3:55 P. M.
to
4:40 P. M.
FULL SCALE X-RAY CHEST EXAMINATIONS
FRED J. HODGES, M. D.
Ann Arbor, Mich.
4:45 P. M.
to
5:30 P. M.
METABOLIC EFFECTS IN MAN OF ACTH AND CORTISONE (COMPOUND E)
JEROME W. CONN, M. D
Ann Arbor, Mich.
7:30 P. M.
ANNUAL BANQUET, BALLROOM,
350
The Ohio State Medical Journal
MEETING— 1950
CLEVELAND PUBLIC AUDITORIUM
WEDNESDAY, MAY 17
Instructional Course 3
Room B — South Wing
Third Floor
BLOOD TRANSFUSIONS
HORACE B. DAVIDSON, M. D.
Columbus, Moderator
(See following pages for details)
Instructional Course 4
Room A — South Wing
Second Floor
DRUG THERAPY IN THE AGED
JOSEPH I. GOODMAN, M. D.
Cleveland, Moderator
(See following pages for details)
Instructional Course 5
Room B — North Wing
Third Floor
DIAGNOSIS AND TREATMENT
OF THE INFERTILE COUPLE
ALLAN C. BARNES, M. D.
Columbus, Moderator
(See folloiving pages for details)
EUCLID ROOM, STATLER HOTEL, FOLLOWED BY LUNCHEON IN PINE ROOM
GENERAL SESSION
BALLROOM, NORTH WING, FOURTH FLOOR
MEDICAL TOPICS OF THE DAY
PERIPHERAL VASCULAR DISORDERS
Room B — South Wing
Third Floor
WILLIAM D. HOLDEN, M. D.
Cleveland, Moderator
(See following pages for details)
RETROPERITONEAL TUMORS
Room C — South Wing
Fourth Floor
WILLIAM J. ENGEL, M. D.
Cleveland, Moderator
(See following pages for details)
RECESS FOR VISITING THE EXHIBITS
<
>
GENERAL SESSION
BALLROOM, NORTH WING, FOURTH FLOOR
MEZZANINE FLOOR, HOTEL CLEVELAND
for April, 1950
351
1950— ANNUAL
OHIO STATE MEDICAL ASSOCIATION
THURSDAY, MAY 18
TIME
9:00 A. M.
to
10:30 A. M.
Instructional Course 6
Room B — South Wing-
Third Floor
OSTEOPOROSIS AND OTHER
DISEASES OF BONE
CHARLES A. DOAN, M. D.
Columbus
(See following pages for details)
Instructional Course 7
Ballroom — North Wing
Fourth Floor
POLIOMYELITIS
JAMES G. KRAMER, M. D.
Akron
(See following pages for details)
10:30 A. M.
to
12:00 Noon
Instructional Course 11
Room B — South Wing
Third Floor
PEDIATRIC ROENTGENOLOGIC
DIAGNOSIS
FREDERIC N. SILVERMAN, M.D.
Cincinnati
(See following pages for details)
Instructional Course 12
Room A — South Wing
Second Floor
INJURIES TO THE CHEST,
ABDOMEN AND SPINE
DONALD M. GLOVER, M. D.
Cleveland
(See following pages for details)
12:00 Noon
LUNCHEON AND BUSINESS SESSION OF HOUSE OF
1:30 P. M.
to
1:50 P.M.
PREVENTION AND TREATMENT OF DEAFNESS IN CHILDREN
HARRY C. ROSENBERGER, M. D.
Cleveland
1:50 P.M.
to
2:10 P. M.
EARLY RECOGNITION OF VISUAL DEFECTS IN CHILDREN
LORAND V. JOHNSON, M. D.
Cleveland
2:15 P. Ml
to
3:00 P. M.
THE PRIMARY TUBERCULOUS COMPLEX: SOME CLINICAL AND
ROENTGENOGRAPHIC FEATURES
JOHN CAFFEY, M.D.
New York
3:00 P.M.
to
3:45 P. M.
REVIEW OF ACUTE UPPER RESPIRATORY DISEASES
JOHN H. DINGLE, M. D.
Cleveland
352 The Ohio State Medical Journal
MEETING— 1950
CLEVELAND PUBLIC AUDITORIUM
THURSDAY, MAY 18
Instructional Course 8
Instructional Course 9
Instructional Course 10
Room A — South Wing
Second Floor
Room C — South Wing
Fourth Floor
Room B — North Wing
Third Floor
PROLONGED LABOR
CARE OF THE NEWBORN
AND PREMATURE
ANTIBIOTICS
RICHARD D. BRYANT, M. D.
Cincinnati
CHARLES F. McKHANN, M. D.
Cleveland
MAURICE A. SCHNITKER, M. D.
Toledo
(See following pages for details)
(See following pages for details)
(See following pages for details)
Instructional Course 13
Ballroom — North Wing
Fourth Floor
UNDERSTANDING AND TREATING THE
ALCOHOLIC
CHARLES W. HARDING, M. D.
Columbus
(See following pages for details)
Instructional Course 14
Room C — South Wing
Fourth Floor
EMERGENCIES IN EYE, EAR, NOSE
AND THROAT
CLAUDE S. PERRY, M. D.
Columbus
(See folloiving pages for details)
DELEGATES, BALLROOM, MEZZANINE FLOOR, HOTEL CLEVELAND
<
GENERAL SESSION
BALLROOM, NORTH WING, FOURTH FLOOR
for April, 1950
353
TUESDAY, MAY 16
10:00 A. M.-— 12:00 Noon
HOUSE OF DELEGATES
FIRST BUSINESS SESSION AND LUNCHEON FOR
MEMBERS OF THE HOUSE OF DELEGATES
Ballroom, Mezzanine Floor, Hotel Cleveland
TUESDAY, MAY 16
1:00 to 2:30 P. M.
Cleveland Public Auditorium
MEDICAL TOPICS OF THE DAY
RISK FACTORS IN ANESTHESIA
C. L. BAKER, M. D,
MAURICE LEVINE, M.D.
Room B, North Wing, Third Floor
Moderator: R. J. Whitacre, M. D., East Cleve-
land, Director, Department of Anesthe-
siology, Huron Road Hospital, East Cleve-
land.
Panel Discussants:
The Anesthetist: Skill, Experience and
Equipment — Ralph M. Tovell, M. D., Hart-
ford, Conn.
Medical Conditions Influencing Anesthesia —
D. E. Hale, M. D., Cleveland.
Emergencies of Anesthesia — A. J. Fisher,
M. D., Youngstown.
NEPHRITIS AND NEPHROSIS
Room A, South Wing, Second Floor
Moderator: J. M. Hayman, Jr., M. D., Cleve-
land, Professor of Medicine, Western Reserve
University School of Medicine.
Panel Discussants: Max Miller, M. D., Arthur
C. Corcoran, M. D., Cleveland; Frederick S.
Coombs, M. £>., Youngstown; Albert A. Brust,
M. D., Cincinnati; George I. Nelson, M. D.,
Columbus.
NEUROSES AND EARLY PSYCHOSES IN GENERAL
PRACTICE
Ballroom, North Wing, Fourth Floor
Moderator: Calvin L. Baker, M. D., Columbus,
Commissioner of Mental Hygiene, Ohio De-
partment of Public Welfare.
Panel Discussants: Clyde B. Simson, M. D.,
Dayton; Thomas E. Rardin, M. D., Columbus;
Howard D. Fabing, M. D., Cincinnati; A. V.
Black, M. D., Centerville.
2:30 to 3:00
RECESS FOR VISITING THE EXHIBITS
R. J. WHITACRE, M. D. & J. M. HAYMAN, JR. M.,D.
TUESDAY, MAY 16
3:00 P. M.
GENERAL SESSION
Ballroom, North Wing, Fourth Floor
Public Auditorium
3:00 to 3:45
The following address is sponsored by the
Section on Nervous and Mental Diseases.
PSYCHIATRY IN GENERAL PRACTICE
Maurice Levine, M. D., Cincinnati, Professor
of Psychiatry, University of Cincinnati Col-
lege of Medicine.
G. J. ANDROS, M. D. R. M. TOVELL, M. D.
3:45 to 3:55
RECESS
3:55 P.M.
The following three addresses are jointly
sponsored by the Section on Obstetrics and Gyne-
cology and the Section on Anesthesiology.
3:55 to 4:25
PRESENT-DAY PRACTICE IN OBSTETRIC ANALGESIA
George J. Andros, M. D., Ann Arbor',’ Mich.,
Assistant Professor of Obstetrics and Gyne-
cology, University of Michigan Medical
School.
4:25 to 4:55
MODERN CONCEPTS OF ANESTHETIC MANAGEMENT
FOR GYNECOLOGICAL AND OBSTETRICAL PATIENTS
Ralph M. Tovell, M. D., Hartford, Conn., Lec-
turer in Anesthesia, Yale University School
of Medicine, New Haven.
354
The Ohio State Medical Journal
4:55 to 5:25
RESUSCITATION OF THE NEWBORN
J. J. Jacoby, M. D., Columbus, Associate Pro-
fessor of Surgery, Ohio State University
College of Medicine.
WEDNESDAY, MAY 1 7
9:00 to 10:30 A. M.
Cleveland Public Auditorium
INSTRUCTIONAL COURSES
(Admission by Ticket Only)
i. TREATMENT OF HEART DISEASE
Ballroom, North Wing, Fourth Floor
Moderator: A. Carlton Ernstene, M. D., Cleve-
land, Chief of Staff, Division of Medicine,
Cleveland Clinic.
Panel Discussants:
Congestive Heart Failure — John W. Martin,
M. D., Cleveland.
Angina Pectoris — Johnson McGuire, M. D.,
Cincinnati.
Acute Myocardial Infarction — R. W. Scott,
M. D., Cleveland.
Cardiac Arrhythmias — R. K. Bartholomew,
M. D., Dayton.
Ohio Academy of General Practice
To Hold Annual Meeting
The Annual Meeting of the Ohio Academy
of General Practice will be held at the
Hotel Cleveland, Tuesday, May 16, at 7 :30
p. m. This will be a business meeting at
which the nomination and election of state
officers and state Board of Directors from
the even numbered districts will take place;
voting of new proposed amendments to the
Constitution and By-Laws will be accom-
plished; report of all Committee Chair-
men, and installation of the President-
Elect and the newly elected officers. All
members are urged and requested to be
present.
2. OFFICE ANESTHESIA
Room C, South Wing, Fourth Floor
Moderator: K. C. McCarthy, M. D., Toledo, Di-
rector of Anesthesiology, Maumee Valley
Hospital.
Panel Discussants: A. S. Gardiner, M. D., Cin-
cinnati; D. H. Goodman, M. D., Cleveland;
Leo Weiss, M. D., Toledo.
3. BLOOD TRANSFUSIONS
Room B, South Wing, Third Floor
Moderator: Horace B. Davidson, M. D., Colum-
bus, Assistant Professor of Pathology, Ohio
State University College of Medicine.
Panel Discussants: Paul Hoxworth, M. D., Cin-
cinnati; Robert Daly, M. D., C. J. DeLor,
A. C. ERNSTENE, M. D.
k. c. McCarthy, m. d.
H. B. DAVIDSON, M. D. J. I. GOODMAN, M. D.
M. D., John P. Garvin, M. D., Warren E.
Wheeler, M. D., Columbus.
4. DRUG THERAPY IN THE AGED
Room A, South Wing, Second Floor
Moderator: Joseph I. Goodman, M. D., Cleve-
land, Senior Clinical Instructor, Western Re-
serve University School of Medicine.
Panel Discussants:
Central Nervous System — Siegfried Bau-
moel, M. D., Cleveland.
Cardiovascular Drugs — Harold Feil, M. D.,
Cleveland.
Hormone Therapy in the Aged — Reginald
A. Shipley, M. D., Cleveland.
5. DIAGNOSIS AND
TREATMENT OF THE
INFERTILE COUPLE
Room B, North Wing,
Third Floor
Moderator: Allan C.
Barnes, M. D., Co-
lumbus, Chairman,
Department of Ob-
stetrics and Gyne-
cology, Ohio State
University College
of Medicine.
A. C. BARNES, M. D.
Panel Discussants:
George Wilcoxon,
M. D., Alliance; Wm. F. Forsythe, M. D.,
Cleveland; Irving Rothchild, Ph. D., Colum-
bus.
{or April, 1950
355
WEDNESDAY, MAY 1 7
9:00 A. M.
ANNUAL MEETING OF OHIO STATE
RADIOLOGICAL SOCIETY
Euclid Room, Statler Hotel
Edward L. Voke, M. D., Akron President
Arnold D. Piatt, M. D., Newark Vice-President
Edward C. Elsey, M. D., Cincinnati Secy.-Treas.
Members of Executive Committee:
Edward L. Voke, M. D., Akron
Arnold D. Piatt, M. D., Newark
Edward C. Elsey, M. D., Cincinnati
Donald D. Brannan, M. D., Cleveland
Huston F. Fulton, M. D., Columbus
9:00 to 10:00
RADIO-ACTIVE COBALT. INTERSTITIAL AND OTHER
METHODS FOR THE USE OF COBALT 60 (SIXTY) IN
CANCER THERAPY
Joseph L. Morton, M. D., Associate Professor of
Radiology, Ohio State University College of
Medicine, Columbus.
10:00 to 11:00
MASS SURVEY PROCEDURES IN RADIOLOGY
Fred J. Hodges, M. D., Professor of Radiology,
University of Michigan Medical School, Ann
Arbor, Mich.
11:00 to 12:00
RADIO-ACTIVE IODINE IN THE DIAGNOSIS AND
TREATMENT OF HYPERTHYROIDISM
Hymer L. Friedell, M. D., Professor of Radi-
ology, Western Reserve University School
of Medicine, Cleveland.
Reginald A. Shipley, M. D., Department of
Radiology.
John P. Storaasli, M. D., Department of Radi-
ology.
12:00 Noon
Pine Room, Statler Hotel
Business Luncheon Meeting for Members of the
Ohio State Radiological Society
THE HON. R. A. TAFT G. F. LULL, M. D.
M. T. SCHNITKER, M. D. W. D. HOLDEN, M. D.
12:00 Noon
LUNCHEON
CORRELATED BRONCHOGRAMS IN TUBERCULOSIS
Maurice G. Buckles, M. D., Columbus.
WEDNESDAY, MAY 1 7
1:00 to 2:30 P. M.
MEDICAL TOPICS OF THE DAY
WEDNESDAY, MAY 1 7
10:30 A. M. to 12:00 Noon
GENERAL SESSION
Ballroom, North Wing, Fourth Floor
Public Auditorium
Address: The Honorable Robert A. Taft of Ohio,
Member of the United States Senate;
subject — “Progress in Medical Care.”
Address: George F. Lull, M. D., Chicago, 111., Sec-
retary and General Manager of the
American Medical Association.
WEDNESDAY, MAY 1 7
ANNUAL MEETING OF OHIO CHAPTER
AMERICAN COLLEGE OF CHEST
PHYSICIAINS
Hotel Statler
Karl P. Klassen, M. D., Columbus, President
E. F. Conlogue, M. D., Dayton, Secretary-
Treasurer
CONVULSIVE DISORDERS : RECOGNITION AND
TREATMENT
Room A, South Wing, Second Floor
Moderator: Max T. Schnitker, M. D., Toledo,
Chief, Department of Neurosurgery, St.
Vincent’s Hospital.
Panel Discussants: Howard Fabing, M. D., Cin-
Section on Nervous-Mental Diseases
Invited for Social Hour
Members of the Section on Nervous and
Mental Diseases of the Ohio State Medical
Association attending the Annual Meeting
are invited by the Cleveland Society of
Neurology and Psychiatry to attend a
cocktail party at 5 p. m., Tuesday, May 16,
at the Hollenden Hotel, East Sixth Street
and Superior Avenue.
356
The Ohio State Medical Journal
cinnati; Joseph L. Fetterman, M. D., Cleve-
land.
PERIPHERAL VASCULAR DISORDERS
Room B, South Wing, Third Floor
Moderator: William D. Holden, M. D., Cleve-
land, Associate Professor of Surgery, West-
ern Reserve University, School of Medicine.
Panel Discussants: Richard W. Zollinger, M. D.,
Columbus; Lawrence Peters, M. D., and
Lawrence Atlas, M. D., Cleveland.
RETROPERITONEAL TUMORS
Room C, South Wing, Fourth Floor
Moderator: William J. Engel, M. D., Cleve-
land, Urologist, Cleveland Clinic.
Panel Discussants: Fred Douglass, M. D.,
Toledo; Parke G. Smith, M. D., Cincinnati;
John B. Hazard, M. D., Cleveland; T. Leu-
cutia, M. D., Detroit, Mich.
2:30 to 3:00
RECESS FOR VISITING THE EXHIBITS
WEDNESDAY, MAY 1 7
3:00 P. M.
GENERAL SESSION
Ballroom, North Wing, Fourth Floor
Public Auditorium
The following three addresses are sponsored
by the Section on General Practice.
3:00 to 3:15
DIABETIC KETOSIS
Cecil Striker, M. D., Cincinnati, Senior At-
tending Physician, Jewish Hospital, Cincin-
nati.
3:15 to 3:30
URINARY BLADDER EMERGENCIES
Eugene A. Ockuly, M. D., Toledo, Department
of Urology, St. Vincent’s Hospital, Toledo.
W. J. ENGEL, M. D.
CECIL STRIKER, M. D.
E. A. OCKULY, M. D. J- P. EVANS, M. D.
4:45 to 5:30
The following address is sponsored by the Sec-
tion on Medicine.
METABOLIC EFFECTS IN MAN OF ACTH AND CORTI-
SONE (COMPOUND E)
Jerome W. Conn, M. D., Ann Arbor, Mich., As-
sociate Professor of Internal Medicine, Uni-
versity of Michigan Medical School.
WEDNESDAY, MAY 1 7
7:30 P.M.
3:30 to 3:45
ANNUAL BANQUET
IMMEDIATE management OF head injuries Ballroom, Mezzanine Floor, Hotel Cleveland
Joseph P. Evans, M. D., Cincinnati, Associate
Professor of Surgery, University of Cin-
cinnati College of Medicine, and Director of
the Division of Neurological Surgery.
3:45 to 3.55
RECESS
3:55 to 4:40
The following address is sponsored by the
Ohio State Radiological Society.
FULL SCALE X-RAY CHEST EXAMINATIONS
Fred J. Hodges, M. D., Ann Arbor, Mich., Pro-
fessor of Roentgenology and Chairman, De-
partment of Roentgenology, University of
Michigan Medical School.
4:40 to 4:45
MUSIC DANCING
ENTERTAINMENT
RECESS
J. W. CONN, M. D.
C. A. DOAN, M. D.
for April, 1950
357
THURSDAY, MAY 1 8
9:00 to 10:30 A. M.
Cleveland Public Auditorium
INSTRUCTIONAL COURSES
(Admission by Ticket Only)
6. OSTEOPOROSIS AND OTHER DISEASES OF BONE
Room B, South Wing, Third Floor
Moderator: Charles A. Doan, M. D., Columbus,
Dean, College of Medicine, Ohio State Uni-
versity.
Panel Discussants: Joseph L. Morton, M. D,,
Dept, of Radiology; George J. Hamwi, Dept,
of Medicine, and Hans G. Schlumberger,
Dept, of Pathology, all of Ohio State Uni-
versity, Columbus.
7. POLIOMYELITIS
Ballroom, North Wing, Fourth Floor
Moderator: James G. Kramer, M. D., Akron,
Pediatrician to Akron Children’s Hospital,
Akron City Hospital, and Summit County
Children’s Home.
Panel Discussants: Alex J. Steigman, M. D.,
New York, N. Y.; Robert Eiben, M. D., Cleve-
land; Walter M. Solomon, M. D., Cleveland;
and Albert L. Bershon, M. D., Toledo.
8. PROLONGED LABOR
Room A, South Wing, Second Floor
Moderator: Richard D. Bryant, M. D., Cincin-
nati, Assistant Professor, Department of
Obstetrics, University of Cincinnati College
of Medicine.
Panel Discussants: A. Hirsheimer, M. D., Day-
ton; N. E. Wentsler, M. D., Akron; Burdette
Wylie, M. D., Lakewood; Dean Sheldon, M. D.,
Sandusky.
9. CARE OF THE NEWBORN AND PREMATURE
Room C, South Wing, Fourth Floor
Moderator: Charles F. McKhann, M. D., Cleve-
land, Professor of Pediatrics, Western Re-
serve University School of Medicine.
Panel Discussants:
Prematurity— J. Victor Greenebaum, M. D.,
Cincinnati.
Resuscitation of the Newborn — Marion M.
Black, M. D., Cleveland.
Hemorrhage — Robert D. Mercer, M. D. Cleve-
land.
Infection— Samuel Spector, M. D., Cleveland.
10. ANTIBIOTICS
Room B, North Wing, Third Floor
Moderator: Maurice A. Schnitker, M. D.,
Toledo.
Panel Discussants: Charles H. Rammelkamp,
M. D., Cleveland; Norman W. Thiessen, M. D.,
Lakewood; John E. Brown, Jr., M. D., Co-
lumbus.
J. G. KRAMER, M. D.
R. D. BRYANT, M. D.
C. F. McKIIANN, M. D. M. A. SCHNITKER, M. D.
10:30 A. M. to 12:00 Noon
11. PEDIATRIC ROENTGENOLOGIC DIAGNOSIS
Room B, South Wing, Third Floor
Moderator: Frederic N. Silverman, M. D., Cin-
cinnati, Director, Department of Roentgen-
ology, Children’s Hospital.
Panel Discussants: Eugene L. Saenger, M. D.,
Cincinnati; James F. Martin, M. D., Cleve-
land; W. H. R. Howard, M. D., Columbus;
John Caffey, New York, N. Y.
12. INJURIES TO THE CHEST, ABDOMEN AND SPINE
Room A, South Wing, Second Floor
Moderator: Donald M. Glover, M. D., Cleve-
land, Associate Clinical Professor of Surgery,
Western Reserve University School of Medi-
cine.
F. N. SILVERMAN, M. D.
D. M. GLOVER, M. D.
358
The Ohio State Medical Journal
Panel Discussants: Edward Harlan Wilson,.
M. D., Columbus; William H. Falor, M. D.,
Akron; Vinton E. Siler, M. D., Cincinnati;
Stanley 0. Hoerr, M. D., Cleveland.
13. UNDERSTANDING AND TREATING THE ALCOHOLIC
Ballroom, North Wing, Fourth Floor
Moderator: Charles W. Harding, M. D., Co-
lumbus, Instructor, Neuropsychiatry Dept.,
Ohio State University and Clinical Consul-
tant, University Hospital, Columbus.
Panel Discussants: Philip Piker, M. D., Cin-
cinnati; Carl Wyler, M. D., Cincinnati; Ed-
ward 0. Harper, M. D., Cleveland; D. W.
Badal, M. D., Cleveland; and Charles L.
Anderson, Harding Sanitarium, Worthington.
14. EMERGENCIES IN EYE, EAR, NOSE, AND THROAT
Room C, South Wing, Fourth Floor
Moderator: Claude S. Perry, M. D., Columbus.
Panel Discussants: Albert L. Brown, M. D.,
Cincinnati; Charles I. Thomas, M. D., Cleve-
land; William H. Evans, M. D., Youngstown;
D. W. Brickley, Jr., M. D., Marion.
THURSDAY, MAY 1 8
12:00 Noon
HOUSE OF DELEGATES
LUNCHEON FOR MEMBERS OF THE HOUSE OF
DELEGATES AND FINAL BUSINESS SESSION
Ballroom, Mezzanine Floor, Hotel Cleveland
THURSDAY, MAY 1 8
1:30 P. M.
GENERAL SESSION
Ballroom, North Wing, Fourth Floor
Public Auditorium
The following two addresses are sponsored
by the Section on Eye, Ear, Nose and Throat.
1:30 to 1:50
PREVENTION AND TREATMENT OF DEAFNESS IN
CHILDREN
Harry C. Rosenberger, M. D., Cleveland, Senior
Visitant in Otolaryngology, St. Luke’s Hos-
pital, Cleveland.
1:50 to 2:10
EARLY RECOGNITION OF VISUAL DEFECTS IN CHIL-
DREN
Lorand V. Johnson, M. D., Cleveland, Associate
Professor of Ophthalmology, Western Re-
serve University School of Medicine.
2:10 to 2:15
RECESS
C. W. HARDING, M. D. C. S. PERRY, M. D.
H. C. ROSENBERGER, M.D. L. V. JOHNSON, M. D.
2:15 to 3:00
The following address is sponsored by the
Section on Pediatrics.
THE PRIMARY TUBERCULOUS COMPLEX: SOME
CLINICAL AND ROENTGENOGRAPHIC FEATURES
John Caffey, M. D., New York, N. Y., Profes-
sor of Clinical Pediatrics, College of Phy-
sicians and Surgeons, Columbia University.
3:00 to 3:45
The following address is sponsored by the Sec-
tion on Public Health and Preventive Medicine.
REVIEW OF ACUTE UPPER RESPIRATORY DISEASES
John H. Dingle, M. D., Cleveland, Professor of
Preventive Medicine and Associate Profes-
sor of Medicine, Western Reserve University
School of Medicine.
JOHN CAFFEY, M. D. J. H. DINGLE, M. D.
for April, 1950
359
?4wxid ‘J&at Tflwocte
Make Hotel Reservations Now
for the
1950 Annual Meeting
Ohio State Medical Association
Cleveland, Ohio . . . May 16, 17, 18
NAME AND LOCATION
SINGLE
DOUBLE
DOUBLE
TWIN BED
ALLERTON HOTEL, 1802 E. 13th St.
$3.50-6.50
$5.50-10.00
$6.00-10.00
AUDITORIUM HOTEL, 1315 E. Sixth St.
$3.50-3.75
$4.50-5.00
$5.50-6.00
$7.00
$7.50 and Up
CARTER HOTEL, PUBLIC SQUARE
$4.75-7.00
$7.00-10.00
$8.00-12.00
CLEVELAND HOTEL (Headquarters Hotel)
$4.50
$6.50-9.00
$9.00-14.00
HOLLENDEN HOTEL, 610 Superior Ave.
$3.50-8.00
$5.50-10.00
$7.00-14.00
OLMSTEAD HOTEL, Superior & E. Ninth
$3.00-6.00
$5.00-8.00
$7.00-9.50
$7.00-9.50
STATLER HOTEL, Euclid at E. 12th St.
$4.00-6.00
$7.00-10.00
$8.00-12.00
HOTEL RESERVATION BLANK
Mail the coupon to hotel selected
Manager Hotel, Cleveland, Ohio
You are requested to reserve the following accommodations during the period of the Annual Meeting
of the Ohio State Medical Association, May 16, 17, 18, 1950, or for such other period as may be
indicated herein.
□ Single Room with Bath □ Double Room with Bath Price
□ Twin Bed Room with Bath □ Suite
Arriving May at A. M. P. M.
PLEASE VERIFY MY RESERVATION
Name
Address
360
T he Ohio State Medical Journal
SCIENTIFIC AND EDUCATIONAL EXHIBITS
THE Scientific and Educational Exhibits in the Arena, Main Floor, Cleveland Public
Auditorium, will be open daily from 9:00 A. M. to 6:00 P. M. on Tuesday, May 16,
and Wednesday, May 17; and from 9:00 A. M. to 12:00 Noon on Thursday,
May 18.
TRANSLUMBAR ARTERIOGRAPHY
Parke G. Smith, M. D., T. W. Rush, M. D.,
and Arthur T. Evans, M. D., Division
of Urology, College of Medicine, Univer-
sity of Cincinnati.
TREATMENT OF COLLES’ FRACTURES
Joseph M. Strong, M. D., Elyria Memorial
Hospital and Gates Hospital for Crip-
pled Children, Elyria.
PULMONARY RESECTION IN TUBERCULOSIS
Maurice G. Buckles, M. D., and Wm. L.
Potts, M. D., Benjamin Franklin Hos-
pital, Department of Thoracic Surgery,
Ohio State University, Columbus.
AGNOSIA, APRAXIA, APHASIA
Robert E. Slemmer, M. D., College of Medi-
cine, University of Cincinnati; Thomas
Scott, M. D., Roy J. Secrest, M. D.,
Harry E. LeFever, M. D., Columbus;
Department of Anatomy, St. Mary’s
Hospital, Cincinnati; College of Medi-
cine, Ohio State University; Department
of Neurosurgery, White Cross Hospital,
Columbus.
FIRST TEN YEARS— CLEVELAND HEALTH MUSEUM
Bruno Gebhard, M. D., Director, Cleveland
Health Museum, Cleveland.
HEBERDEN’S NODES— OSTEOARTHRITIS OF
FINGER JOINTS
R. M. Stecher, M. D., Walter M. Solomon,
M. D., Ralph Wolpaw, M. D., Cleveland
City Hospital, Cleveland.
BONE TUMORS FOUND IN A SMALL HOSPITAL-
FIVE-YEAR PERIOD
M. C. Kolczun, M. D., D. A. Russell, M. D.,
R. D. Berkebile, M. D., Charles Chesner,
M. D., St. Joseph Hospital, Lorain.
TUMORS OF THE HEAD AND NECK
Clifford L. Kiehn, M. D., Donald M. Glover
M. D., Plastic Surgery Section, Depart-
ment of Surgery, School of Medicine,
Western Reserve University, Cleveland.
NASAL SINUSES
Fred W. Dixon, M. D., Department of
Otolaryngology, Western Reserve Uni-
versity, Cleveland.
CORONERS’ PROBLEMS
S. R. Gerber, M. D., Cleveland, Ohio State
Coroners’ Association.
THE TREATMENT OF ANEMIA
Charles S. Higley, M. D., Willard C.
Stoner, M. D., Richard G. Norby, M. D.,
St. Lukes Hospital, Cleveland.
FASCIA IN REPAIR OF HERNIAS
Robert C. Austin, M. D., and Eugene F.
Damstra, Dayton.
SPINAL ANESTHESIA
J. J. Jacoby, M. D., Ohio Society of Anes-
thetists, University Hospital, Columbus.
THE SURGICAL MANAGEMENT OF INTRATHOR-
ACIC ABNORMALITIES OF THE NEWBORN
Karl P. Klassen, M. D., Douglas R. Morton,
M. D., Department of Research Sur-
gery, Ohio State University, Columbus.
TUMORS OF THE LUNG: PATHOLOGICAL ASPECTS
AND BRONCHIAL SMEAR INTERPRETATION
John B. Hazard, M. D., Donald B. Effler,
M. D., Department of Pathology, Cleve-
land Clinic Hospital, Cleveland.
PATHOGENESIS OF ERYTHROBLASTOSIS FETALIS
Viola Startzman, M. D., Roger Marster,
Ph. D., Babies’ and Children’s Hospital,
MacDonald House of University Hospi-
tals, Cleveland. Benjamin Kline, Mount
Sinai Hospital, Cleveland.
FLUOROSCOPIC SPOT-FILM TECHNIQUE IN CHOLE-
CYSTOGRAPHY
Mortimer Lubert, M. D., George Krause,
M. D., Department of Radiology, Mount
Sinai Hospital, Cleveland.
BLOOD FACTOR IN ACUTE LUPUS ERYTHEMATOSUS __
John R. Haserick, M. D., Cleveland Clinic
Hospital, Cleveland.
PHYSICAL MEDICINE REHABILITATION
Bert A. Treister, M. D., U. S. Veterans Ad-
ministration Hospital, Brecksville.
OCCUPATIONAL LUNG DISEASE
James P. Hughes, M. D., Kettering Labor-
atory of Applied Physiology, University
of Cincinnati, College of Medicine, Cin-
cinnati, and Carroll C. Dundon, M. D.,
Department of Radiology, University
Hospitals of Cleveland.
PRECANCEROUS LESIONS AND CANCER OF THE
SKIN AND MUCOUS MEMBRANES
Harold N. Cole, Sr., M. D., James R.
Driver, M. D., Harold N. Cole, Jr., M. D.,
Department of Dermatology and Syphi-
lology, Western Reserve University,
School of Medicine, Cleveland.
STILL SPACE IN SCIENTIFIC EXHIBIT,
IF YOU HURRY
There still is space available in the
Scientific and Educational Exhibit at the
1950 Annual Meeting in Cleveland, May 16,
17 and 18.
Those having material suitable for
this exhibit should get in touch with Dr.
Charles L. Hudson, 2102 Abington Rd.,
Cleveland, chairman of the Committee on
Scientific and Educational Exhibit.
for April, 1950
361
TECHNICAL EXHIBITORS
ARENA, MAIN FLOOR, CLEVELAND PUBLIC AUDITORIUM
Open from 9:00 A. M. to 6:00 P. M. on Tuesday, May 16, and Wednesday, May 17;
and from 9:00 A. M. to 12:00 Noon on Thursday, May 18
Exhibitor Address Booth Number
Abbott Laboratories, North Chicago, 111 101
Aloe Company, A. S., St. Louis, Mo 57
Ames Company, Inc., Elkhart, Ind 16
Ayerst, McKenna & Harrison, Limited, New
York, N. Y 41
Baby Development Clinic, Chicago, 111 83
Baker Laboratories, Inc., The, Cleveland, Ohio 29
Beech-Nut Packing Co., Canajoharie, N. Y. 20
Borden Company, The, New York, N. Y 3
Bowman Bros. Drug Co., The, Canton, Ohio_76, 77
Burroughs Wellcome & Co. (U. S. A.) Inc.,
Tuckahoe, N. Y 43
Caldwell and Bloor Company, The, Mans-
field, Ohio 90
Camel Cigarettes, New York, N. Y 98, 99
Cameron Surgical Specialty Company, Chi-
cago, 111 .. 19
Camp & Company, S. H., Jackson, Mich 52
Carnation Company, Los Angeles, Cal 61
Ciba Pharmaceutical Products, Inc., Sum-
mit, N. J 60
Coca-Cola Company, The, Atlanta, Ga 87, 88
Columbus Hospital Supply Co., Columbus,
Ohio — ^ 75
Denver Chemical Mfg. Co., Inc., The, New
York, N. Y 50
Electro Medical Equipment Co., Cleveland,
Ohio 74
Endo Products, Inc., Richmond Hill, N. Y 36
Fischer & Co., H. G., Franklin Park, 111 65
Fleet Co., Inc., C. B., Lynchburg, Va 58
Garinger X-Ray Sales, Cleveland, Ohio 97
General Electric X-Ray Corporation, Cleve-
land, Ohio 71
Gerber Products Company, Fremont, Mich 13
Heinz Company, H. J., Pittsburgh, Pa 8
Holland-Rantos Company, Inc., New York,
N. Y 2
“Junket” Brand Foods, Little Falls, N. Y. 7
Kelley-Koett Manufacturing Co., The, Cov-
ington, Ky .. 25, 26
Kremers-Urban Co., Milwaukee, Wis 47
Lanteen Medical Laboratories, Inc., Evan-
ston, 111 38
Lea & Febiger, Philadelphia, Pa 46
Lederle Laboratories Division, American
Cyanamid Co., New York, N. Y 73
Liebel-Flarsheim Company, The, Cincinnati,
Ohio . 27/28
Lilly and Company, Eli, Indianapolis, Ind-— 48
M & R Dietetic Laboratories, Inc., Colum-
bus, Ohio 24
Massengill Company, S. E., The, Bristol,
Tenn. 64
Exhibitor Address Booth Number
Mead Johnson & Company, Evansville, Ind. 33
Medical Aids, Inc., Chicago, 111 40
Medical Protective Company, The, Fort
Wayne, Ind 42
Merrell Company, Wm. S., The, Cincinnati,
Ohio 59
Mosby Company, C. V., The, St. Louis, Mo. 10
Mueller & Company, V., Chicago, 111 68
Natenberg, Maurice, Chicago, 111 63
National Drug Co., The, Philadelphia, Pa. 5
Ohio Medical Indemnity, Inc., Columbus,
Ohio 89
Ortho Pharmaceutical Corporation, Raritan,
N. J 55
Parke, Davis & Company, Detroit, Mich 67
Pelton & Crane Company, The, Detroit,
Mich. ... 70
Pet Milk Company, St. Louis, Mo... 17, 18
Philip Morris & Co., Ltd., Inc., New York,
N. Y 54
Picker X-Ray Corporation, New York,
N. Y 44, 45
Safety First Supply Company, Pittsburgh,
Pa 39
Sanborn Company, Cambridge, Mass 14
Sandoz Chemical Works, Inc., Pharmaceuti-
cal Division, New York, N. Y 6
Saunders Company, W. B., Philadelphia, Pa. 49
Schenley Laboratories, Inc., New York, N. Y. 51
Schering Corporation, Bloomfield, N. J 72
Schuemann — Jones Co., The, Cleveland,
Ohio 102,103
Searle & Co., G. D., Chicago, 111 37
Sharp & Dohme, Inc., Philadelphia, Pa 53
Smith, Kline & French Laboratories, Phila-
delphia, Pa . 31
Squibb & Sons, E. R., New York, N. Y 9
Swift & Company, Chicago, 111 32
Testagar & Co., Inc., Detroit, Mich 4
U. S. Vitamin Corporation, New York, N. Y. 11
Upjohn Company, The, Kalamazoo, Mich. 30
Van Pelt & Brown, Inc., Richmond, Va 62
Warren-Teed Products Company, The, Co-
lumbus, Ohio 1
Wendt-Bristol Co., The, Columbus, Ohio 15
Westinghouse Electric Corporation, Pitts-
burgh, Pa 21, 22
White-Haines Optical Company, The, Co-
lumbus, Ohio 12
White Laboratories, Inc., Newark, N. J 23
Winthrop-Stearns, Inc., New York, N. Y — 34
Wocher & Son Company, Max, The, Cincin-
nati, Ohio 100
Wyeth, Incorporated, Philadelphia, Pa 56
362
The Ohio State Medical Journal
DELEGATES AND ALTERNATES
Counties
Delegates Alternates
FIRST DISTRICT
ADAMS S. J. Ellison
BROWN W. L. Faul
BUTLER Neil Millikin
C. T. Atkinson
CLERMONT J. M. Coleman
CLINTON E. K. Yantes
HAMILTON Arthur W. Wendel
Joseph Lindner
Richard D. Bryant
John W. Hauser
William F. Hunting
Kent E. Martin
Charles H. Moore
Herman J. Nimitz
Stanley D. Simon
HIGHLAND J. Martin Byers
WARREN O. L. Layman
R. L. Lawwill
Geo. P. Tyler, Jr.
J. F. Borelli
William Neel
A. A. Gruber
R. R. Buchanan
Robert H. Kotte
C. R. Rittershofer
Richard B. Homan
Daniel V. Jones
Robert M. Woolf ord
Charles S. Blase
Herbert J. Brinker
J. S. McMath
J. Edwin Reed
Daniel C. Rivers
Leland D. McBride
A. E. Stout
SECOND DISTRICT
CHAMPAIGN.. D. C. Houser
CLARK S. C. Yinger
R. M. Turner
DARKE J. E. Gillette
GREENE H. C. Messenger
MIAMI G. A. Woodhouse
MONTGOMERY... R. S. Binkley
A. W. Carley
R. D. Dooley
T. L. Light
PREBLE E. P. Trittschuh
SHELBY H. E. Crimm
E. R. Earle
Carl T. Doeing
E. W. Schilke
Gilbert E. Sayle
Paul D. Espey
Harry E. Shilling
C. W. Beane
V. W. LeMaster
THIRD DISTRICT
ALLEN :. F. P. Berlin
AUGLAIZE C. W. Berry
CRAWFORD John S. Kiess
HANCOCK Frank M. Wiseley
HARDIN Floyd M. Elliott
LOGAN
MARION A. E. Morrison
MERCER L. M. Otis
SENECA R. F. Machamer
VAN WERT R. E. Shell
WYANDOT
R. L. Tecklenberg
R. S. Oyer
J. W. Arnold
Harold Treece
H. R. Johanson
Warren F. Mills
Robert T. Gray
Ralph J. Beare
Paul J. Leahy
T. L. Edwards
Counties
Delegates
Alternates
GEAUGA Phillip P. Pease Alton W. Behm
LAKE Morris G. Carmody B. S. Park
SIXTH DISTRICT
COLUMBIANA....
MAHONING V. L. Goodwin R. E. Odom
I. C. Smith C. A. Gustafson
Wm. M. Skipp J. C. Vance
PORTAGE Robert M. Dumm R. C. Neely, Jr.
STARK John E. Dougherty A. A. Lichtblau
C. C. Couch G. M. Wilcoxon
R. K. Ramsayer Harry Beck
SUMMIT Kurt Weidenthal W. T. Bucher
C. A. Raymond J. W. Ewing
E. W. Burgner R. G. McCready
F. T. Moore R. H. Wilson
TRUMBULL D. Thomas S. J. Shapiro
SEVENTH DISTRICT
BELMONT Harvey H. Murphy
CARROLL W. G. Lyle
COSHOCTON E. J. Booth
HARRISON Carl F. Goll
JEFFERSON John Gallagher
MONROE
TUSCARAWAS—J. S. Adler
David Danenberg
Glenn C. Dowell
F. W. Craig
D. L. Tippett
S. L. Burkhardt
E. C. Davis, Jr.
EIGHTH DISTRICT
ATHENS Beatrice Postle
FAIRFIELD L. E. Stenger
GUERNSEY Robert A. Ringer
LICKING George A. Gressle
MORGAN Henry Bachman
MUSKINGUM George C. Malley
NOBLE Edward G. Ditch
PERRY
WASHINGTON.... Donald S. Williams
M. H. Mitchell
W. M. Kuntz
B. S. Gillespie
J. B. Johnson
A. A. Coulson
Paul Jones
N. S. Reed
R. M. Meredith
NINTH DISTRICT
GALLIA
HOCKING
JACKSON
LAWRENCE-.
MEIGS
PIKE
SCIOTO
VINTON
..Charles E. Holzer, Jr. Jacob Weinberger
C. T. Grattidge
John L. Frazer
Newton Spears
E. F. Maag
O. D. Tatje
H. D. Chamberlain
H. M. Boocks
Earl J. Levine
George G. Hunter
Roger P. Daniels
W. M. Singleton
Richard E. Bullock
TENTH DISTRICT
FOURTH DISTRICT
DEFIANCE.... D. J. Slosser
FULTON E. R. Murbach
HENRY B. L. Johnson
LUCAS A. L. Bershon
O. E. Todd
E. E. Lyon
R. Kuebbeler
R. A. Diethelm
Paul B. Newcomb
R. E. Merrill
Thomas W. Quinn
H. L. Hauman
T. C. Kiess
J. W. Erkert
D. C. Frick
C. R. Forrester
OTTAWA G. A. Boon
PAULDING R. H. Mouser
PUTNAM W. B. Recker
SANDUSKY J. J. Gedert
WILLIAMS H. R. Mayberry
WOOD Paul F. Orr
C. R. Wood
G. L. Doster
M. B. Rice
E. B. Vogel
R. A. Gilreath
R. N. Whitehead
FIFTH DISTRICT
ASHTABULA.. M. R. Martin P. J. Collander
CUYAHOGA H. B. Wright
D. A. Chambers
J. H. Budd
D. C. Darrah
C. L. Hudson
J. T. Ledman
J. E. Brown
George A. Tischler
F. L. Browning
L. H. Dembo
C. S. Higley
W. P. Garver
H. A. Crawford
J. M. Rossen
I. M. Hinnant
E. A. Marshall
J. W. Conwell
P. A. Mielcarek
I. L. Schonberg
W. E. Smith
Walter Zeiter
E. F. Schroeder
W. F. Boukalik
F. A. Spittler
G. T. Kent
G. L. Sackett
J. D. Osmond, Jr.
R. J. Whitacre
DELAWARE George J. Parker
FAYETTE J. E. Rose
FRANKLIN Charles W. Pavey
F. C. Hugenberger
Phillip T. Knies
Richard L. Meiling
Gilman D. Kirk
Robert E. S. Young
KNOX Henry T. Lapp
MADISON Wm. T. Bacon
MORROW J. P. Ingmire
PICKAWAY E. L. Montgomery
ROSS Ralph W. Holmes
UNION
Edward C. Jenkins
J. H. Persinger
Anthony Ruppersberg
George F. Collins
Clark P. Pritchett
Reuben B. Hoover
Thomas E. Rardin
Raymond S. Lord
H. E. Karrer
C. S. Jackson
E. S. Shane
Harold M. Crumley
ELEVENTH DISTRICT
ASHLAND R. J. Ferguson M. A. Shilling
ERIE .....Ross M. Knoble H. W. Lehrer
HOLMES N. P. Stauffer A. J. Earney
HURON Owen J. Nicholson Wm. H. Kauffman
LORAIN Leonard A. Stack A. F. Piraino
Russell Arnold G. R. Wiseman
MEDINA Wm. Dwyer A. J. Karson
RICHLAND P. A. Blackstone W. H. Buker
WAYNE Lyman A. Adair Harold G. Beeson
OFFICERS
Pres. Carl A. Lincke Treas. H. P. Worstell
Pres. -Elect E. O. Swartz Past-Pres. A. A. Brindley
COUNCILORS
District
First D. W. Heusinkveld
Second Merrill D. Prugh
Third J. Craig Bowman
Fourth Carll S. Mundy
Fifth Fred W. Dixon
Sixth Paul A. Davis
District
Seventh R. J. Foster
Eighth Chester P. Swett
Ninth J. P. McAfee
Tenth H. M. Clodfelter
Eleventh John S. Hattery
for April, 1950
363
• • •
Auxiliary’s Annual Meeting
Wives of Doctors Invited To Attend Business and Social Functions
In Cleveland Concurrent With Annual Meeting of State Association
WIVES of all physicians who attend the
Annual Meeting of the Ohio State Medi-
. cal Association are invited to attend
both the business sessions and the social func-
tions being planned for the Tenth Annual Meet-
ing of the Woman’s Auxiliary, May 16, 17 and 18,
at the Cleveland Hotel.
Mrs. C. W. Kirkland, Bellaire, president, will
preside at sessions of the Auxiliary. Co-chairmen
of the Annual Meeting Committee on Arrange-
ments are Mrs. Farrell Gallagher and Mrs. D.
M. Keating, both of Cleveland.
Auxiliary Headquarters will be the Hotel
Cleveland.
PROGRAM
TUESDAY, MAY 16, 1950
9:30 A. M. — Pre-Convention Board Meeting
(Cleveland Hotel).
12:00 NOON — Luncheon of Board of Directors.
1:30 P. M. — Formal Opening Session — Auxiliary
Members and House of Delegates.
Presiding — Mrs. C. W. Kirkland, President.
Invocation — Reverend Leroy Lawther.
Pledge of Loyalty — Mrs. John L. Stevens.
Address of Welcome — President of Cleveland
Academy of Medicine,
Response — Mrs. George Wilcoxon, President,
Stark County Auxiliary.
Minutes of Ninth Annual Meeting — Mrs. C. H.
Bell.
Organization of Convention.
Introduction of Convention Chairmen — Mrs.
Farrell Gallagher and Mrs. D. M. Keating.
Announcements.
Roll Call.
President’s Address — Mrs. C. W. Kirkland.
Reports of Officers:
President-Elect — Mrs. George Cooperrider.
Vice-President — Mrs. Paul Woodward.
Recording Secretary — Mrs. C. H. Bell.
Corresponding Secretary — Mrs. R. H. Mc-
Common.
Treasurer — Mrs. A. Paul Hancuff.
Reports of Chairmen of Standing Committees:
Finance — Mrs. E. Benjamin Gillette.
Legislation — Mrs. Carll S. Mundy.
Historian — Mrs. Fred Brosius.
Hygeia — Mrs. Paul A. Davis.
Organization — Mrs. George Cooperrider.
Program — Mrs. R. S. Fidler.
Publicity — Mrs. S. L. Meltzer.
Public Relations — Mrs. Farrell Gallagher.
4:00 P. M. — Time to shop and visit Exhibits.
WEDNESDAY, MAY 17, 1950
9:30 A. M. — Second Session: Auxiliary Members
and House of Delegates.
Reports of Special Committees.
Report of Nominating Committee (First Read-
ing).
Reports of County Auxiliary Presidents.
Special Recognition of new Auxiliaries.
12:00 NOON — “In Memoriam” — Mrs. Paul Wood-
ward.
Co-chairmen of the Auxiliary’s Annual Meeting Committee
on Arrangements are Mrs. Farrell Gallagher (seated) and
Mrs. D. M. Keating.
1:00 P. M. — Presidents’ Luncheon —
Honoring: Mrs. C. W. Kirkland, State Presi-
dent; Dr. Carl A. Lincke, President, O.S.M.A.;
Out-of-State Presidents and Presidents-Elect.
Other Special Guests: Advisory Council of
Woman’s Auxiliary to Ohio State Medical
364
The Ohio State Medical Journal
Association — Dr. H. M. Clodfelter, Dr. Paul
A. Davis, Dr. Chester P. Swett.
Guest Speaker — Dr. George F. Lull, Secretary
and General Manager of American Medical
Association.
3:00 P. M. — Round Table Discussion, “Questions
and Answers” Period, with State Officers
and Chairmen.
7:30 P. M. — Annual Banquet of Ohio State Medi-
cal Association.
THURSDAY, MAY 18, 1950
9:30 A. M. — Third Session.
Unfinished Reports of County Auxiliary
Presidents.
Unfinished Business.
New Business:
Finance — Acceptance of budget.
Recommendations of Board.
Election of Delegates to National Auxiliary
Meeting.
Report of Convention Chairmen.
Announcement of winners in Credits and
Awards.
Report of Nominating Committee (Final Read-
ing).
Election of officers.
Installation of officers — Mrs. V. E. Holcombe,
Charleston, W. Va., President of National
Auxiliary 1940-41.
Inaugural Address — Mrs. George Cooperrider.
Introduction of New Board — Mrs. George
Cooperrider.
Courtesy Resolutions.
1:00 P. M. — Luncheon —
Honoring — Mrs. George Cooperrider, and
Mrs. David B. Allman, President of the
Woman’s Auxiliary to the American Medi-
cal Association.
Adjournment.
Post Convention Board Meeting.
New Student Center at
Athens Is Opened
Ohio University’s new $500,000 Student Health
Center was opened for use in January. It is the
second step completed in a five-fold building
program on the campus.
The center is of three floors and a basement.
It has a 40-bed capacity with a limit of 50 in
emergency. It is designed primarily for handling
out-patient activities, but can accommodate stu-
dents requiring hospitalization for a few days.
ARE YOU AND MEMBERS OF YOUR
FAMILY REGISTERED TO VOTE?
Auxiliary Amendment Would Provide
For Honorary Members
The following amendment to the By-Laws
of the Constitution of the Woman’s Auxiliary
to the Ohio State Medical Association was
voted on at the March 14 meeting of the
Board and will be presented for approval at the
Annual Meeting in Cleveland.
“Amendment to the By-Laws of the Constitu-
tion of the Woman’s Auxiliary to the Ohio
State Medical Association:
“To provide for Honorary Membership, amend
Chapter I of the By-Laws by adding Section 5,
to read:
“Members of the Woman’s Auxiliary to the
Ohio State Medical Association, who have ren-
dered long and signal service may be eligible
to become Honorary members by action of the
House of Delegates upon recommendation of
the Board of Directors.
“An Honorary member shall enjoy all the
privileges of active membership without pay-
ment of States dues. The State Auxiliary shall
pay the dues of such members to the National
Auxiliary.”
Mahoning Doctors Sponsor Student
Contest on Voluntary System
The Mahoning County Medical Society an-
nounced an essay contest for college students of
Mahoning County on the subject, “Why We Should
Preserve the Voluntary System of Medical Care
in the United States.”
Any college student of Mahoning County
whether he attends a local college or any college
in the United States is eligible for participation.
The Health Education Committee of the So-
ciety is conducting the contest which is part of
the local Medical Society’s effort in bringing to
the public data on certain aspects in medical
practice and an over-all improved public under-
standing of medical problems. The Health Edu-
cation Committee is headed by Dr. C. F. Gustaf-
son with the following members: Dr. E. J.
Reilly, chairman of Public Relations and Eco-
nomics; Dr. W. M. Skipp, Legislative Committee
Chairman; Dr. Stephen W. Ondash, chairman of
Lay Education and Speakers Committee, and Dr.
James Miller.
Judges of the contest are being selected and
will be announced in the near future. They will
be furnished with the copies of final essays and
given two weeks to study them. Copies of the
essays from which the judges make their selec-
tions will carry neither the name nor address of
the contestants. All winners will be announced
by the president of the Mahoning County Medi-
cal Society on May 15, 1950.
for April, 1950
365
Rural Health Betterment . . .
Closer Cooperation With County Medical Society Committees Is Among
Objectives of Farm Bureau Councils in ‘Keeping Alive Longer’ Program
FARM Bureau Advisory Councils, the grass-
roots study groups organized throughout
the State by the Ohio Farm Bureau Feder-
ation, dealt with the problem of “Keeping
Alive Longer,” in their December deliberations.
To stimulate discussion and to provide facts
for consideration by the councils, the Ohio Farm
Bureau published each month the “Advisory
Council Guide,” which is attractively printed
in two colors and contains illustrations and lists
of reference material for further information
on the subject.
In the December issue the suggestion was
offered that rural health is “not all that it
should be,” and that in spite of clean country
air, fresh foods, and outdoor life, the cities
have a better health record than do the rural
communities. It was stated that “while the aver-
age length of life for men living in cities in-
creased 40 per cent between 1900 and 1939,
the increase for rural people was only 19
per cent.
“Now is the time,” the guide advised,
“for us here in Ohio to work together to
improve rural health. There are ways to
get good doctors and good hopsitals; ways
to get adequate public health units to help
us in the prevention of disease accidents
and illness.”
In an inventory of rural health conditions,
it was said that cities are far ahead of rural
areas in sanitation, housing and modern medi-
cine and that “cities have most of the doctors,
dentists, the best clinics and modern hospitals.”
“Black Marks” which will have to be wiped
out in rural areas if we are to have a healthy
America, according to the publication, are the
following:
Preventable deaths, to which rural areas con-
tribute “more than their share”; accidents,
which “are more prevalent in rural areas”; lack
of physicians, nurses and dentists; shortage
of hospitals; need for better sanitation; and
substandard nutrition in the country.
OHIO RANKS 48th
It was pointed out that Ohio ranks 48th
among the states in per capita appropriations
for its State Health Department, providing
only nine cents per person in contrast with
the $1.36 appropriated in New York.
Surveying “what we have” and “what we
need,” the folder contained suggestions that
although we have legislation allowing us to set
up efficient local health departments, we
need to take advantage of the legislation and
get large enough health districts to support
fully staffed health departments.
It was stated that there is a well-planned health
course for high schools as prepared by the
State Departments of Health and Education,
but that only 200 high schools of the 1,337
have the course in the curriculum.
The publication made reference to phy-
sicians appointed by County Medical So-
cieties in most counties to work with schools
and health departments on school health
programs. “We need to help these doctors
and our health commissioners and school
superintendents to get together on a more
effective school health program,” the state-
ment continued.
Reference also was made to County Medi-
cal Society Rural Health Committees, with
the advice that “we need to work more
closely with these doctors and to meet our
rural health needs.”
Cooperation with the local health depart-
ment in getting well-child conferences was
listed as a need. The suggestion was em-
phasized that each county have an active Farm
Bureau Home and Community Committee to
find out what the health problems are and to
carry out activities and projects to improve
them.
Attention was called to the fact that the
Ohio Farm Bureau Federation has a group
hospitalization plan which is widely used. It
was stated that “a bill is now before Congress
which would provide compulsory health insur-
ance. There is also a bill before Congress
which would provide more money for better
public health departments and hospitals.” The
question was asked, “Which of these bills do
you think we should support?” In this con-
nection six reasons were given as to why many
doctors oppose compulsory health insurance,
and in conclusion it was asked, “Can we solve
the rural health problem ourselves or do wre
need compulsory health insurance?”
According to a digest compiled from the
minutes of the December meetings with
295 councils reporting, better health was
the unanimous plea; there was voiced a
definite need for more doctors and nurses;
and compulsory health insurance was defi-
nitely voted down by all.
ARE YOU REGISTERED TO VOTE?
IF NOT, ACT PROMPTLY
366
The Ohio State Medical Journal
SPACE STILL AVAILABLE ON OHIO STATE MEDICAL SPECIAL
TRAIN TO SAN FRANCISCO NEXT JUNE; BETTER HURRY
A RE you interested in a grand, all-expense trip of three weeks to the Pacific
Coast next June when the A. M. A. will meet in San Francisco? The Ohio
State Medical Association is planning to run a special train. Space still
is available. All rooms on the train have been assigned hut LOWER AND
UPPER BERTH ACCOMMODATONS ARE AVAILABLE. Those interested
should write the Columbus Office of the Ohio State Medical Association im-
mediately for complete details, costs, itinerary, etc.
The Special Train will leave Chicago, June 19 (providing the required
minimum sign up for the trip) and will return to Chicago, July 8.
En route there will be sightseeing at Santa Fe, New Mexico; Grand Canyon;
Riverside, Calif.; and Los Angeles (two nights and two days in that city).
Five days will be spent in San Francisco to permit all to attend the annual
session of the American Medical Association.
Coming home, the Special Train will visit the following for sightseeing and
entertainment: Portland, Oregon; Victoria, British Columbia; and Glacier Na-
tional Park (three nights and three days in the Park).
The railroad accommodations will be first-class, standard, air-conditioned
equipment. Excellent hotel accommodations will be provided in Los Angeles,
San Francisco, and Glacier Park. Plenty of sightseeing, fun and entertainment
will be provided. The cost is reasonable.
APPLICATIONS FOR SPACE WILL BE HANDLED ON A FIRST-COME,
FIRST-SERVED BASIS UNTIL ALL REMAINING SPACE— LOWER AND
UPPER BERTHS— HAS BEEN SOLD.
Better write in at once if you want to make this excellent vacation trip.
for April, 1950
367
County Officers Conference . . .
Medicine’s Stake in the Legislative and Political Fronts Is Theme
At Columbus Meeting ; Organization and Individual Goals Are Outlined
THE Annual Conference of County Medical
Society Presidents, Secretaries and Commit-
teemen, sponsored by the Ohio State Medical
Association, drew nearly 200 persons to Columbus
on Sunday, March 5, where distinguished speakers
discussed matters of vital importance to the
medical profession.
Dr. Carl A. Lincke, Carrollton, President of the
Association, explained the three-fold purpose of
the conference: First, to take an inventory of
some of our major current activities; secondly, to
discuss events and developments which are of
vital concern to all physicians, not only as phy-
sicians but as citizens; and thirdly, to lay plans
for future activities and actions.
GOALS
Dr. Lincke pointed out that the Ohio State
Medical Association is a federation of 88 county
medical societies, and that the end results of the
medical profession’s program in the long run will
depend on what actions local societies take.
Following are briefs of some of the goals of
the Association as Dr. Lincke enumerated them:
To improve and expand the “excellent” public
education program, especially in getting every
society and every member active;
To get every member to take an active interest
in political, civic and community affairs;
To expand the fine work now being done by
the Committee on Rural Health;
To develop a more active school health pro-
gram under guidance of the Committee on School
Health with the help of similar committees in
each society;
To expand the present provisions for supplying
speakers for medical society programs;
To continue to give active and financial support
to the Ohio Committee on Public Health and to
the Ohio Rural Health Council;
To promote more vigorously activities on be-
half of Ohio Medical Indemnity, with the hope
of having a million persons covered with prepaid
medical expense by the end of the year;
To provide more active field service from the
Columbus Office to the County Medical Societies;
To establish a Committee on Chronic Illness.
To continue to expand contacts with various
state and Federal agencies engaged in activities
involving services of physicians.
Dr. Lincke explained that the goals mentioned
are only a few highlights in the over-all program
of the Association and that the summary did not
make any attempt to include the many services
now being carried on by the state organization.
“YOUR A. M. A.”
Dr. Edward J. McCormick, Toledo, member of
the Board of Trustees of the A. M. A., issued a
challenge to every doctor to participate in a
program which he described as rendering to the
public and to its members more than any other
program of a similar organization.
Criticism of and lack of participation in the
A. M. A.’s educational program by some mem-
bers are based on misinformation or lack of in-
formation on the part of doctors as well as on
the part of persons in other walks of life, the
speaker said.
Probably not 50 per cent of doctors know what
the program of the medical profession “is all
about,” Dr. McCormick challenged. He em-
phasized that the present campaign against com-
pulsory health insurance is merely an expansion
of the constantly growing program of the
A. M. A. and component organizations.
Dr. McCormick then reviewed some of the
services of the A. M. A. Twenty-four councils,
bureaus and permanent committees, supplemented
by a full-time staff of more than 800 persons, are
constantly supplying information and rendering
services to the profession and to the public.
Such an extensive program of services, he stressed,
has not been attempted by any other organiza-
tion.
Prior to 1949, Dr. McCormick pointed out, all
of the services of the A. M. A. were carried on
without any dues being paid by its members.
The A. M. A. was supported largely by revenues
from its publications and from fellowship dues,
which in fact covered the subscription rate of The
Journal of the A. M. A.
In 1948, he continued, it became evident that
the A. M. A. would have to expand its public re-
lations program to counteract the multimillion
dollar propaganda programs of those who would
destroy the free practice of medicine.
The speaker pointed out that the $25 annual
dues of the A. M. A. had been voted according to
the most liberal democratic principles. The House
of Delegates first voted the $25 assessment and
a year later, for the first time in history, ap-
proved the $25 annual dues. He confessed, how-
ever, that press relations on both of these oc-
casions were poorly handled, resulting in poorly
slanted initial announcements. The dues them-
selves, he reminded, are much less than those
368
The Ohio State Medical Journal
Candid Shots at Columbus Meeting
O.S.M.A. Staff Photos
These photographs show a few activities at the Con-
ference of County Medical Society Presidents, Secretaries
and Committeemen. (See story beginning on facing page
for details.)
1. William M. McCulloch, member of the U. S. House of
Representatives (left), and Roscoe R. Walcutt, member of
the Ohio Senate, pose before the meeting at which both
spoke.
2. Members of the Fourth District hold a conference
presided over by Dr. Carll S. Mundy, Councilor. Each
district held a similar meeting.
3. Campaign material is always available for the asking.
4. Dr. Charles A. Doan, Dean, O. S. U. College of Medi-
cine.
5. Paul Daugherty of the Ohio Chamber of Commerce.
6. Dr. Edward J. McCormick, member. Board of Trustees,
A. M. A.
7. Some of the nearly 200 doctors who attended the
meeting, enjoy luncheon at the Hotel Fort Hayes.
for April, 1950
369
of many trade and other organizations which
render much less service in return.
In regard to the national educational campaign
being directed by Whitaker and Baxter, Dr.
McCormick said that it is receiving nothing but
favorable comments from legislators because they
have been informed exactly what the program
will include. The speaker emphasized that the
plan is purely one of education and information.
No representative of the A. M. A. ever has or
ever will solicit the vote of a legislator, he as-
sured.
In regard to the shortage of doctors, Dr. Mc-
Cormick said that the A. M. A. is doing every-
thing that it can to increase the supply of doctors
while maintaining standards. He branded as
ridiculous criticism that the A. M. A. had at-
tempted to limit the supply of doctors. On the
contrary, he affirmed, many professional organiza-
tions are now following the example of the
A. M. A. in demanding that the standards be
kept at the highest possible level.
SOLON PRESCRIBES
State legislative matters were reviewed by Mr.
Roscoe R. Walcutt, Columbus, Republican Floor
Leader in the Ohio Senate of the 98th General
Assembly, in an address entitled “Solon Prescribes
for Hippocrates.”
After a stimulating talk in which Mr. Walcutt
reminded doctors of their political and civic re-
sponsibilities, the seasoned legislator enumerated
some ways through which members of the medi-
cal profession can exercise their duties as citizens:
Doctors should encourage legislators who stand
up for the interests of the public and doctors
in matters of medical and health legislation;
Doctors should appear and express themselves
when a health or medical matter is up for dis-
cussion before a House or Senate Committee;
Doctors should make their wishes known to
county political party committees, which are
the grass roots of national trends;
Doctors by all means ought to vote (he char-
acterized as “terrible” the profession’s voting
record) ;
Doctors should belong to a political party and
should take part in politics.
Mr. Walcutt complemented the Association’s
representatives in legislative matters for their
“fairness and honesty” in discussing medical and
health matters with legislators. He reminded
doctors, however, that lay workers cannot be
expected to work alone in respect to legislation.
The speaker concluded his talk by saying that
doctors can have more influence in molding pub-
lic opinion than any other class of people and
that they ought to use that influence.
DRUMS ALONG THE POTOMAC
Legislative developments on the national level
were reviewed by Mr. William M. McCulloch,
Piqua, member of the House of Representatives,
81st Congress, Fourth Congressional District, in
a talk entitled, “Drums Along the Potomac.”
Mr. McCulloch predicted that the provisions of
the compulsory sickness insurance proposals
would not be passed in this session of Congress,
and that they would not be passed at any time
“if the medical profession will assume the duties
which naturally fall upon it” as protectors of
the people’s health.
He reminded his audience that some of the pro-
visions for Federal aid in the field of health and
medicine already have been passed, and predicted
that still others would be passed.
Provisions for more extensive medical research
has an even chance of passing, he said.
The hospital survey and construction act (Hill-
Burton Law) recently has been extended.
Federal aid for rural health provisions is under
consideration.
An extensive research project into the field
of children’s health has been made, and proposals
for Federal aid along this line will be made, he
predicted.
Serious consideration is being given toward
Federal grants to medical schools, he said.
Mr. McCulloch acknowledged that the general
trend seems to be toward what he terms “the
illusion of security in contrast to the fundamental
idea of personal and individual liberty.” He
bemoaned the observation that most of us are
too busy pursuing the “goddess of getting on”
to do our duty to the state. In the end, he said,
we will lose something much more important
than the material interests we are striving for.
Among other legislative matters which he
reviewed was that of the proposed Federal aid
toward education. The speaker branded the pro-
posed $300,000,000 Federal aid to education as
“the nose of the camel in the tent door.”
SOCIAL SECURITY
“Facts and Figures on the ‘Welfare State’ ”
were presented by Mr. Paul Daugherty, Colum-
bus, director of the Legislative Department of
the Ohio Chamber of Commerce. Mr. Daugherty
summarized legislation in the field of social
security, and asserted that all social security pro-
grams start small and grow big. To substantiate
this observation, he pointed out that in 1935 old
age benefits in Ohio were paid on the basis of a
maximum of $30 per month, half of which was
contributed by the Federal government. In 1948
the amount had been raised to $50 with the
Federal share proportionately higher.
Commenting on H. R. 6000, which contains pro-
posed expansion of the present social security
benefits, Mr. Daugherty said that the bill if
passed would extend the number of persons re-
ceiving old age and survivors’ insurance to about
eleven million. In addition to liberalizing cov-
erage in almost every phase, he said, it would
370
The Ohio State Medical Journal
increase the wage base for payroll deductions
from the present $3,000 to $3,600 and perhaps to
$4,800.
If the provisions of H. R. 6000 are put into
effect, the speaker estimated, by 1980 the amount
going out for old age, survivors’ and disability
benefits will be about $8,400,000 or 6 per cent
of the payroll. Mr. Daugherty pointed out
that this bill is entirely separate from any com-
pulsory health insurance proposals.
The speaker said that the provisions of the
bill follow the trend of the welfare state toward
doling out benefits on the basis of so-called
“needs” rather than on the basis of the em-
ployee’s contributions as provided in original
proposals of social security programs.
MEDICAL EDUCATION
Dr. Charles A. Doan, Columbus, dean of the
Ohio State University College of Medicine, ad-
dressed the conference on the subject, “Prob-
lems Confronting Our Medical Schools.”
Reviewing the needs of medical schools, Dr.
Doan said that the combined annual budgets
of the 79 schools operating at present, amount
to about $53,500,000 — an amount that is small in
comparison to expenditures in less urgent fields.
Of that amount, he revealed, there is a present
deficit of around $9,500,000. Forty-eight medical
schools are financially in the red. Only eight
have resources sufficient to carry on their present
programs, without allowance for expansion. The
average school, of those not on a sound financial
basis, needs between $100,000 and $400,000 per
year to carry on, again without considering ex-
pansion.
Contrary to certain reports that medical schools
are not advancing, Dr. Doan pointed out that
while in 1910 there were 66 Class A medical
schools, today there are 79. In 1930 there were
21,000 students in medical schools while today
there are 24,800. In the last 40 years, he said,
the number of students in medical schools has
doubled.
Summing up where he considered responsibility
rests for support of medical education, Dr. Doan
specified these sources: Private benefactors with
small or large contributions to supplement com-
munity enterprises; state appropriations; private
foundations such as the heart fund; certain in-
dustrial corporations which are taking many
doctors out of other fields for their industrial
health programs; and the Federal government
which requires the talents of many doctors both
in time of war and of peace.
THE JOB AHEAD
In a stimulating talk at the conclusion of the
meeting, Dr. E. O. Swartz, Cincinnati, President-
Elect of the Association, spelled out some
suggested methods for county medical society
officers and committeemen to promote the inter-
est of free medicine. Highlights of his sug-
gestions included the following:
To get physicians registered and do everything
possible to get them to vote;
To supplement the work of professionals in
promoting election of public officials who have
the interest of the people at heart;
To convince doctors that they have a stake irr.
the election;
To remember that candidates for all political
offices are important — not only those on the
national level;
To support those legislators and other public
officials who have stood up for the interests of
medicine;
To promote a vigorous legislative committee
in each county society;
To remember that candidates are human and
are easier to talk to before elections than after-
ward;
To let legislators know how doctors stand
on legislative matters.
Dr. Swartz pleaded for a more vigorous effort
on the part of county societies to curb the
minority of doctors who are bringing discredit
on the profession. Some societies, he pointed
out, have taken action on the rebate question.
A number have set up systems to take care of
emergency and night calls. Others have estab-
lished committees to arbitrate differences between
patients and doctors.
DISTRICT CONFERENCES
An important phase of the conference was that
part of the program in which doctors of respec-
tive districts got together and discussed local
problems and exchanged ideas.
A. M. A. Joins in Formation
Of Health Committee
Six national associations, including the A. M. A.,
have formed the Inter-Association Committee on
Health.
The associations, besides the A. M. A., are the
American Dental Association, American Hospital
Association, American Nurses Association, Ameri-
can Public Health Association and the American
Public Welfare Association.
The committee will serve as a means for the
exchange of information on the health programs
of the participating organizations to the end
that a common understanding may be reached
toward the solution of national health problems.
The committee will carry on activities contri-
buting to the major objectives of improving the
health of the nation.
ARE YOU REGISTERED TO VOTE?
IF NOT, ACT PROMPTLY
for April , 1950
371
Ohio Academy of General Practice
Supports $25 A. M. A. Dues
Following is a resolution which was drawn
up by the board of directors of the Ohio Aca-
demy of General Practice, February 22, at
the St. Louis Annual Scientific Assembly of
the American Academy of General Practice,
and forwarded to The Journal by Dr. Earl D.
McCallister, Columbus, secretary-treasurer of
the Academy. Dr. McCallister reported that
the resolution was passed by unanimous vote
of the Board of Directors, the state officers,
and approved by other members present.
“Whereas, the American Medical Association
has always been and continues to be recognized
as the Mother Medical Association, and
“Whereas, this honored and respected Asso-
ciation has existed up to the present on the re-
muneration from the Journal and minimum Fel-
lows dues, and
“Whereas, the national, state and local in-
dependence in the practice of medical, surgical
and other specialties is being threatened by so-
cialized governmental form of medical care, even
though the people of this nation have at their
command the best medical care in the world, and
“Whereas, the American Medical Association
has been forced to combat this national socialistic
force by informing and educating the general pub-
lic into the real meaning of socialized medicine
by requiring each member to pay annual dues of
twenty-five dollars with which to accomplish this
duty and task, and
“Whereas, one of the requirements for active
and continued membership in the American Medi-
cal Association is the payment of these dues, and
“Whereas, one of the requirements for ad-
mission and continued membership in the Ameri-
can Academy of General Practice is full and
active membership in the American Medical
Association, therefore,
“Be it resolved that the Board of Directors,
state officers and state delegates of the Ohio
Academy of General Practice assure the Ameri-
can Medical Association of its complete support
and approval of the annual twenty-five dollar
dues, and
“Be it further resolved that the Ohio Academy
of General Practice will continue its present re-
quirements for new or active membership of its
members.
“(Signed) Board of Directors of the Ohio
Academy of General Practice.”
Dr. Jermyn F. McCahan, formerly medical
director of Bausch & Lomb Optical Co., is the
new assistant to Dr. Carl M. Peterson, secretary
of the A. M. A. Council on Industrial Health. Dr.
McCahan will travel extensively, visiting in-
dustries throughout the Nation.
Health Days Exhibits Again Sponsored
In Akron by Auxiliary
The third annual Medical Health Days ex-
hibits, sponsored by the Woman’s Auxiliary to
the Summit County Medical Society, were held
February 17 and 18 in the O’Neil Department
Store Auditorium in Akron.
Under the chairmanship of Mrs. Robert E.
Brubaker and Mrs. J. P. Sauvageot of Akron, 37
organizations participated, including the Summit
County Medical Society and the Ohio State
Medical Association. The former organization
sponsored an exhibit on bones and muscles se-
cured from the American Medical Association
Bureau of Exhibits, and in addition showed a
panel which described the program of the society
which guarantees to everyone the services of
a physician any hour of the day or night, re-
gardless of his ability to pay. Dr. A. S. Mc-
Cormick of Akron provided a historical display
of medical developments in Summit County and
medical literature.
The display of the Ohio State Medical Asso-
ciation demonstrated the operation of the human
respiratory system, use of the bronchoscope, and
the nasopharyngoscope. Panels showed the
anatomy of the lungs, description of pneu-
mothorax, tuberculous lungs, silicosis, pneumonia,
and other conditions. This exhibit also was se-
cured from the American Medical Association.
Attendants answered questions about the dis-
play and furnished literature on various health
subjects. Mr. Hart F. Page, assistant director
of the Department of Public Relations, was in
charge of the exhibit.
To stimulate interest in the Medical Health
Days program, Dr. W. W. Bauer, director of the
Bureau of Health Education, American Medical
Association, and editor of Today's Health, came
to Akron February 6 and 7, where he addressed
the students at South High School, Old Trail
High School, Buchtel High School, West Akron
Kiwanis Club, The Downtown Lion’s Club of
Akron, and talked at a tea given by the Summit
County Medical Society Auxiliary. He also
made several radio appearances.
See pictures on facing page.
Diseases of Chest
The Third Annual Postgraduate Course in
Diseases of the Chest, sponsored by the Ameri-
can College of Chest Physicians, Pennsylvania
Chapter, and the Laennec Society of Philadelphia,
will be presented at the Warwick Hotel, Phila-
delphia, Pa., April 10-14. The tuition fee is $50.
Applications should be sent to: American Col-
lege of Chest Physicians, 500 North Dearborn
Street, Chicago 10, Illinois.
TO BE A GOOD CITIZEN, YOU MUST
BE REGISTERED TO VOTE
372
The Ohio State Medical Journal
Health Days In Akron
On this page are candid photographs
taken during the third annual Medical
Health Days exhibit sponsored by the
Woman’s Auxiliary to the Summit
County Medical Society in Akron,
February 17 and 18, in the O’Neil
Department Store.
Above is part of the Summit County Medical So-
ciety’s exhibit portraying in lay terms the growth
of bones.
To the right is a ehart which states that the Sum-
mit County Medical Society “guarantees everyone
the services of a physician any hour of the day or
night regardless of his ability to pay.”
Pictures in the center circle and to
the right are visitors inspecting the ex-
hibit of the Ohio State Medical Asso-
ciation which demonstrated how a per-
son breathes.
See story on facing page.
— O.S.M.A. Staff Photos.
for April, 1950
373
A.M.A. Warns on 4Cold Cures’
• • •
Public Is Advised That Indiscriminate Use of Antihistaminic Drugs
Can Cause Toxic Reactions; More Accurate Research Being Conducted
A STATEMENT by the Council on Pharmacy
and Chemistry of the A. M. A. on the
effectiveness of antihistaminic drugs will
be of particular interest to Ohio physicians, com-
ing as it does immediately after a statement by
the Food and Drug Administration, report of
which appeared in the March issue of The
Journal.
Effectiveness of these drugs in the prevention
and treatment of colds has not been demonstrated
by the reports on which a widespread promotion
of “cold cures” is based, in the opinion of the
Council.
In a lengthy report published in the February
25 issue of the Journal of the A. M. A., and made
public, the Council on Pharmacy and Chemistry
holds that “the evidence so far presented should
be properly classified as the honest opinion of
the investigators and not as fact.” It concludes:
“Until a scientifically acceptable study is per-
formed, the true effectiveness of the antihista-
minic drugs in the control of the common cold
cannot be evaluated.”
As a guide for further investigations, the
Council outlines a procedure which in its opinion
“would be a true test of these agents in the
treatment and prophylaxis of the common cold.”
WARNINGS
Meanwhile, the Council is standing upon a
warning which it issued to the press December 2,
1949. The warning had pointed out that records
show that many people who take these drugs
become drowsy or even fall asleep while at work
or in occasional cases even when driving cars
or operating machinery.
Reporting on toxic reactions and even death
from overdosage, the Council in its current report
adds the further warning:
“With over-the-counter sale, careless and
habitual use of the antihistaminics may be
expected and the medical profession should antic-
ipate similar serious reactions. Basic research
is indicated on the chronic toxicity of these
agents in human subjects.”
QUALIFIES RESEARCH RESULTS
The Council reviews the results reported by
four groups of investigators. These reports
covered 2,357 patients, more than one-half being
studied by a single observer. Summarizing its
analysis, the Council says:
“The diagnostic methods employed have not
conclusively demonstrated that the condition
treated was actually the common cold. Over
half of the cases were investigated in studies
with inadequate controls or even without controls',
and the interpretations of the results are open
to question.”
It further says: “None of the studies estab-
lished the diagnosis of a common cold beyond
reasonable doubt. By exclusion of bacterial in-
fection as a cause, one cannot arbitrarily assume
that a virus is the agent responsible for the ap-
pearance of symptoms; allergy may be involved.
MANY SOURCES OF ERROR
“Acceptance of the patient’s own diagnosis of
a cold introduces many sources of error. The
patient may have been mistaken in his belief
that he was getting a cold; he may have been
manifesting the symptoms of an allergy, or his
‘cold’ may have been aborted without the aid of
any therapeutic agent. By physical examination
alone, the cause of coryza certainly cannot be
established as the virus of the common cold.
“Thus, in none of the studies is there clearcut
evidence of a verified diagnosis of the common
cold.”
The Council adds that the prophylactic study
of one group, “while suggestive, requires veri-
fication because the series is small and contrary
to the experience of allergists.” It points out that
“the antihistaminic agents apparently produce
considerable subjective relief owing to inhibition
of nasal discharge. Similar results may be
obtained by use of ephedrine or atropine.”
OPINION, NOT FACT
Commenting on the studies as a whole, the
Council says:
“The acceptance of claims for therapeutic or
prophylactic value of antihistaminic agents in
the common cold requires demonstration that the
condition treated in the studies was the common
cold. Validity of diagnosis and cure must not
be left to the discretion of patients, and the in-
terpretation of results should be unquestionable.
“The evidence so far presented should be
properly classified as the honest opinion of the
investigators and not as fact. The common cold
is such an economic hazard that this opinion
must be checked by more basic research in the
pathogenesis (origin and development) of the
disease and the toxicity of the drugs employed,
as well as by more authentic clinical evaluation.”
In detailing an investigation technique, the
Council suggests the use of a large group of
normal volunteers in whom allergy has been
eliminated by history and proper tests. One-
374
The Ohio State Medical Journal
third should be designated as the prophylactic
group, another third as the treatment group and
the remaining as a control.
MULTIMILLION BUSINESS
In an editorial comment on the Council’s re-
port, The Joui'nal points out that it has been
estimated that the sale of antihistaminic drugs
this year may reach $100,000,000 and adds: “This
is a plum for those who want to pluck it.”
It says this “perhaps is one of the reasons for
the ambitious selling program,” which some of
the promotors of antihistaminic drugs have
launched in the face of warnings from medical
authorities.
“Advertising is a part of our everyday life,
and we accept it for what it is,” says The
Journal. “Properly employed it plays an im-
portant part in the marketing of goods, but
drivel such as some of the pleas for over-the-
counter antihistaminics should not be thrust on
the American public. There is a limit to what
the public should be asked to stomach. Non-
sensical advertising does not benefit anyone ex-
cept the seller, and even his benefits may be of
brief duration if the advertising boomerangs.
“The current advertising splurges for over-
the-counter antihistaminics do not bring credit
to their promoters. Such puffery should be
controlled sensibly and on a voluntary basis. If
this is impractical, however, enforcement agencies
should not hesitate to meet their responsibilities.
The moral obligations for those who supply
services to the public should be self-evident to
all interested parties. When health is included
in these services, the moral obligations assume
even greater significance.”
A. M. A. Witnesses Point Flaws
In Disability Clause
Three official spokesmen have presented
A. M. A.’s arguments against the permanent
and total disability clause of H. R. 6000, social
security extension bill. They are Dr. James
E. Paullin of Atlanta, Ga., Dr. R. L. Sensenich
of South Bend, Ind., and Dr. Gunnar Gunder-
sen of La Crosse, Wis., who testified February
28 before the Senate Committee on Finance.
They stressed three points: 1. Determination
of permanent and total disability would strain
the relationship between physician and pa-
tient. 2. This clause would put a cash premium
on malingering and deprive patients, perhaps
unconsciously, of the “will-to-recover,” recognized
as an important therapeutic factor. 3. Restric-
tions would inevitably be relaxed, bringing more
and more people under the benefits and stimu-
lating socialized medicine.
IF YOU’RE NOT REGISTERED TO VOTE,
VISIT YOUR ELECTION BOARD
FOR YOUR PATIENTS:
Order the following campaign materials
for your waiting room. Make the facts
on Compulsory Health Insurance readily
available to your patients.
Title Quantity
Booklet: “The Voluntary Way Is the
American Way” (Revised 1950) . .
Booklet: “You and Socialized Medi-
cine” .
Folder: “Keep Politics Out Of This
Picture” (Revised 1950) ....
Assortment of Stickers for Your Cor-
respondence (Revised 1950) . .
Mark quantity desired and mail this blank
to Ohio State Medical Association, 79 E.
State St,, Columbus 15, Ohio.
Name
Address
City
Health Service To Study
Radiological Hazards
Formation of a new unit under the Public
Health Service, Federal Security Agency, to de-
velop a radiological health program to meet po-
tential health hazards created by increased use
of radioactive materials an,d radiation-producing
machinery has been announced.
Established within the recently formed En-
gineering Resources Division of the Public
Health Service, the new unit is known as the
Radiological Health Branch and is under the di-
rection of Dr. Edwin G. Williams, a Public
Health Service medical director.
The Radiological Health Branch will correlate
radiological health activities in the Public Health
Service, develop a training program in radio-
logical health for Service officers and other pub-
lic health workers, and act as a source of infor-
mation on radiological health for other units of
the Service, for other Federal agencies, and for
State and local health agencies.
Surgeon General Leonard A. Scheele of the
Public Health Service said the new branch was
established “because of the recent rapid increase
in the use of radioactive materials and radiation-
producing machines in hospitals, industry, ex-
perimental laboratories and other places through-
out the country.”
“This in turn,” Dr. Scheele said, “has created a
need for some consideration in the Nation’s pub-
lic health program of the control of potential
radiation hazards.”
for April, 1950
375
Cancer Campaign . . .
Efforts of Physicians and Laymen Toward Education of Profession
And Public Will Culminate in April Drive; Ohio’s Goal is $850,000
APRIL has been designated by act of Con-
gress and by Presidential proclamation as
L Cancer Control Month. Those closely as-
sociated with the fight against this disease, how-
ever, like to point out that the approaching cam-
paign is only the climax of eleven months of
intensive education and service activities by
county units of the American Cancer Society.
All physicians of Ohio are being urged to
actively participate in the 1950 Cancer Control
program. The Ohio State Medical Association
took an active part in organizing the Ohio unit
of the American Cancer Society. Prominent
members of the Association have been, and still
are, members of its executive committee which
is in charge of setting policies and administer-
ing activities of the Ohio unit.
Repeatedly The Council of the Ohio State
Medical Association has urged county medical
societies and individual physicians to take part
in cancer control work, to cooperate with the
county cancer societies and to guide them in their
activities.
GOAL IS SET
The national goal this year is $14,500,000 with
Ohio’s share set at $850,000. Governor Frank J.
Lausche is lending support to the Cancer So-
ciety’s efforts as honorary chairman for this
year. Paul A. Warner, Mount Vemon, is cam-
paign chairman and Don H. Ebright, Columbus,
co-chairman.
Mr. Warner sounded the keynote of the cam-
paign when he said: “Greater public interest in
regular physical examinations is the ultimate
goal of the thousands of volunteers who are
trying to reach every person directly with the
facts about cancer. We view this effort in
April as a powerful educational program, and
we view the problem of cancer control as a
medical problem.”
In each county, Mr. Warner pointed out,
there is a Medical Advisory Committee appointed
by the County Medical Society serving with the
county unit to guide that unit in its cancer
control efforts.
“A great deal of credit should be given to
the members of the Ohio State Medical Associa-
tion and the County Medical Societies,” Mr.
Warner continued, “because without their guid-
ance cancer control in Ohio would not be at
its comparatively high point of attainment. Our
State, with less than five per cent of the national
population, has 12 per cent of the country’s
detection and diagnostic services. Medical fa-
cilities have been improved in many areas by the
addition of necessary equipment, establishment
of cytology laboratories, institution of detection
and diagnostic services and loan cabinet projects.”
DOCTORS PLAY KEY ROLES
Mr. Warner praised the work of Dr. Carl A.
Wilzbach of Cincinnati, president of the Ohio
Division of the American Cancer Society; Dr.
J. H. Lazzari, Cleveland, chairman of the Service
Committee; Dr. C. E. Hufford, Toledo, chairman
of the Professional Education Committee, and
Dr. M. M. Zinninger, Cincinnati, chairman of
the Lay Educational Program Committee. “With
the help of members of their committees, these
doctors have helped us steer a course in sound
cancer control within the State of Ohio,” Mr.
Warner said.
As part of the Professional Education work
in Ohio, the Ohio Division underwrote the cost
of the National Radiological Society meeting held
several months ago in Cleveland, as well as the
cost of brochures giving the latest data on
cancer to medical men. Under Dr. Zinninger’s
direction, 13 training schools for volunteers were
held in the State so that volunteers might be bet-
ter equipped to interpret the urgencies of early ex-
amination, as well as a sound attitude toward
cancer as a problem of the layman. Seventy-two
counties were represented by more than two thou-
sand workers at these training schools.
“We all realize that the answer to cancer will
come from science and the marshalling of all
scientific disciplines to bear on the problem,”
Mr. Warner concluded. “The cancer program in
Ohio is designed to help science to help the aver-
age man.”
Northwest Health Officers Meet
An organization meeting of the Northwest
District of the Ohio Public Health Association
was held January 27 in Findlay, at the call of
Dr. F. E. Mahla, health commissioner of Lucas
County, president.
Dr. Carll S. Mundy, Toledo, Councilor of the
Fourth District of the Ohio State Medical Asso-
ciation, and chairman of the Association’s Com-
mittee on Rural Health, spoke on “Rural Health
Programs in Ohio and the Nation.”
Dr. John D. Porterfield, director of the Ohio
Department of Health, opened the general dis-
cussion on the purposes and values of regional
public health conferences.
37 6
The Ohio State Aiedical Journal
Extensive mucosal destruction
and ulceration from chronic
ulcerative colitis with only a
few inflammatory polyps.
SEARLE
In COLITIS MANAGEMENT — In the constipation of spastic, atonic
and even ulcerative colitis, 'the smoothage action of METAMUCIL
is of proved value.
METAMUCIL® provides a bland, soft bulk with a
tendency to incorporate irritating particles with the fecal residue
and is thus a valuable adjunct in correcting the constipation and
minimizing irritation of the inflamed mucosa. METAMUCIL is
the highly refined mucilloid of a seed of the psyllium group,
Plantago ovata (50%), combined with dextrose (50%).
for April , 1950
377
Deans Report on British System . . .
Three Medical College Heads Return From Study of Medical Practice
In England and Declare That Socialization Was Move of Desperation
SOCIALISM in Great Britain, its welfare
state and its nationalization of medicine are
measures of desperation “and should not be
regarded as an expression of evolutionary social
and economic advance to be widely emulated by
more fortunate nations.”
This opinion is expressed in a report to the
Board of Trustees of the American Medical As-
sociation after two months’ study of medical prac-
tice in England under the National Health Serv-
ice Act, by three American medical school deans,
one of them, Dr. Stanley E. Dorst, dean of the
University of Cincinnati College of Medicine. The
other two are Dr. Harold S. Diehl, Minneapolis,
dean of medical sciences, University of Minnesota
Medical School, and Dr. Loren R. Chandler, San
Francisco, dean of Stanford University School of
Medicine.
The report traces the development of socialism
in England to changing economic conditions. It
points out that the population of Britain has
been growing while its “market has shrunk to a
shadow of its former greatness.” Furthermore,
it adds, the impact of the war has left that
country in desperate circumstances.
“It should be understood,” the deans report,
“that with the end of World War II only the
state controlled the money necessary to maintain
and operate the hospitals of Britain; to finance
the medical schools and promote medical research
and to provide medical care for approximately
two-thirds of the people.
OUR METHODS EVOLUTIONARY
“When these facts are fully comprehended it
seems clear that what is necessary and per-
haps admirable in Great Britain may be unneces-
sary and even undesirable in the United States.
Whereas Great Britain resorted to revolutionary
methods to meet a critical emergency, we are
still fortunate enough to have the opportunity
to work out our problems in a wise way, em-
ploying evolutionary methods.”
During the war the British government sub-
sidized hospitals frequently to the extent of half
of operating costs, the report points out, adding:
“When these subsidies were discontinued in
1946 most of the hospitals were insolvent. Faced
with the very real danger of hospital closure
on a nationwide scale it became apparent that
IF YOU’RE NOT REGISTERED TO VOTE,
VISIT YOUR ELECTION BOARD
large grants from public funds designed for
hospital expenditure must immediately be forth-
coming or rapid disintegration of the hospitals
of Great Britain would occur.
STUDENT SUBSIDIES
“Not only were state funds essential to the
continued operation of hospitals but a five-fold
increase in public money was needed for the medi-
cal schools. Concurrently, scholarships and grants
to medical students from public monies were
enormously increased, for the difficult economic
conditions prevented all but the children of
wealthy persons from matriculation in medical
schools.
“Before the war approximately 20 per cent
of medical students received financial aid. Now
at least 80 per cent are receiving educational
grants or scholarships, mostly from government
sources.”
Under the National Health Service Act which
went into effect in July 1948, the Ministry of
Health took over all the hospitals in Great
Britain. All patients are hospitalized free of
charge, the operating costs and capital expen-
ditures being provided through the budget of
the ministry.
“Since the adoption of the Act, the general
practitioner no longer has hospital privileges,”
the report says. “Nor does he command the
direct use of those ancillary departments which
have become essential to good medical work, the
clinical laboratory, X-ray facilities, etc. He
must confine his activities to home calls and
office visits, now almost entirely under the
capitation-fee system.
GENERAL PRACTICE FRUSTRATION
“The frustration within the field of general
practice which was beginning to become ap-
parent under the old panel system has been
greatly accelerated by the regulations of the
Act.”
As a result of this situation, the report adds,
“the future of this backbone of the profession
is in grave doubt.” Under the capitation-fee
system most of the practitioners are accepting
the maximum of 4,000 patients to have a rea-
sonably satisfactory income, the deans say.
This was held to be excessive for best medical
service.
Although the general practitioner can take
postgraduate training at the expense of the
378
The Ohio State Medical Journal
Ministry of Health relatively few men are taking
advantage of the opportunity, the deans found.
LASSITUDE IN TRAINING
“The reason most frequently given is that
he cannot practice medicine under present re-
strictions any more effectively after he takes
the course, so why take it,” says the report.
“The frustration of the man in general practice
under existing circumstances is by far the most
significant defect in British medicine.”
It adds that the Act has practically destroyed
all interest in training for the position of public
health officer or administrator because of the
limitation on scope of activities and the low
salary in comparison with that which the phy-
sician in clinical practice can obtain.
“The source of the future full-time physician
in the public health service is problematical,”
the deans say.
Also cited as a disturbing element is the
tendency of medical students to study for the
specialties rather than general practice because
of the favored position of the specialists.
NATIONAL-LOCAL BUFFERS
In medical education and research, the deans
say, “buffers have been devised to protect the
traditional freedom from the immediate control
of statism.” This protection is through authority
given the University Grant Committee, the
Medical Research Council and the General Medi-
cal Council.
“It is most important to note that there
is nothing analogous in the program of the
American protagonists of state medicine,” the
report adds.
“It was the frank opinion of almost everyone
with whom we conferred that it would be a
tragic mistake not to establish a similar and
equally effective buffer between the medical
schools of the United States and the government
if our schools are to have Federal funds to
augment their budgets.”
Concluding, with emphasis on “the all im-
portant social, economic and geographic back-
ground against which British socialism de-
veloped,” the report says:
“The National Health Service Act is only one
facet of British socialism. The welfare state
does not exist except as a part of the whole.
Conditions in Great Britain are so different from
those in the United States that it is folly to
contend that what may be necessary for Britain
today should be admirable for transfer to the
United States. We, fortunately, have the time
which is necessary to evolve an adequate medical
service for our people without resorting to the
centralization of authority in a welfare state.”
An Observation on the Accuracy of Digitalis Doses
Withering made this penetrating observation in
his classic monograph on digitalis: "The more I
saw of the great powers of this plant, the more it
seemed necessary to bring the doses of it to the
greatest possible accuracy.”1
To achieve the greatest accuracy in dosage and at
the same time to preserve the full activity of the
leaf, the total cardioactive principles must be iso-
lated from the plant in pure crystalline form so
that doses can be based on the actual weight of the
active constituents. This is, in fact, the method by
which Digilanid® is made.
Clinical investigation has proved that Digilanid is
"an effective cardioactive preparation, which has
the advantages of purity, stability and accuracy as
to dosage and therapeutic effect.”2
Average dose for initiating treatment: 2 to 4 tab-
lets of Digilanid daily until the desired therapeutic
level is reached.
Average maintenance dose: 1 tablet daily.
Also available: Drops, Ampuls and Suppositories.
1. Withering, W An account of the Foxglove, London, 1785.
2. Rimmerman, A. B.: Digilaaid and the Therapy of Congestive
Heart Disease, Am. J. M. Sc. 209 : 33-41 (Jan.) 1945.
Literature giving further decails about Digilanid and Physician's Trial
Supply are available on request.
Digilanid contains all the initial glycosides from
Digitalis lanata in crystalline form. It thus truly
represents "the great powers of the plant" and
brings "the doses of it to the greatest possible
accuracy”.
Sandoz
Pharmaceuticals
DIVISION OF SANDOZ CHEMICAL WORKS, INC.
68 CHARLTON STREFT, NEW YORK 14, NEW YORK
for April, 1950
379
In Our Opinion:
FIGURES ON INERTIA OF
CITIZENS, INCLUDING DOCTORS
One of the speakers in Chicago on Febru-
ary 12 at the Second National Conference
on the A. M. A. Education Campaign, sponsored
by the A. M. A., was Charles S. Nelson, execu-
tive secretary of the Ohio State Medical As-
sociation. Mr. Nelson described the activities of
the physicians of Ohio in an election year with
respect to interviewing candidates and arous-
ing doctors to support worthy candidates. The
part of his talk which made a deep impression
on the audience was that which cited figures
on the failure of physicians, businessmen,
teachers, ministers, and others to vote or to
even register so they can vote. Mr. Nelson also
urged representatives of all states to return
home and do a bit of checking to find out how
much inertia there may be in their own
states.
Here’s what the A. M. A. Secretary's Letter ,
written by Dr. George F. Lull, had to say about
the comments of Ohio’s executive secretary:
“Physicians can’t win their fight by stay-
ing away from the polls on election day,
Charles S. Nelson, executive secretary of the
Ohio State Medical Association, said at the
Second National Conference on the A. M. A.
Education Campaign in Chicago recently.
“Mr. Nelson provided some startling facts
which show the medical profession’s inertia
at election time.
“ ‘Let me give you some almost unbelievable
data which have been uncovered in Ohio,’ Mr.
Nelson said, adding:
“ ‘After the surprise party which Mr. Truman
threw in November, 1948, some of the political
leaders in Ohio decided to hold a postmortem.
They selected one of Ohio’s industrial areas —
Summit County, including the city of Akron.
The records of the county board of elections
were scrutinized. Believe them or not, here
are some of the findings:
“ ‘18 per cent of the physicians of the
county did not vote in the 1948 election —
13 per cent of them were not even registered
and therefore not eligible to vote.
“ ‘22 per cent of the wives of physicians
did not vote — 16 per cent of them were not
registered.
“ ‘10 per cent of the members of the
Rotary Club did not vote — 3 per cent were
not registered.
“ ‘The tally on Kiwanis Club members
was about the same.
Comments on Current Economic and Social
Questions and Professional Problems ;
Suggestions Regarding Organized Activities
“ ‘18 per cent of the druggists did not
vote — 15 per cent were not registered.
“ ‘11 per cent of the teachers did not
vote — 6 per cent were not registered.
“ ‘32 per cent of the bank employees, in-
cluding executives, did not vote — 26 per
cent were not registered.
“ ‘33 per cent of the ministers did not
vote — 26 per cent were not registered.
“ ‘34 per cent of the retail grocers did
not vote — 29 per cent were not registered.
“‘Here’s one for the books: 21 per cent
of the members of the Chamber of Com-
merce did not vote — 15 per cent were not
registered.
“ ‘I could give you additional statistics.
However, these will suffice to show why we
are bearing down on registration of voters
and voting this year. We’re sure that similar
data could be uncovered in other parts of the
state.
“ ‘Elections are still won by votes, strange
as that may seem to some people.
“ ‘And, the politician still has a warm spot
in his heart for groups which vote and produce
votes. If you doubt that, just ask one,’ ”
ACTION CALLED FOR IN
COLUMBIANA COUNTY
We suggest that the Columbiana County
Medical Society step forward and take a bow
as recognition for a resolution which the so-
ciety adopted on Feb. 7, 1950, advocating an
adequately financed, efficient public health set up
for that county.
Doubtless, the public health program in that
county is as good as programs in many
other counties. Nevertheless, it isn’t good
enough to satisfy the medical society. So, it
decided to do something about it.
Here’s the text of the resolution which many
other medical societies would do well to use as
a model for similar action:
“1. Public health is one of the specialized
branches of medicine.
“2. As a branch of medicine, public health
becomes the specific and intent interest of the
Columbiana County Medical Society.
“3. Public Health in Columbiana County has
suffered because of lack of sound cooperative
administration.
“4. The health departments of the county
have not provided complete services of Public
Health to the people of the county as recom-
mended and required by the laws of the State
of Ohio.
“5. Public health work in Columbiana County
380
The Ohio State Medical Journal
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for April , 1950
381
has been greatly retarded by the lack of co-
operative support both officially and unofficially.
‘‘6. The number of health districts in ratio
to the distribution of population is unsound and
unsatisfactory.
“7. The physicians of the county have not
been able to participate actively in securing
good public health for the people of the county
because of the lack of organization and unifica-
tion of the Public Health Departments of the
county.
“Be it resolved that the following recommenda-
tions were made by the Columbiana County
Medical Society, on February 7, 1950.
“1. That adequate working facilities, proper
personnel and suitable quarters be made avail-
able to a centralized Health Department.
“2. That adequate amounts of money be
budgeted and spent to secure good public
health in the county.
“3. That all health districts of Columbiana
County be fused into one strong Central Health
Department as provided by the Laws of Ohio
and recommended by the Ohio Department of
Health.
“4. That the County Medical Society should
advise, with the County Department of Health,
on matters of a medical nature relative to
public health.
“5. That the County Medical Society should
have an active and representative committee
on Public Health to study the needs and desires
of the people.
“6. That the County Medical Society endorse
and support a complete comprehensive public
health program for the county.
“7. That a record of the action of the County
Medical Society should be forwarded to the
various responsible, official and interested agen-
cies.”
HOW TO PAY A. M. A. DUES
AGAIN EXPLAINED
Misunderstandings regarding the payment of
1950 A. M. A. dues of $25.00 persist despite
announcements made by the A. M. A. and the
Ohio State Medical Association.
Remittances for A. M. A. membership dues
should not be sent direct to the A. M. A. by
county medical societies or by individual phy-
sicians. They should be sent to the Columbus
Office of the Ohio State Medical Association
for forwarding to the A. M. A., and made pay-
able to the Ohio State Medical Association.
As soon as possible after dues are received
from the State Association, the A. M. A. will
send a membership certificate and pocket card
to a member. This is being done now. How-
ever, thousands of dues are being received by
the A. M. A. This requires detailed handling.
Therefore, members are requested to be pa-
tient. They will get their certificates and cards
just as soon as the A. M. A. can wade through
this mass of paper work.
The A. M. A. Board of Trustees also has
settled the controversial question of who is
entitled to exemption from the payment of
A. M. A. membership dues, as follows:
The county shall determine when the pay-
ment of dues is a hardship, but in no case will
the A. M. A. dues be remitted unless the county
and state dues also are remitted.
A person in actual training for not more
than five years after his graduation from
medical school will be exempted, provided he
also is exempted from state and county dues.
The dues of a physician who joins his county
society after July 1 will be $12.50; if he
joins before July 1, his dues will be $25 for
that year.
A physician who transfers from one state
or county to another will not be expected to
pay the dues a second time, but a physician
must pay once.
The Constitution and By-Laws of the Ohio
State Medical Association contain no provision
for the exemption of members from paying
state dues. Therefore, the above policies do
not apply at this time to Ohio physicians. Au-
thority to amend the Constitution and By-Laws
is vested in the House of Delegates.
WHEN DISCARDING SAMPLES
DO A COMPLETE JOB
The Post Office Department has requested
physicians not to discard unwanted samples
of medicine in wastebaskets at post offices,
warning that children frisk these baskets for
pictures and old stamps and might pick up
samples which would be harmful if used.
Probably most physicians don’t discard samples
in post office wastebaskets. However, there
is a warning here regarding the disposal of
samples anyplace. They should be discarded
in safe receptacles. They should not be left
unprotected in office or home where adults,
as well as children, can get them.
MOVE TO HELP TAXPAYER
CAUSES LOUD WAILS
Congressional investigation of Secretary of
Defense Johnson’s consolidation of military hos-
pitals and closing of some of them as economy
measures as recommended by Ohio’s Dr. Richard
L. Meiling, director of medical services of the
Office of Defense, has been making the newspaper
headlines.
Some Congressmen are yelling bloody murder
especially when the order affects their own
districts. Naturally, the braid and the brass
are howling. Johnson and Meiling contend the
job can be done without impairing the efficient
and services of the medical department of the
armed services. Prominent civilian physicians
and others have jumped to the defense of
Johnson and Meiling, including Dr. Raymond
B. Allen, president, University of Washington,
Seattle, Meiling’s predecessor, whose statement
said:
“I am depnly disturbed about Admiral Boone’s
attack on Dr. Meiling and the Armed Forces
382
The Ohio State Medical Journal
OR
YOUNG
AT
SIXTY?
LINICAL observation and
nutritional science agree
that much depends upon the diet whether
the individual will be biologically old at
forty or biologically young at sixty.
To extend biologic youthfulness and
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of many physiologic processes is involved
in maintaining good nutrition. On the
other hand, only the adequate diet can sus-
tain these processes. To assure such dietary
adequacy under many conditions of
physiologic stress encountered in day to
day living, a properly organized food sup-
plement often assumes vital importance.
The multiple-nutrient dietary food supple-
ment Ovaltine in milk richly provides many
nutritional essentials when such supple-
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the important minerals calcium, iron and
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protein. Its satisfying flavor and its easy
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general and special diets whether for chil-
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The wealth of nutrients presented by
three glassfuls of Ovaltine in milk is
shown in the table below.
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CALORIES
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VITAMIN A . . . .
. . .3000 I.U.
PROTEIN
. . 32 Gm.
VITAMIN Bi. . . .
FAT
. . 32 Gm.
RIBOFLAVIN . . .
CARBOHYDRATE. . .
. . 65 Gm.
NIACIN
CALCIUM
. .1.12 Gm.
VITAMIN C . . . .
. . . 30.0 mg.
PHOSPHORUS ....
. .0.94 Gm.
VITAMIN D . . . .
... 417 I.U.
IRON
COPPER
for April, 1950
383
hospital unification program. As your former
director and present member of your Medical
Advisory Committee I strongly endorse your
steps to achieve efficiency and economy by clos-
ing non-essential hospital facilities. This means
better distribution for work load and more
efficient use of personnel. Dr. Meiling, though
young, is one of the ablest medical administra-
tors in the country. My experience with him
last summer confirmed my conviction that it
would be most difficult to find anyone better
qualified to do the job you want done in the
medical area. If this attack succeeds in un-
dermining Dr. Meiling or the Office of Medical
Services the program of medical unification will
be set back almost irreparably.”
Who knows whether Secretary Johnson and
Meiling will be able to make the order stick?
It’s the same old story of economy is o. k. for
the other fellow; not for me. About time for
someone to think about John Q. Taxpayer; or
is that asking too much?
IT’S TIME FOR A
HOUSE CLEANING
Some physicians are not going to like the
statement issued recently by the Board of
Trustees of the American Medical Association,
taking the hide off those few doctors who
charge excessive fees. Said the Board:
“The Board of Trustees looks with dis-
favor on the few members of the Association
who charge excessive fees. It urges state
and county societies to discipline those mem-
bers who, after a fair hearing and a decision
that the fees charged have been excessive,
refuse to reduce their fees to a level that is
reasonable for the services rendered.”
Let those who object to the sentiments ex-
pressed above remember that the public will
stand just so much; that the house cleaning
will come either from within or without. Where
the job should be done is apparent. Now
will not be one minute too soon.
WHAT’S DOWN “THE
ROAD AHEAD?”
In a recent editorial, labeled, “Our Road
to Socialism,” the Cleveland Plain Dealer said:
The Road Ahead is the title of a book by
John T. Flynn in which the author tells how so-
cialism came to Britain and in which he charges
that socialist planners are trying to establish the
same system in the United States.
This book is an arresting document. It de-
scribes how the government planners, without
calling themselves socialists, have moved into the
labor unions and the Democratic party to pro-
mote socialist objectives which are similar to
those of the British Labor party.
The book can be secured from the publisher,
The Devin-Adair Company, 23 East 26th Street,
New York City, or at most book stores.
It’s recommended reading for those who want
the low-down on where we’ve been and where
we seem to be going.
FORD MAKES ANOTHER
SMART MOVE
Henry Ford did a lot of smart things in his
time. Looks as if Henry Ford, 2nd, is a chip off
the old block. Here’s hoping more businesses
with money in the bank will follow the lead of
the Ford Motor Co., (and some other concerns, to
be sure) described in the following story released
by the Associated Press:
“The Ford Motor Co., wanting to discharge its
obligations as an ‘industrial citizen,’ is setting
up a special philanthropic organization.
“Formation of a new non-profit corporation,
known as the Ford Motor Company Fund, was an-
nounced yesterday by Henry Ford II, president
of the family-owned motor firm.
“Ford did not divulge the amount of money
which the corporation, chartered under Michigan
law, would handle. But he said that contributions
would come ‘principally’ from the Ford company.
“The fund’s purpose, he said, ‘will be the
alleviation of want and human suffering and the
betterment of mankind.’
“It will make contributions ‘in the fields of
charity, education, public and private health
and hospitalization, civic and community develop-
ment,’ he said.
“ ‘It is our observation,’ he continued, ‘that
traditional sources of financial support of private
institutions operating in these fields are tending
to disappear.
“ ‘We do not like the consequences inherent in
the alternative facing such private institutions —
that of having to turn to government for much-
needed financial aid.
“ ‘In our opinion, this situation places an in-
creasing responsibility upon American businesses
in their role of industrial citizens. ’ ”
DOCTOR SAYS FRIENDLY RIVALRY
PUTS PHYSICIANS ON TOES
Dr. D. C. Houser of Urbana, former president
of the Ohio State Medical Association, upon
receiving the Association’s 50-Year Pin and Cer-
tificate, made some pertinent observations in
regard to free enterprise in the practice of medi-
cine.
In an interview reported in the Urbana Daily
Citizen, Dr. Houser modestly emphasized that
any success he might claim as a doctor has
been the result of community demands and good
professional competition.
“They were good doctors, all good,” he said,
“and I had to either keep up with them or drop
out.”
Dr. Houser was reflecting the philosophy
which has made doctors of today — both young
and elderly — the best practitioners in the history
of medicine.
How different from the proposed program of
certain bureaucrats who would assign each doctor
his place of practice, toss him a list of patients,
clock him in at 8 in the morning and out again
at 5 with an hour off for lunch — and let the
patients be “jammed.”
384
The Ohio State Medical Journal
price reduction
of 26%
A price reduction of 26 % makes it possible
now for more patients to receive the thera-
peutic advantages of Depo*-Heparin.
Upjohn research and production workers
have so improved methods of extraction, puri-
fication, and assay of this long-acting anti-
coagulant that it is now possible to meet
increasing clinical needs and to reduce its
cost by 26%.
Literature describing anticoagulant therapy
in detail is available on request.
*Trademark , Reg. U. S. Pat. Off.
in the service of the profession of medicine
THE UPJOHN COMPANY. KALAMAZOO 99. MICHIGAN
for April, 1950
385
Do You Know? . . .
Hospital Care Corporation of Cincinnati, which
provides Blue Cross in a 14-county area, paid
100,555 hospital bills in 1949, amounting to
$7,256,125.03 and covering 650,987 days of hos-
pital care. Three most frequent reasons for
hospitalization were: pregnancies, 22.8 per cent of
all hospital admissions; injuries, 20 per cent; and
tonsillectomies, 9.3 per cent.
H* 5»C
Dr. A. A. Brindley, Toledo, Past-President of
the Ohio State Medical Association, spoke on
“Compulsory Health Insurance” at a public meet-
ing sponsored by the American Legion, at Oak
Harbor, February 20.
* * ❖
A total of 78 per cent of the country editors
of America fear that our nation is headed to-
ward Socialism, according to a poll conducted
recently by The American Press magazine. In-
cluded in the group polled were over 500 weekly
newspaper editors. Many believe that Congress’
action on compulsory health legislation will deter-
mine whether or not we are “going socialistic.”
Opposition to this type of health legislation was
expressed by 89 per cent of the editors.
* * *
Dr. Roger M. Gove, director of the Upper
Miami Valley Guidance Center at Piqua and Troy
since 1947, will become superintendent of the
Columbus State School for the Feeble Minded,
April 1.
sj: sj:
Dr. Judson D. Wilson, Columbus, has been
named a member of the Russell A. Hibbs Society
of New York, in recognition of his outstanding
work in the field of orthopedic surgery.
fj: H5 %
More than 72 per cent of the income of Cleve-
land’s Lutheran Hospital last year was ob-
tained through either non-profit or commercial
forms of hospital insurance.
❖ 5^ ❖
The 10,000th patient recently was admitted to
the Central Ohio Rapid Treatment Center, which
opened in January, 1946. The Center, located in
Fort Hayes Station Hospital, Columbus, is ad-
ministered by the Ohio Department of Health.
It is supported by funds from the U. S. Public
Health Service.
❖ H*
Dr. Louis H. Bauer, Chairman of the Board of
Trustees of the American Medical Association,
and Charles S. Nelson, Executive Secretary of
the Ohio State Medical Association, were guest
participants in a round-table discussion entitled
“What’s the A. M. A. to Us and We to the
A. M. A.?” during the 1950 Conference of County
and State Officers of the Connecticut State Medi-
cal Society, March 16, at New Haven, Conn. Mr.
Nelson also spoke on “The Doctor in Politics.”
H* H* Hs
The activities and structure of the Ohio Rural
Health Council were discussed by Mr. Hart F.
Page, assistant director of public relations, Ohio
State Medical Association on WRFD, the Ohio
Farm Bureau radio station, February 27.
• ^ ^
The Southwestern Ohio Society of General
Physicians collaborated with the University of
Cincinnati College of Medicine in presenting a
series of round-table discussions on general
practice, Tuesdays and Thursdays, 10 a. m. to
12 noon, March 2 through March 27, in the
auditorium of the College.
H« ^ H*
George Richards Minot, M. D., for many years
professor of medicine at Harvard Medical School,
died recently at his home in Boston, aged 64,
of coronary thrombosis and pneumonia. Dr.
Minot won the Nobel Prize for his discovery of
a cure for pernicious anemia.
Hi H* H*
Harvard Medical School has received a bequest
of $500,000 from the late Paul V. Bacon, Wel-
lesley, Mass., a textbook publisher, for re-
search on the common cold.
^ *
“What is the Situation, Mentally Speaking?”
was the topic discussed by Dr. Thomas E. Rardin,
Columbus, at the annual county-wide Achievement
Day Program of Champaign County, held at
Urbana, March 17. The meeting was attended
by several hundred women. The appearance of
Dr. Rardin was arranged by the Woman’s Auxi-
liary to the Champaign County Medical Society.
Hi H1 Hi
President Truman, on March 13, sent 21 re-
organization plans to the Congress, but omitted
the inclusion of a plan to establish a joint edu-
cation, health and welfare department similar to
the plan defeated by the Senate last year.
Hi Hi Hi
George H. Saville, Director of Public Relations,
Ohio State Medical Association, recently ad-
dressed a class in “Community Health Organiza-
tion” in the School of Social Administration of
Ohio State University. He discussed national
health legislation and explained the viewpoint of
the medical profession on current issues in the
health field.
386
The Ohio State Medical Journal
-no
• •
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for April, 1950
387
• • •
On the Firing Line
Shots at Truman-Ewing Compulsory Sickness Insurance Scheme;
Ammunition For Doctors in Speeches Against Federalized Medicine
“If this state-guaranteed ‘security’ idea were
new, it might help explain why so many people
insist on trying it. But it is not new. It was
written into the Code of Hammurabi over 4,000
years ago. In one form or another, it has been
tried time and again throughout history — always
with the same result. In the Roman Empire
it was called ‘bread and circus.’ More recently,
Karl Marx called it socialism.” — from Wards of
the Government by Dean Russell, published by
the Foundation for Economic Education, Inc.
* * *
“The total cost of the National Health Service
program for 1949-1950, including Scotland, is
estimated at £352,324,600 . . . About six per cent
of the cost is met by the individual. Approxi-
mately 94 per cent of the cost is met from gen-
eral taxation. It is important to keep in mind
that the National Health Service is not an in-
surance plan but almost entirely a direct govern-
ment expenditure.” — The National Health Service
of Great Britain, by Willard C. Rappleye, M. D.,
Vice-President in Charge of Medical Affairs,
Columbia Universty.
* * *
“I didn’t get out of England because I couldn’t
make a dollar. I was making about 10 per cent
more than before the program was put into
effect. But I had 3,200 patients. I was making
up to 36 house calls a day and seeing 60 or more
patients in three one-hour office periods per day.
That’s an average of one patient every three
minutes.” — Dr. Ralph J. Gampbell, self exile
from England’s socialized medicine program,
quoted from the Journal of the Maine Medical
Association.
^ ^ ^
“The abrupt deterioration in the treatment of
the sick is serious enough, but the effect of the
British National Health Program on preventive
medicine is tragic. Public health work, measures
for the prevention of disease, either in existence
or planned, have been retarded and even aban-
doned.”— Harold E. Stassen, President, Univer-
sity of Pennsylvania in Reader’s Digest, for
January, 1950.
* * *
“Socialism is the syphilis of medicine. It is easy
to take, but rots the body to death.” — Nashville
Doctor.
“While the theory of sickness insurance in-
dicates its use as a powerful weapon in disease
prevention, there is no indication that it has
ever occupied this role. The efforts of the family
physician in the field of alleviation are so in-
creased (by it) that he commonly lacks the
time to make the thoroughgoing examinations
that result in an earlier discovery of a serious
disease . . . the theory envisions but the prac-
tice inhibits.” — Sickness Insurance in Europe,
by the late J. G. Crownhart, Madison, Wisconsin.
^ ^ ^
“This most dangerous enemy is the American
counterpart of the British Fabian Socialist, who
denies that he is a Socialist and operates behind
a mask which he calls National Planning.” —
John T. Flynn’s book, The Road Ahead, as con-
densed in the February, 1950, issue of Reader’s
Digest.
* * *
“There are 78,000,000 life insurance policy-
holders. As money becomes cheap, their security
vanishes. A $10,000 policy paid up in 1940 has
lost $4,000 or more in terms of what it will buy
today.” — Hon. Samuel B. Pettengill, former Con-
gressman from Indmota, in an address October 12,
19U9.
* * *
Socialized medicine makes doctors responsible
to politicians first — and their patients second.
* * *
“Seven hundred and fifty thousand doctors,
nurses, and hospital personnel would enter our
Government employment, Washington would
guide and control it, drying up the voluntary
source of skill, mercy, health, and hospitalization.
Multiply 750,000 by four and you get another
group who will vote according to the promises
of appropriations for their particular benefit.” —
Hon. Ralph W. Gwinn, Congressman from New
Y ork.
* * *
“We are following in the footsteps of Great
Britain. We are much further along the road
than we suspect. If we do not clearly recog-
nize that fact and abandon that fatal road, we
shall inevitably, perhaps in less than a decade,
be in the condition the British now find them-
selves.”— John T. Flynn’s book, The Road Ahead,
as condensed in the February, 1950, issue of
Reader’s Digest.
CLIP THIS MATERIAL FOR REFERENCE
388
The Ohio State Medical Journal
rfachine
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Facilities for
Chronics and Convalescents
for April, 1950
389
In Memoriam
• • •
George Dana Cameron, Sr., M. D., Chagrin
Falls; Cleveland University of Medicine and Sur-
gery, 1895; aged 80; died February 15. Dr.
Cameron began his practice in Chagrin Falls
shortly after completion of his education. He was
mayor of the town at one time; and was a 50-year
member of the Masons and one of the founders
of the local Kiwanis Club. Surviving are his
widow; two sons, including Dr. George D. Camer-
on, Jr., and two brothers.
Chelsea Austin Coleman, M. D., Dayton; In-
diana Medical College, School of Medicine of
Purdue University, Indianapolis, 1906; aged 65;
died February 13 in Hollywood, Fla.; member of
the Ohio State Medical Association and the
American Medical Association; member of the
American Urological Association and the Ameri-
can College of Surgeons. Dr. Coleman practiced
his profession in Dayton from 1913 until his
retirement about nine years ago. Among survi-
vors is a brother, Dr. Marion Coleman of Dayton.
Sara Davies, M. D., Toledo; Cleveland-Pulte
Medical College, 1899; aged 84; died February 10.
Dr. Davies began her practice in Toledo in 1905
and continued until a few months ago. Surviving
are two sisters.
Ralph Waldo Dawson, M. D., Detroit, Mich.;
Starling Medical College, Columbus, 1905; aged
71; died February 28. Dr. Dawson practiced for
a short time in East Liverpool before leaving for
Detroit in 1919. Surviving are his widow, two
sons and a sister.
Reaves Warren DeCrow, M. D., Wilmington;
Eclectic Medical College, Cincinnati, 1901; aged
70; died February 10; member of the Ohio State
Medical Association and the American Medical
Association; secretary- treasurer of the Clinton
County Medical Society, 1943-1950; chairman of
its legislative committee, 1943-44. Dr. DeCrow
had been in public health work since 1920. He
was commissioner of Clinton County from 1940
until the time of his death, and formerly served
for 12 years as health commissioner of Scioto
County. He served for the year 1944-45 as
president of the Ohio Federation of Public
Health Officials. He was active in several
Masonic orders and was a member of the Ameri-
can Legion, being a veteran of World War I. Sur-
viving are his widow, a son and two daughters.
Joseph Deutsch, M. D., Cleveland Heights;
Western Reserve University School of Medicine,
1920; aged 58; died March 8; former member
of the Ohio State Medical Association and the
American Medical Association through 1926. Dr.
Deutsch served his entire professional career
in the Cleveland Heights area. Surviving are
his widow, a son, his mother, two brothers and
two sisters.
John Henry Duncan, M. D., Killbuck; Ohio
Medical University, Columbus, 1904; aged 72;
died March 13 as the result of a traffic accident;
former member of the Ohio State Medical Asso-
ciation and the American Medical Association
during the years 1934, 1937 and 1945. Dr. Dun-
can was a native of Killbuck and served all of
his professional career in Holmes County. He
held memberships in the Methodist Church, the
Masonic Lodge and the Odd Fellows Lodge. Sur-
viving are two daughters, a sister and a brother.
John W. Evers, M. D., Flint, Mich.; Rush Medi-
cal College, University of Chicago, 1902; aged
73; died February 11. Dr. Evers formerly prac-
ticed in Fostoria before moving to Flint about
thirty years ago. Surviving are his widow, two
children and a sister.
Germanus Elvery Gardner, M. D., Barberton;
Starling Medical College, Columbus, 1891; aged
83; died February 28; former member of the
Ohio State Medical Association and Fellow of
the American Medical Association through 1946.
Dr. Gardner practiced his profession in Barberton
for 40 years before retiring several years ago
and before that practiced for several years in
Doylestown. Recently he was honored by the
Summit County Medical Society by being pre-
sented the 50-Year Pin and Certificate of the
Ohio State Medical Association. He was a
member of the Catholic Church, the Knights of
Columbus, the Elks and was an honorary member
of the Rotary Club. He made his residence
with his son-in-law and daughter, Dr. and Mrs.
Joseph J. Weber of Barberton. Also surviving
are another daughter, three sisters and two
brothers.
Richard Kittle, M. D., Cleveland; Cleveland
Medical College-Homeopathic, 1896; aged 82;
died February 18. Dr. Kittle practiced most of
his life in the Glenville area. One daughter
survives.
Paul Hermann Krebs, M. D., Cleveland; Uni-
versity of Wooster Medical Department, Cleve-
land, 1894; aged 79; died February 27; member
of the Ohio State Medical Association and a Fel-
low of the American Medical Association. Dr.
Krebs practiced his profession from the same
office for approximately 54 years. Surviving
are a brother and a sister.
Morton Morgenstern, M. D., Cleveland; Uni-
versity of Louisville School of Medicine, 1928;
aged 46; died February 19; member of the Ohio
State Medical Association and a Fellow of the
390
The Ohio State Medical Journal
from head to toe
CEREVim
CEREALS + VITAMINS + MINERALS
1. "A Study of Enriched Cereal in Child Feeding" Urbach,
C.; Mack, P. B., and Stokes, Jr., J: Pediatrics 1:70, 1948.
*Cerevim contains neither vitamin A nor C but possibly
exercises an A-and-C sparing effect attributed to its
high content of protein and major B vitamins.
SIMILAC DIVISION
M Sc R DIETETIC LABORATORIES, Columbus 16, Ohio
CEREViM-fed children showed greater
clinical improvement, in the following
nutrition-influenced categories, than
children fed on ordinary unfortified
cereal or no cereal at all:1
Here’s why: Cerevim is not just a cereal.
Much more : Cerevim provides 8 natural
foods: whole wheat meal, oatmeal, milk
protein, wheat germ, corn meal, barley,
Brewers’ dried yeast and malt — PLUS
added vitamins and minerals .
hair lustre
recession of comeal invasion
retardation of cavities
condition of gums
condition of teeth
skin color
skeletal maturity
skeletal mineralization
*b1ood plasma vitamin A increase
*blood plasma vitamin C increase
subcutaneous tissues
dermatologic state
urinary riboflavin output
musculature
plantar contact
for April, 1950
391
American Medical Association. Dr. Morgen-
stern had practiced in Cleveland for approxi-
mately 19 years. He was a member of Phi
Delta Epsilon, Kappa Nu and several Masonic
orders. He also was a captain in the Reserve
Medical Corps. Surviving are his widow, two
daughters, his mother, two sisters and a brother.
Oliver U. O’Neill, M. D., Ironton; University
of Louisville School of Medicine, 1897; aged 79;
died February 24; member of the Ohio State
Medical Association and the American Medical
Association; delegate of the Lawrence County
Medical Society, 1918, 1927 and 1930. Dr. O’Neill
practiced his profession for many years in Ironton
and vicinity and for a number of years was
city health commissioner. Surviving are his
widow, a son and a daughter.
Henry Francis Rohs, M. D., Cincinnati; Creigh-
ton University School of Medicine, Omaha, 1929;
aged 48; died February 14; member of the Ohio
State Medical Association and a Fellow of the
American Medical Association. Dr. Rohs was
chief of staff at Our Lady of Mercy Hospital
for a number of years. Surviving are his widow,
three sons and two daughters.
Charles Jerome Shepard, M. D., Columbus;
Bellevue Hospital Medical College, New York,
1894; aged 79; died March 8; member of the
Ohio State Medical Association and a Fellow
of the American Medical Association; diplomate
of the American Board of Dermatology and
Syphilology; member of the American Academy
of Dermatology and Syphilology. Since 1940
Dr. Shepard had been professor emeritus in
dermatology at Ohio State University College of
Medicine where he previously had served for some
40 years. He was a member of the Methodist
Church and several Masonic orders. Surviving
are his widow, a daughter, a brother and two
sisters.
Karl Jacob Siipon, M. D., Canton; Western Re-
serve University School of Medicine, 1932; aged
43; died March 8; member of the Ohio State
Medical Association and the American Medical
Association; member of the American College of
Surgeons. A practicing physician in Canton,
Dr. Simon was a veteran of World War II, dur-
ing which he served in the Army Medical Corps.
He was a member of the Catholic Church.
Surviving are his widow, three children and his
parents.
Harry Streett, M. D., Leroy; Baltimore Medi-
cal College, 1894; aged 79; died February 14;
member of the Ohio State Medical Association
and a Fellow of the American Medical Associa-
tion; secretary- treasurer of the Medina County
Medical Society in 1926, and its president from
1932 through 1934. Dr. Streett began his prac-
tice in Litchfield in 1900 and continued there
until his retirement about five years ago when
he moved to Leroy. He recently was honored
by the Medina County Medical Society by being
presented the 50- Year Pin and Certificate of
the Ohio State Medical Association. He was
a veteran of the Spanish- American War and
was a member of several Masonic orders. Sur-
viving are a son, two brothers and two sisters.
Arthur Dice Traul, M. D., Akron; Starling
Medical College, Columbus, 1903; aged 71; died
February 27; member of the Ohio State Medical
Association and the American Medical Associa-
tion. Dr. Traul practiced for several years in
North Robinson before moving his practice to
Akron many years ago. During World War I
he served with the Volunteer Medical Service
Corps. He was a member of the Methodist
Church and several Masonic orders. Surviving
are a son, Dr. Donald M. Traul of Cuyahoga
Falls, and a sister.
Dwight Addison Weir, M. D., Mansfield; Uni-
versity of Rochester School of Medicine, 1930;
aged 46; died February 15; member of the Ohio
State Medical Association and a Fellow of the
American Medical Association; secretary-
treasurer of the Richland County Medical Society,
1934; vice-president, 1935; president, 1936; dip-
lomate of the American Board of Pediatrics;
member of the American Academy of Pediatrics.
Dr. Weir had practiced his profession in Mans-
field since 1933. In addition to his medical work,
he was a member of the Rotary Club, the Elks
Lodge, the Presbyterian Church and was active
in other civic affairs. Surviving are his widow,
two daughters, a son, two brothers and a sister.
Herman Welland, M. D., Greenville, Va.; Col-
lege of Physicians and Surgeons of Baltimore,
1899; aged 78; died February 28; former member
of the Ohio State Medical Association and the
American Medical Association through 1945;
president of the Stark County Medical Society
in 1933. After 26 years of practice in Canton.
Dr. Welland retired from active practice in 1945
and returned to his former home in Virginia.
Surviving are his widow, a son and a daughter.
Public Health Association
To Meet May 11-12
The annual meeting of the Ohio Public Health
Association is scheduled for May 11-12 in Co-
lumbus. Theme of the conference will be “Pub-
lic Health Education in Ohio.”
Speakers are being invited to discuss the topics,
“Methods of Health Education”; “Health Edu-
cation in the Newer Fields of Public Health”;
and “Professional Staff In-service Training in
Public Health.”
Section groups are urged to carry this theme
of public health education through their group
discussions.
392
The Ohio State Medical Journal
Before Treatment (5
prior to Dihydro-
streptomycin therapy)
Diffuse lobular tubercu-
lous pneumonia, lower
half of left lung; thin-
walled cavity above hilus
(.3 x 3.5 cm.).
m-*-
After 3 Mos. Treat-
ment (2 days after dis-
continuance of Dihydro-
streptomycin) Consider-
able clearing of acute
exudative process in the
diseased lung; cavity
smallerand wallthinner.
Preferred Adjuvants in the
treatment of
a
Dihydrostreptomycin and Streptomycin are unquestionably the most
potent antibiotics now available for use against tuberculosis. Extensive
clinical results have defined the important role of these antibiotics in
suppressing the activity of the tubercle bacillus.
Detailed literature including in-
dications, pharmacology, dosage,
and administration is available
upon request.
MERCK & CO., Inc.
Manufacturing Chemists
RAHWAY, N. J.
Streptomycin Dihydrostreptomycin
Calcium Chloride Sulfate
Complex Merck Merck
for April, 1950
393
• •
Buckeye News Notes .
Ashland — Officers of the medical staff of the
Samaritan Hospital are: Dr. E. L. Clem, presi-
dent; Dr. L. Harold Martin, vice-president; and
Dr. Wayne C. Smith, secretary-treasurer.
Ashtabula — Dr. Harold C. Franley of Jefferson
was elected a member of the Ashtabula County
District Board of Health.
Belleville — Dr. F. J. Heringhaus, Mansfield, ad-
dressed the local P.-T. A. on the subject, “So-
cialized Medicine.”
Calcutta — Dr. Robert M. Dunlap, East Liver-
pool, Columbiana County health commissioner,
spoke before the local P.-T. A. on reorganization
of public health in the district and the proposed
new school health program.
Canton — Dr. E. Scott Hill, upon his return from
a trip to England, reported in a public interview
the dissatisfaction of British doctors with the
health program in that country.
Chardon — Dr. William P. Edmunds, Independ-
ence, was named Geauga County health com-
missioner.
Cleveland — Dr. Irvine H. Page addressed mem-
bers of the Michigan Heart Association at the
annual meeting held in Detroit on the subject of
high blood pressure.
Cleveland — Dr. Charles L. Hudson addressed
members of the Northeast Property Owners
Civic Association on the subject, “Compulsory
Health Insurance.”
Gallipolis — Dr. Franklin H. Schaefer, New
Haven, Conn., has accepted the position as head
of the new department of pediatrics at the
Holzer Hospital.
Kenton — Dr. John A. Mooney is now in Japan
serving as a civilian doctor with the U. S. Army.
Lima — Dr. Calvin L. Baker, Columbus, com-
missioner of mental hygiene for the Ohio De-
partment of Public Welfare, addressed the Allen
County Mental Hygiene Association.
Mansfield — Dr. Harry Wain spoke before the
Lincoln Heights P.-T. A', where he explained the
work of the Richland County Health Department.
Millersburg — Dr. Harry Duncan addressed the
Holmes County Cancer Society at the Pomerene
Memorial Hospital.
Piqua — Dr. Harry E. Shilling, Troy, was re-
elected president of the Miami County Tuber-
culosis and Health Association.
Westerville — Dr. Harrison S. Evans, Worthing-
ton, spoke before the Northern Franklin County
Mental Hygiene Association which met at Otter-
bein College.
Wooster — Dr. John Paul Miller of Orrville
was elected to the Wayne County Board of
Health for a five-year term.
New Members of O. S. M. A.
Following are the names of new members of
the Ohio State Medical Association, since Febru-
ary 1, 1950. The list shows the county in which
they are affiliated, city in which they are prac-
ticing, or temporary addresses in cases where
physicians are taking postgraduate work.
BROWN COUNTY
Charles H. Maly, Sardinia
COLUMBIANA COUNTY
Wade A. Bacon, Lisbon
CRAWFORD COUNTY
Glenn R. Margard, Galion
CUYAHOGA COUNTY
Gilbert I. Anderson Cleve-
land
Raymond N. Ferreri,
Cleveland
Willard T. Hill, Cleveland
Gerhard Hoffman, Cleve-
land
Shozo Iba, Cleveland
Walter R. Katzenmeyer,
Bay Village
Avard C. Long, Cleveland
Norman S. Manica,
Cleveland
Robert B. Marshall, Lake-
wood
William E. Neville, Cleve-
land
Richard T. F. Schmidt,
Cleveland
FRANKLIN COUNTY
Norman E. Goulder, Co-
lumbus
John E. Stephens, Co-
lumbus
HAMILTON COUNTY
Albert A. Brust, Cincin-
nati
Noble O. Fowler, Jr., Cin-
cinnati
Charles V. Pfahler, Cin-
cinnati
Lee S. Rosenberg, Cin-
cinnati
Robert E. Shirley, Cin-
cinnati
HIGHLAND COUNTY
Andrew M. Brenner, Hills-
boro
JEFFERSON COUNTY
Irving Dreyer, Toronto
Frances J. Shaffer,
Toronto
KNOX COUNTY
John F. Robinson, Mt.
Vernon
LAKE COUNTY
Richard W. McBurney,
Painesville
LOGAN COUNTY
Donald E. Minch, Lake-
view
LUCAS COUNTY
Merlin B. Budd, Toledo
Herbert A. Richardson,
Toledo
Gregor Sido, Toledo
MEIGS COUNTY
LeGrande Gribble, Pomeroy
MONTGOMERY COUNTY
Edith Gitman, Dayton
SANDUSKY COUNTY
Robert A. Borden, Fremont
SCIOTO COUNTY
Louis R. Chaboudy,
Portsmouth
STARK COUNTY
Norman Lewis, Canton
Myrl D. Musgrave, Canton
WYANDOT COUNTY
Talmadge R. Huston,
Carey
Frederick B. Western,
Apple Creek
Hamilton Academy Elects
The annual meeting of the Hamilton Academy
of Medicine was held in mid- January at the
Hamilton City Club. Officers for the year are:
Dr. C. U. Hauser, president; Dr. Edward Keat-
ing, president-elect; Dr. G. E. Marr, secretary;
Dr. John Borelli and Dr. H. A. Moore, councilors.
Dr. Hauser reported that the group of physi-
cians of the City of Hamilton now beginning its
third year numbered 52. Subjects discussed in-
cluded: Improvement of the practice of medicine
in Hamilton; care of indigent especially in re-
spect to legislation; advisability of having a doc-
tor on the Hamilton Safety Council. It was de-
cided to hold monthly educational meetings.
IF/ YOU’RE NOT REGISTERED TO VOTE,
VISIT YOUR ELECTION BOARD
394
The Ohio State Aiedical Journal
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for April, 1950
395
Activities of County Societies . . .
First District
(COUNCILOR: D. W. HEU SINK VELD, M. D.,
CINCINNATI)
BROWN
Dr. William L. Faul, Georgetown, and Dr.
George P. Tyler, Jr., Ripley, were reelected
president and secretary-treasurer, respectively,
of the Brown County Medical Society. Dr. Faul
also is delegate and Dr. Tyler, alternate.
CLINTON
Two physicians were honored by being pre-
sented the 50-Year Pin and Certificate of the Ohio
State Medical Association through the Clinton
County Medical Society. They are Dr. Elizabeth
Shrieves and Dr. Frank A. Peelle, both of Wil-
mington. Since neither doctor was able to be
present at the meeting, Dr. David W. Heusink-
veld, Cincinnati, Councilor of the First District
of the Ohio State Medical Association, passed
the pins on for presentation to Dr. R. H. Vance,
president of the Society. Dr. Vance later made
the presentations at the homes of the 50-Year
doctors.
Dr. Richard R. Buchanan, Wilmington, has
been elected to succeed the late Dr. R. W. DeCrow
as secretary of the Clinton County Medical So-
ciety.
In place of the regular March meeting, the
Clinton County Medical Society met with the
societies of Highland and Fayette counties in a
tri-county meeting in Greenfield, March 1. Subject
of discussion was “Intestinal Obstructions.”
Clinton County was represented by the follow-
ing doctors: Drs. R. H. Vance, Robert Conard,
J. H. Frame, Kelley Hale, A. F. Lippert and
R. R. Buchanan. Two more tri-county meetings
will be held during the remainder of 1950.
HAMILTON
The program of the Academy of Medicine of
Cincinnati for April and May includes the fol-
lowing features and speakers:
April 4 — “The Psychology of Eating,” by Dr.
Hilde Bruch, College of Physicians and Surgeons,
Columbia University, New York.
April 18 — “Factors in the Control of Bleed-
ing,” by Walter H. Seegers, Ph. D., Wayne Uni-
versity College of Medicine, Detroit.
May 2 — “Management of Menstrual Irregu-
larities,” by Dr. William F. Mengert, Southwest-
ern Medical College, Dallas, Texas.
May 16— “Drug Allergy,” by Dr. William B.
Sherman, College of Physicians and Surgeons,
Columbia University.
Second District
(COUNCILOR: M. D. PRUGH, M. D„ DAYTON)
CHAMPAIGN
Dr. D. C. Houser was honored at a meeting
of the Champaign County Medical Society on
Feb. 15, by being presented the 50-Year Pin and
Certificate of the Ohio State Medical Associa-
tion. Dr. Houser is a Past-President of the
Association. He has not missed an Annual
Meeting of the Association since 1898, and for
most of those years he has attended as a member
of the House of Delegates.
Presentation was made by Dr. Merrill D.
Prugh, Dayton, Councilor of the Second District,
and Dr. R. D. Dooley, also of Dayton, president
of the Second District.
CLARK
Dr. Milton M. Parker, Ohio State University
College of Medicine, Columbus, addressed the
Feb. 20 meeting of the Clark County Medical
Society on the subject “Epilepsy.” The meeting
was held in. the Nurses’ Residence of City Hos-
pital, Springfield, where the Woman’s Auxiliary
afterwards served refreshments.
DARKE
“Recent Advances in Geriatrics” was the topic
of a talk by Dr. John Tucker of Cleveland at the
Feb. 21 meeting of the Darke County Medical
Society in Greenville.
MIAMI
The regular meeting of the Miami County
Medical Society was held on March 3 at Memorial
Hospital in Piqua. Dr. Allan C. Barnes, chairman
of the Department of Obstetrics and Gynecology,
Ohio State University College of Medicine, Co-
lumbus, discussed “The Diagnosis and Manage-
ment of the Infertile Couple.”
The secretary announced that he had obtained
100 copies of the book, The Road Ahead, for dis-
tribution at 50 cents per copy, in agreement with
a resolution passed by the Society.
Upon completion of the Society’s present radio
program series entitled “The Public Comes First,”
over Station WPTW on Saturday mornings, two
special programs, “Compulsory Health Insurance”
and “The Health Insurance of England,” will be
presented.
PREBLE
Preble County Medical Society officers for
the year are: Dr. A. L. Ross, West Alexandria,
pres.; and Dr. Birna R. Smith, Lewisburg,
secy.-treas. Delegate and alternate, respectively,
ARE YOU AND MEMBERS OF YOUR
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396
The Ohio State Medical Journal
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for April, 1950
397
are Dr. E. P. Trittschuh, Lewisburg, and Dr.
C. W. Beane, Eaton.
Third District
(COUNCILOR: J. CRAIG BOWMAN, M. D.,
UPPER SANDUSKY)
HARDIN
Officers of the Hardin County Medical Society
for the present year are: Dr. C. L. Johnson,
pres.; Dr. Henri A. Kerns, vice-pres.; and Dr.
Elizabeth Brungard, secy.-treas.; all of Kenton.
Delegate and alternate, respectively, are Dr. F.
M. Elliott of Ada and Dr. Johnson.
MERCER
Dr. M. L. Downing, Rockford, recently was
honored by being presented the 50-Year Pin and
Certificate of the Ohio State Medical Society
through the Mercer County Medical Society. Dr.
Downing has served 48 of his years of practice
in Rockford.
WYANDOT
Members of the Wyandot County Medical So-
ciety elected the following officers for the present
year: Dr. Franklin M. Smith, Sycamore, pres.;
Dr. Henry Vogtsberger, Upper Sandusky, vice-
pres.; and Dr. Raymond T. Murphy, Carey, secy.-
treas.
Dr. Claude W. Montgomery of Sycamore was
honored by the Wyandot County Medical Society
by being presented the 50-Year Pin and Certif-
icate of the Oiho State Medical Association.
Dr. J. Craig Bowman, Upper Sandusky, Coun-
cilor of the Third District of the Ohio State
Medical Association, made the presentation.
Fourth District
(COUNCILOR: CARLL S. MUNDY, M. D., TOLEDO)
HENRY
Dr. J. A. Ruder of McClure was honored on
March 2 at a community gathering in which
members of the Henry County Medical Society
took a leading part. He was presented the 50-
Year Pin and Certificate of the Ohio State Medi-
cal Association.
LUCAS
The program of the Academy of Medicine of
Toledo and Lucas County included the following-
speakers and features:
General Meeting, Feb. 3 — “Intern and Resi-
dency Training and Specialization Problems in
Medicine Today,” Dr. Edwin P. Jordan, Cleve-
land.
Section on Pathology, Experimental Medicine
and Bacteriology, Feb. 10 — “Recent Concepts of
the Etiology and Pathogenesis of Arterioscler-
osis,” Dr. Donald C. Wilson, Toledo; and “Hodg-
kin’s Disease Discovered During Breast Surgery,”
Dr. Fred M. Douglass, Jr., Toledo.
Medical Section, Feb. 17 — “Nutritional Prob-
lems in Relation to Anastomotic Surgery,” Dr.
Chester M. Jones, Harvard Medical School,
Boston.
Surgical Section, Feb. 24 — “Surgery of Patent
Ductus Arteriosus,” Dr. Willis J. Potts, Chil-
dren’s Memorial Hospital, Chicago.
PUTNAM
Officers of the Putnam County Medical Society
are: Dr. M. W. Palestrant, Continental, pres.;
Dr. Donald B. Lucas, Columbus Grove, vice-pres.;
Dr. Carl J. Heitz, Fort Jennings, Secy.-treas.
The delegate is Dr. Wayland B. Recker, Leipsic,
and alternate, Dr. Milo B. Rice, Pandora.
Guest speaker at the Feb. 7 meeting of the
Society was Dr. Harry E. Tebrock, medical di-
rector for the Sylvania Electric factories, New
York, who discussed health and accident prob-
lems encountered by industrial employees.
WOOD
Dr. Henry Zimmerman, teaching fellow in
Medicine at Western Reserve University School
of Medicine, spoke to the Wood County Medical
Society at the regular dinner meeting at the
Midway Restaurant Perrysburg on Feb. 16. His
subject was “Newer Aspects of Diagnoses of
Congenital Heart Disease.”
With the aid of diagrams projected on the
screen Dr. Zimmerman was able to present the
technique of cardiac catheterization and its in-
dications in a very interesting manner.
The variations in oxygen concentration in the
chambers of the heart in the different types of
deformity as determined by this method and its
refinement at Western Reserve University were
described. Dr. Zimmerman spoke briefly also
on the surgical treatment as indicated by heart
catheterization.
The paper was discussed by Dr. Frank Clif-
ford of Toledo and Dr. Nathan Worth Brown,
also of Toledo. The discussants brought out the
various practical applications of this new method
in routine practice and spoke of its essential
harmlessness.
Dr. Zimmerman generously replied to the
many questions put by the members who ex-
pressed themselves as delighted with the paper.
A rising vote was tendered Dr. Zimmerman.
Fifth District
(COUNCILOR: FRED W. DIXON, M. D., CLEVELAND)
LAKE
A movie on “Malnutrition” was shown to the
Lake County Medical Society at Lake County
Memorial Hospital on Feb. 14, as part of a
program for which Dr. Paul E. Reading, presi-
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398
The Ohio State Medical Journal
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dent, was chairman. The Society heartily ap-
proved of an extension of the Blue Cross plan
for hospital insurance to cover more persons in
Lake County than are now members.
Seventh District
(COUNCILOR: R. J. FOSTER, M. D., NEW
PHILADELPHIA)
TUSCARAWAS
Dr. Elizabeth Rowland-Aplin, Dover, county
health commissioner, addressed the January meet-
ing- of the Tuscarawas County Medical Society in
New Philadelphia on the theme of necessity for
prompt report and classification of birth and death
certificates. She also discussed control of ring-
worm infection. Dr. R. J. Foster, New Philadelphia,
Councilor of the Seventh District of the Ohio
State Medical Association, gave a report on can-
cer.
TO BE A GOOD CITIZEN, YOU MUST
BE REGISTERED TO VOTE
Eighth District
(COUNCILOR: CHESTER P. SWETT, M. D., LANCASTER i
GUERNSEY
Dr. M. C. McCuskey was in charge of the
scientific program for the Feb. 2 meeting of the
Guernsey County Medical Society. In his talk
entitled “Medical Economics” he reviewed the
practice of medicine during the past 25 years.
The Society met in regular session for lunch-
eon at the Hotel Berwick in Cambridge on
Feb. 16. Dr. W. I. Denny, chairman of the com-
mittee on public relations, reported regarding
a recent meeting of his committee with the
Guernsey County commissioners. It was agreed
upon at that meeting that the commissioners
would pay physicians for the care of the indigent
at the same rates as are now current in Ohio j
Aid for the Aged fee schedule.
A motion was passed authorizing the secre-
tary to send a letter to the Ohio State Medical
Association, advising it that members of the
Guernsey Society are dissatisfied with the man-
ner in which fees for medical services in Aid
to the Aged cases are handled. Another motion
specified that it is the policy of members to deal
directly with the patient in cases which are
eligible to receive benefits from the Division of
Aid for the Aged, except in those cases involv-
ing surgery.
The scientific program was in charge of Dr.
Henry Wells who introduced his son, Dr. Arthur
Wells of Cincinnati, as the speaker of the day.
His subject was “Office Proctology.” The talk
was followed by a period of discussion. Dr.
Kenneth J. Frakes, Cambridge, was received
into membership.
At the March 2 meeting, Dr. Denny was in
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The Ohio State Medical Journal
/charge of the scientific program and introduced
Dr. James Morton of Zanesville as guest speaker.
His topic was “A Study of Sterility.”
Further discussion was held on relationship
between county commissioners and the profession
on the care of indigents. It was announced that
fhe Senior Chamber of Commerce had offered the
Society use of its mimeograph and that Miss
Helen Rigby, Dr. F. Gordon Lawyer’s assistant,
had offered to operate the machine when neces-
sary.
Dr. Ben. S. Gillespie announced that he will
take graduate w^ork for two years in Cleveland
and introduced Dr. William W. Bryant who will
take over his practice in Senecaville.
LICKING
Ralph W. Jordan, Columbus, executive vice-
president of the Central Hospital Service (Blue
Cross), spoke at the Jan. 31 meeting of the
Licking County Medical Society at Granville
Inn. His subject was “Voluntary Hospital Care.”
MUSKINGUM
“Doctors’ Legal Duty and Liability for Mal-
practice” was the topic of a talk by Mr. Richard
Schannan, attorney for the Medical Protective
Company, at the Feb. 1 meeting of the Mus-
kingum County Academy of Medicine in Zanes-
ville. A business meeting was held on March 1.
WASHINGTON
Five physicians were presented the 50-Year Pin
and Certificate of the Ohio State Medical As-
sociation at the Feb. 1 meeting of the Wash-
ington County Medical Society in Marietta. They
are: Dr. E. W. Hill, Sr., Marietta; Dr. Harry
W. Hill, Vincent; Dr. I. J. Johnson, Marietta;
Dr. J. B. McClure, Marietta; and Dr. Roseberry
Rowles, Matamoras. Dr. Chester P. Swett, Lan-
caster, Councilor of the Eighth District of the
Ohio State Medical Association, made the presen-
tations. Wives of doctors were guests at the
presentation banquet.
Ninth District
(COUNCILOR: -J. PAUL McAFEE, M. D.,
PORTSMOUTH)
SCIOTO
Two physicians from Ohio State University
^College of Medicine presented discussions at the
Feb. 13 meeting of the Hempstead Academy of
Medicine at General Hospital in Portsmouth. Dr.
J. J. Jacoby, head of the Department of Anes-
thesia, University Hospital, spoke on “The Anes-
thetist in Medical Therapy.” Dr. John Garvin,
assistant anesthetist, University Hospital, dis-
cussed the subject, “Anesthetics for Special Risk
Patients.” Mr. E. C. Buckner, of Provident Life
and Accident Insurance Company, gave a resume
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of the insurance setup at Detroit Steel Corpora-
tion.
Guest speaker for the March 13 meeting of
the Academy was Dr. Jack S. Silberstein, Co-
lumbus, Ohio State University College of Medi-
cine, whose subject was “The Coronary Artery.”
Tenth District
(COUNCILOR: H. M. CLODFELTER, M.D., COLUMBUS)
DELAWARE
Dr. J. K. James, Delaware, was honored by
being presented the 50- Year Pin and Certificate
of the Ohio State Medical Association at a
joint meeting of the Delaware County Medical
Society and the Union County Medical Society
at Magnetic Springs in February.
KNOX
Two Knox County physicians were honored
by being presented the 50- Year Pin and Certif-
icate of the Ohio State Medical Association.
They are Dr. James F. Lee of Mount Vernon
and Dr. T. L. Eley of Gambier. Dr. I. S. Work-
man gave a talk on the subject of medical prac-
tice in earlier years. The two doctors also were
presented gifts from the local society. A
delegation of the Society went to the home of
Dr. Eley where he was confined because of
illness and made the presentation.
MADISON
Following are the officers and representatives
elected by the Madison County Medical Society
for 1950: Dr. G. C. Scheetz, West Jefferson, pres.;
Dr. E. S. Crouch, London, vice-pres.; Dr. Wil-
liam T. Bacon, London, secy.-treas. and dele-
gate; Dr. H. E. Karrer, Plain City, alternate.
Eleventh District
(COUNCILOR: JOHN S. HATTERY, M. D., MANSFIELD)
ASHLAND
Officers of the Ashland County Medical So-
ciety for the ensuing year are: Dr. G. Deshler
Fridine, pres.; Dr. R. J. Ferguson, vice-pres.;
and Dr. H. V. Marley, secy.-treas., all of Ashland,
Dr. Ferguson is delegate and Dr. M. A. Shilling,,
also of Ashland, alternate.
LORAIN
Economic, professional and public relations
matters pertaining to the practice of medicine
were discussed at a business meeting of the
Lorain County Medical Society on Feb. 14 at;
the Pueblo in Lorain.
“Cancer Detection in Rural Private Practice”'
was discussed by Dr. A. C. Siddall, Oberlin, at
ff. H. MILLER, M. D.
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402
The Ohio State Medical Journal
the March 14 meeting of the Society. The dinner
meeting began at 5 o’clock.
The Lorain County Medical Society will present
its third annual Postgraduate Symposium on
Wednesday, April 26, at the Spring Valley Coun-
try Club, Elyria, from 2 to 9 p. m.
The program will be given by a team from the
University of Illinois and will consist of the
following subjects: “Present Status of Anti-
biotic Therapy”; “Surgical Therapy of Pancrea-
tic Disease”; “Present Status of Hematological
Diseases”; “Jaundice”; “Treatment of Thyro-
toxicosis”; and the evening topic, “Clinical Ap-
plication of -Cortisone and ACTH.”
MEDINA
Dr. Herbert F. Cowgill, Wadsworth, was
elected secretary of the Medina County Society
to replace Dr. Morris M. Malmud, Sharon Center,
who resigned recently.
ARE YOU AND MEMBERS OF YOUR
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Woman’s Auxiliary . . .
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
President — Mrs. C. W. Kirkland, 4805 Guernsey Street,
Bellaire
Recording Secretary — Mrs. C. H. Bell, 754 Dickson Parkway,
Mansfield
Treasurer — Mrs. A. Paul Hancuff, 3551 Maxwell Road,
Toledo 13
AUGLAIZE
The Woman’s Auxiliary to the Auglaize County
Medical Society met on Feb. 15 at the home
of Mrs. A. W. Veit in Wapakoneta. Mrs. T. H.
Will of Minster w^as welcomed as a new
member and also appointed chairman of To-day's
Health committee. The group received an in-
vitation from the Lima and Allen County Auxi-
liary to attend its meeting on Feb. 28.
CARROLL
Both the Carroll County Medical Society and
its Auxiliary met on March 2 at the home of
Dr. and Mrs. S. L. Weir. The Auxiliary re-
ported on its To-day's Health subscription drive;
the magazine has been placed in all the high
schools in the county.
ERIE
“What’s New About What’s Old” featured the
February meeting of the Erie County Auxiliary,
when many of its members brought exhibits of
their hobbies. The program, which followed the
group’s regular monthly luncheon, began with
Miss Mary McCann’s discussion of the books
on hobbies to be found in the public library.
Miss McCann was introduced by program chair-
man, Mrs. E. J. Meckstroth. Contributors to an
exhibit of rare articles included Mrs. Hugo
Sarchet, Mrs. H. L. Sowash, Mrs. C. B. Bliss,
757 W. Washington St., Charleston 2, W. Vo.
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Mrs. Fred Schoepfle, Mrs. C. E. Swanbeck, Mrs.
F. E. Reed, and Mrs. Paul N. Squire.
Mrs. Duane Love was in charge of the Valen-
tine luncheon; she was assisted by Mrs. A. J.
Tight and Mrs. R. F. Hoffman.
FAIRFIELD
The Auxiliary to the Fairfield County Medi-
cal Society invited their husbands to their meet-
ing on Feb. 16 to hear Dr. Walter T. Secor
speak on “France, Crossroads of Europe.” Dr.
Secor is chairman of the modern language de-
partment of Denison University and president
of the Ohio chapter of the American Associa-
tion of Teachers of French.
Following the doctor’s talk, lunch was served.
FRANKLIN
Dr. Allan C. Barnes was guest speaker on
Feb. 20 when the Auxiliary to the Columbus
Academy of Medicine held its annual Guest Day.
He spoke on “A Gynecologist’s View of Marriage
Counseling.” This annual guest-day tea was
held in the Blue Lounge of Pomerene Hall at
Ohio State University. Mrs. Harve M. Clod-
felter served as chairman, with Mrs. Joseph L.
Ridgeway and Mrs. Dana W. Cox serving as co-
chairmen. They were assisted by members of
the telephone committee.
GUERNSEY
Mrs. Ben E. Gillespie was hostess on March 2
to the Woman’s Auxiliary to the Guernsey
County Medical Society when she entertained
with a luncheon at Meadowbrook Farms. The
luncheon was given as a farewell party by Mrs.
Gillespie, as she and Dr. Gillespie are leaving
shortly to make their home in Cleveland. A
short business session was conducted by Mrs.
W. L. Denny. The afternoon was spent socially.
JEFFERSON
Fifty student nurses attended the party given
for them in February by the members of the
Auxiliary to the Jefferson County Medical So-
ciety. Held in the Nurses’ Home, the social
affair featured games and refreshments. Presid-
ing at the tea table were Mrs. Carl Goehring
and Mrs. W. A. Cunningham.
The social and program committees of the
auxiliary were in charge of arrangements. Mrs.
Albert Sunseri is chairman of the social com-
mittee and Mrs. E. B. Weiman is chairman of
the program committee.
LICKING
A St. Patrick’s Day “theme” provided the at-
mosphere for the dinner arranged on Feb. 28
in the Moundbuilders Country Club by the
Auxiliary to the Licking County Medical Society.
Mrs. G. A. Gressle was appointed chairman
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The Ohio State Medical Journal
of the nominating committee; Mrs. Carl Frye,
Mrs. Warren Koontz and Mrs. Roland Jones will
serve with her. Election of officers will take
place at the March meeting. Following the busi-
ness session, a white elephant auction was held
with Mrs. J. Fleek Miller as auctioneer. The
proceeds will be used to further nurse recruit-
ment, an Auxiliary project.
LOGAN
The Woman’s Auxiliary to the Logan County
Medical Society met February 28 in the Blue
Room of Hotel Ingalls for a luncheon meeting.
Mrs. F. Blair Webster, president, presided and
introduced the speaker, Mrs. R. S. Fidler of Co-
lumbus, who talked on legislation and answered
questions in a general discussion.
IF YOU’RE NOT REGISTERED TO VOTE,
VISIT YOUR ELECTION BOARD
LUCAS
Mrs. C. W. Kirkland, state president, was
guest speaker on Feb. 21 at the luncheon meet-
ing of the Woman’s Auxiliary to the Toledo and
Lucas County Medical Society held in the
Woman’s Building. A panel discussion on “Our
'Children” was also held. The participants in-
cluded: Miss Edna B. Rowe, director of Howe
School; Miss Margaret Muller, children’s serv-
ices consultant, and Miss Dorothy Pasch, super-
visor of special education of Toledo Public
Schools.
A tea honoring Mrs. Kirkland was held the
previous day in the home of Mrs. F. W. Clement,
president of the Toledo Auxiliary. Guests in-
cluded Mrs. E. Benjamin Gillette, former state
president; Mrs. Wilbur Taylor, former state
recording secretary; Mrs. Carll Mundy, state legis-
lative chairman; and Mrs. Eugene A. Ockuly.
Members of the board and chairman of com-
mittees were also guests.
One of the high points of the social calendar
was the supper dance held on February 11 at
the Commodore Perry Hotel. Mrs. Ward Meyers
was chairman of the dance committee.
The study groups on “Child Development” and
“Live Issues of Today” continue to draw high
interest.
MARION
The Auxiliary to the Marion County Medical
Society held its January luncheon meeting at
the Hotel Harding. Preceding the business ses-
sion, Mr. Robert Mason spoke on “The Problem
of Recreation in Marion.” The following slate
of officers for 1950-51 was presented and ac-
cepted:
President, Mrs. J. Greetham; president-elect,
Mrs. J. Smyth; vice-president, Mrs. R. L. Gett-
man; secretary, Mrs. Floyd Yeager; correspond-
ing secretary, Mrs. Merritt Marshall; assistant
secretary, Mrs. W. Leffler; treasurer, Mrs. F.
G. Smith; assistant treasurer, Mrs. Robert
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DERMATOLOGY — Formal Course, Two Weeks, start-
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General, Intensive and Special Courses in all
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for April, 1950
405
Campbell. It was voted that each auxiliary
member will donate to a county school a sub-
scription to Today’s Health.
A brief business meeting was held on Feb. 18
when the Auxiliary met for its regular monthly
meeting. Following the business session, an
auction was held, with Mrs. R. L. Morgan serving
as auctioneer.
MONTGOMERY
The February meeting of the Auxiliary to the
Montgomery County Medical Society was a
luncheon meeting at -the Biltmore Hotel. About
one hundred members were present. Guest
speakers were Dr. C. B. Simson, director of the
Child Guidance Center, and Dr. J. A. Mendelson,
superintendent of the State Hospital. The
monthly report on current legislation was pre-
sented, following the talks of the guest speakers.
OTTAWA
Reports on a number of interesting events
were presented at the February meeting of the
Auxiliary to the Ottawa County Medical Society,
held at the home of Mrs. George Poe. Mrs.
G. A. Boon reported on a rural health confer-
ence recently held at Oak Harbor in an effort
to consolidate the health program in various
points of the county. Mrs. C. R. Wood who at-
tended the northwestern Ohio rural health con-
ference at Bowling Green reported that emphasis
is being put on school health programs in an
effort to promote a strong realization of health
problems. Mrs. W. R. Shortridge told the group
that its work in obtaining Today’s Health sub-
scriptions has shown excellent results. Follow-
ing the business session, the doctors joined their
wives for a social hour.
RICHLAND
Miss Clara Schumm, supervisor of nurses of
public health, was the guest speaker on March 6
when the Richland County Auxiliary held its
regular monthly meeting. Hostesses for the
occasion were Mrs. John Hattery and Mrs.
George Evans; the meeting in the form of a
luncheon was held at the Women’s Club. Spring
flowers were used as centerpieces for the small
tables.
The speaker gave an interesting and com-
prehensive talk on “Public Health Nursing” and
outlined the history of public health in Richland
County and the vastness of its program.
SCIOTO
Dr. L. B. Hatch, president of the Hempstead
Academy of Medicine, was guest speaker at the
luncheon meeting held at the Turkey Shoppe on
March 8 by the Scioto County Auxiliary. Dr.
Hatch’s talk was on socialized medicine — what
has been done, what is being done and what
still needs to be done to combat the threat of
compulsory health insurance. The business session
followed the speaker’s address and was con-
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The Ohio State Medical Journal
ducted by Mrs. W. A. Ray, president. The
nominating committee presented the 1950-51
slate and election of officers was held. The newly
elected officers who take office in May include:
Mrs. Clyde Everett, president; Mrs. Carter
Pitcher, president-elect; Mrs. Carl Braunlin, vice-
president; Mrs. Spencer Miller, secretary; Mrs.
Ralph Lewis, treasurer; Mrs. Dow Allard, ex-
ecutive board member; Mrs. W. E. Gault, execu-
tive board member.
It was voted to designate a recent one hun-
dred dollar contribution of the Academy of
Medicine for the Auxiliary’s student nurse proj-
ect. Mrs. G. E. Neff presented her monthly legis-
lative report. Hostesses for the luncheon in-
cluded: Mrs. W. C. McCann, Mrs. George Blume,
Mrs. B. U. Howland, Mrs. A. B. Mills, Mrs.
Robert Leever and Mrs. Hubert Thurman.
TRUMBULL
The Trumbull County Auxiliary held a lunch-
eon meeting in February at the Trumbull Country
Club. Mrs. D. R. Mathie conducted the busi-
ness meeting, at which the report was given on
the “Gardenia Ball” that was held on Feb. 11
to raise money for the Auxiliary’s two-hospital
projects. The “Ball” was a big success; the
Auxiliary was able to give each hospital ap-
proximately $360. It was also voted to give an
annual $25 bond to the outstanding student nurse
of the year.
The afternoon’s program was an interesting
talk by Mrs. Louise Toombs on “Ceramics,”
presented with effective illustrations. Another
speaker was Mr. Biddlestone who described the
activities of the Warren Health Department.
Dr. Robert M. Hall of Washington, D. C., has
been appointed secretary of the American Medi-
cal Association’s Council on National Emergency
Medical Service, effective January 1, the A. M. A.
Board of Trustees announced. Dr. Hall was re-
leased from active duty with the Research and
Development Board of the U. S. Army Decem-
ber 19.
Fort Steuben Academy
The Fort Steuben Academy of Medicine held
its Fifth scientific meeting of the year at the
Fort Steuben Hotel on February 14. Dr. James
Barrett Brown of St. Louis presented a paper
dealing with plastic surgery in general repair
of compound injuries of the face. Dr. William
L. White, Department of Plastic Surgery of the
University of Pittsburgh, opened discussion on
the paper.
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for April, 1950
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Public Health Grants
Death Rate Reached Low of
9.9 Per 1,000 in 1948
The death rate for the United States in 1948
was the lowest in the history of the country,
according to an announcement based on a com-
pilation just completed by the Public Health
Service’s National Office of Vital Statistics.
The crude death rate for 1948 was 9.9 per
1,000 population — two per cent below the rate
of 10.1 for 1947 and one per cent lower than
the 1946 rate, the previous record low, the re-
port showed.
The leading causes of death remained the
same as in 1947. The major chronic diseases
associated with advanced age accounted for 63
of every 100 deaths. Death rates in this group
showed only slight changes from the 1947 record.
The death rate for diseases of the heart was
322.7 per 100,000 population, while the 1947 rate
was 321.2. The death rate for cancer and other
malignant tumors increased from 132.4 in 1947
to 134.9 in 1948. The death rate for diabetes
remained about the same for the two years; the
1947 rate was 26.2, and the 1948 rate was 26.4.
Deaths from nephritis and from intracranial
lesions of vascular origin each showed small
declines. The 1948 death rate for intracranial
lesions was 89.7, while the 1947 rate was 91.4.
The nephritis death rate dropped from 56.0 in
1947 to 53.0 in 1948.
Mortality from the major infectious diseases
continued their long-time declines. The death
rate for pneumonia and influenza, combined, and
the rate for tuberculosis both reached new lows.
A 10 per cent decline from the 1947 rate brought
the death rate for tuberculosis (all forms) for
1948 down to 30.0 per 100,000 population and
the rate for pneumonia and influenza down to
38.7.
Motor-vehicle accident deaths decreased for
the second successive year. The rate for 1948
for this cause was 22.1 per 100,000 population,
while the 1947 rate was 22.8. The death rate
for accidents other than motor-vehicle accidents
also decreased from the 1947 rate of 46.6 to 45.0
in 1948.
Mortality from twro of the communicable
diseases of childhood increased sharply from
1947, a low year. The number of deaths from
poliomyelitis and acute polioencephalitis increased
from 580 deaths in 1947 to 1,895 deaths in 1948,
bringing the death rate back up to the 1946 level
of 1.3 deaths per 100,000 population.
Public Health Service grants of $907,212 to
aid laboratory and clinical research in non-
Federal institutions were announced. The awards
were made by the National Cancer Institute to
hospitals and universities.
Included in the grants are the following in.
Ohio:
Ohio State University College of Medicine —
Dr. Abraham Towbin, $3,834, Evaluation of the
anterior chamber technique in the assessment
of malignancy; Dr. H. G. Schlumberger, $3,200,
Neoplasia in fishes and amphibians.
Ohio State University — Dr. M. S. Newman,
$8,100, Synthesis of steroid compounds having
oxygenated functions in Ring C.; Dr. H. A.
Hoster, $1,660, Studies on Hodgkin’s disease and
related conditions.
University of Cincinnati College of Medicine —
Dr. R. W. Vilter, $7,895, The culture of human
bone marrow in a synthetic medium.
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The Ohio State Medical Journal
A. M. A. Establishes New
Microbiologic Lab
The American Medical Association has estab-
lished a new microbiologic laboratory.
This new laboratory, which is a section of
the Division of Therapy and Research, will in-
vestigate the biologic, bacteriologic, immunologic
and antibiotic properties of various products
which are offered to the medical profession and
to the public. In addition to drugs, these in-
clude foods, cosmetics, germicides, antiseptics,
beverages, serums and vaccines. The safety of
these products for human use will be determined.
Tests and standards will be formulated for those
products for which criteria are non-existent or
inadequate.
The laboratory will limit its activities to the
examination of products of general interest to
the medical profession. It cannot perform in-
vestigations for commercial firms or for indi-
vidual physicians.
The laboratory is under the direction of Velma
L. Chandler, Ph. D., who was affiliated with the
Food and Drug Administration in the Division of
Antibiotics from 1943 to 1948. She is co-author
of numerous publications on the standardization
and efficacy of several antibiotics. Prior to
1943 Dr. Chandler was engaged in clinical labora-
tory investigations in southern California.
Schering Award
“The Clinical Use of Steroid Hormones in
Cancer,” will be the subject of the Schering
Corporation, Bloomfield, N. J., award for 1950.
Students in medical schools in the United States
and Canada may enter the competition by pre-
paring manuscripts on the designated subject
in the field of endocrinology. Cash awards of
$1,000, $500 and $300 are offered.
The United Cerebral Palsy Associations, Inc.,
has appointed Mrs. J. Howard Brinckerhoff to
head its current program of expansion and na-
tional affiliation of its member units throughout
the United States.
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Defiance County Makes Fifty-Year
Awards Community Project
The Defiance County Medical Society came up
with an excellent example of how presentation
of the 50-Year Awards can be used to educate
the public as to the part the private practice
of medicine is playing in our democratic way
of life.
In the first place, local leaders of Defiance
City and County and a few old friends were
invited as guests to a special dinner meeting
of the Society at which the presentations were
made. The District Councilor, in this case Dr.
Carll S. Mundy of Toledo, was invited to make
the presentations and got in some good plugs
for the medical profession.
Reporters from Defiance Crescent-N ews, upon
invitation of Society officers, interviewed each
of the four physicians, obtained pictures of
them and carried a series of articles, each of
which featured one of the doctors.
The Hicksville High School class in journalism,
upon suggestion of the Society, selected two stu-
dents to visit two of the physicians and write
human interest articles based on their inter-
views. This project was promoted to help
educate youth in the private practice of medicine.
A Defiance City High School senior, Rita
Hewitt, prepared her class talk on the subject,
“Why I Prefer the Private System of Medicine.”
Speaking on the same subject, she was the
winner of a contest sponsored by the Rotary
Club in which three boys and three girls spoke
on subjects of their own choosing. As the girl
winner she was scheduled to be guest of the
Rotary for two days at a meeting in Cincinnati.
COMING MEETINGS
Ohio State Medical Association, Annual Meet-
ing, Cleveland, May 16-18.
American Medical Association, Annual Session,
San Francisco, June 26-30.
American Association of Industrial Physicians
and Surgeons, 35th Annual Meeting, Sherman
Hotel, Chicago, April 22-29.
American Association for Thoracic Surgery,
Denver, Colo., April 15-19.
American College of Physicians, Boston, April
17-21.
American College of Radiology, San Francisco,
Calif., June 25.
American Pediatric Society, French Lick, Ind.,
May 8-10.
National Tuberculosis Association, Washing-
ton, D. C., April 25-28.
INDEX TO ADVERTISERS
Abbott Laboratories 395
Ann Arbor School, The 404
Ar-Ex Cosmetics, Inc. 408
Ayerst, McKenna & Harrison, Ltd. 311
Baker Laboratories, Inc 316
Bell, Kathryn S., Inc. 407
Birtcher Corporation, The 400
Bowen, Charles F., M. D . 409
Bowman Bros. Drug: Company 408
Camp, S. H., Company 314
Cincinnati Sanitarium 308
Clinical and Pathological Laboratory 404
Coca-Cola Company 399
Columbus Orthopaedic Appliance Co 405
Cook County Graduate School of Medicine 405
Denver Chemical Manufacturing: Co. 397
General Electric X-Ray Corp. 312
Hanger, J, E., Inc 403
Harding Sanitarium 309
Ingleside Home, Inc- 389
Lederle Laboratories, Inc. 315
Lilly, Eli, and Company Insert between
pages 316 and 317
McMillen Sanitarium 308
Mead Johnson & Company Back Cover
Medical Protective Company .. 406
Medico Press, The 401
Mercer Sanitarium, The J. 309
Merck & Company, Inc 393
Miller, W. H., M. D 402
M & R Dietetic Laboratories, Inc 391
New York Polyclinic Medical School . 399
Num Specialty Company 409
Oak Ridge Sanatorium — 310
Parke, Davis & Company 412 and
Inside Back Cover
Pogue, The Mary E., School 402
Quincy X-Ray & Radium Laboratories 411
Resthaven 407
Rexair Division, Martin-Parry Corp. 389
Rupp & Bowman Company 403
Sandoz Pharmaceuticals, Inc 379
Sawyer Sanatorium 301
Schering Corporation 303
Schmid, Julius, Inc. 387
Searle, G. D., & Company 377
Squibb, E. R., & Sons 305
Stoneman Press 397
U. S. Vitamin Corporation Insert between
pages 364 and 365
Upjohn Company — : 385
Van Wagner Company 409
Wander Company 383
Wendt-Bristol Company 406
Wickhaven Sanitarium 309
Windsor Hospital 309
j Winthrop-Stearns, Inc 381
Wyeth, Inc. 313
410
The Ohio State Medical Journal
GlaAA^ljjied Adv&Ui&ementA,
Rates: 50 cents per line. Minimum charge of $1.00 for each insertion. Price covers the cost
of remailing answers. Forms close 16th of the month preceding publication.
FOR SALE : Six-room home and four-room office com-
bination in midwestern Ohio community of 100,000. Active,
growing general practice grossed $18,000 in 1949. Office
completely furnished. Specializing. Available about July 1.
Box 96, Ohio State Medical Journal.
WANTED : Capable young physician for temporary posi-
tion in Industrial office. 200 Republic Building, Cleveland.
WANTED : Thoroughly competent physician for Industrial
Office. Must be graduate of Class A School with adequate
hospital training. Salary, $6,000 per year. 200 Republic
Building, Cleveland 15, Ohio.
BACTERIAL INCUBATOR: Hot Pack Model 808, 115 v.
all electric, wet or dry, completely automatic, brand new,
temp, range 80 to 60 deg. cent. Inside 18x18x19%, 2
shelves adjustable any height. Will sell for $200 f. o. b.
Ashland, crated. M. D. Shilling, M. D., 408 Center St.,
Ashland, Ohio.
SANBORN ELECTROCARDIOGRAPH, direct writing, like
new, used a few times. Price $500, net, including base on
ball bearing wheels, f. o. b. Ashland. M. D. Shilling, M. D.,
408 Center St., Ashland, Ohio.
FOR SALE : Established general practice of 39 years ;
also drugs and equipment. Office available ; small, progres-
sive village on Lake Erie ; physician recently deceased.
Box 114, Vermilion, Ohio.
FOR SALE : Furnishings, drugs and equipment. Office
for rent at Spencerville, Ohio. Mrs. I. C. Stayner, Spencer-
ville, O.
WANTED : A registered X-ray technician, 35 or over, with
administrative and academic ability and experience to take
charge of technical division of X-ray Dept. Salary open.
Give full particulars. Box 98, Ohio State Medical Journal.
FOR SALE : Becton, Dickinson blood pressure equip-
ment ; Welch Allyn Company odoscope, three attachments ;
cotton, bandages, ether, alcohol and other staple supplies.
Address Mrs. W. E. Lawhead, 235 South Washington St.,
Van Wert, Ohio.
PHYSICIAN as health commissioner of the Belmont
County General Health District, full or part time basis.
Apply through Miss Mary F. Shepherd, Clerk, Board of
Health, St. Clairsville, Ohio.
FOR SALE : Equipment and supplies ; recently vacated
office in Perrysville, Ohio ; reasonably priced ; office avail-
able; will introduce. F. D. Metcalf, M. D., Macedonia, Ohio.
FOR SALE : Office equipment ; chrome straight back
chairs, metal examining table, instrument cabinet, treat-
ment table, E. E. N. T. chair, goose neck lamp, swivel chair
with arms, 1-walnut, 1-leather. Address P. B. Zollett, M. D.,
13 South Broad St., Middletown, Ohio.
INTERNIST, 31, married, family ; American Board eli-
gible; university hospital residency; now on medical school
faculty ; research experience, publications. Desires associa-
tion with internist, surgeon or group. Box 400, Ohio
State Medical Journal.
BACTERIOLOGIST, Ph. D., with ten years academic and
hospital experience desires position in hospital or public
health laboratory or university. Available July, 1950. Box
300, Ohio State Medical Journal.
O. S. U. ’46 M. D. desires wmrk with doctor from 1 July
to 1 Oct. ; 15 mo. rot. internship ; 1 yr. path. res. ; 2 yrs.
Army. Central Ohio preferred. Box 200 ; Ohio State
Medical Journal.
WANTED JULY 1, 1950 ; Assistant resident for one year
in Obstetrics or three years in Obstetrics and Gynecology.
Approved program in 250-bed Ohio hospital. Stipend $100
month plus complete maintenance. Apply Box 100, Ohio
State Medical Journal.
FOR SALE : General Practitioner’s home and office equip-
ment ; northwest Ohio ; practice unopposed. Leaving to
specialize. Box 99, Ohio State Medical Journal.
DUE TO DEATH, doctor’s office containing four rooms
and lavatory for rent. Equipment and office furnishings
for sale. Prominent location, 12 miles from downtown
Columbus. Excellent opportunity for general practitioner.
Box 500, Ohio State Medical Journal.
OPENING FOR M. D. with W. Va. location and license
in growing industrial area of S. E. Ohio and W. Va. Facilities
of small hospital available. Write Box 97, Ohio State
Medical Journal.
FOR SALE : Two electric sterilizers, Brown-Berger,
McCarthy cystoscopes, urethrascope, metal and glass in-
strument cabinet. Box 95, Ohio State Medical Journal.
Air Purifiers
The best thinking of those who have made
intensive studies of action of air purifier ap-
paratus is crystalized in the- following state-
ment of the Subcommittee for Evaluation of
Methods to Control Air-Borne Infections of
the Committee on Research and Standards of
the American Public Health Association:
“The available evidence strongly indicates
that . . . glycol vapors are useful adjuvants
to aseptic techniques in the reduction or elimina-
tion of air-borne infections in operating rooms,
and in contagious disease and pediatric wards
. . . The general use of disinfectant vapors in
schools, barracks, and in specialized industrial
environments is not justified at the present time.
There is great need for further carefully con-
trolled field studies . . . There is no justification
for indiscriminate use ... in homes, offices, or
places of public congregation.”
RADIUM and RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician-Radiologist)
HAROLD SWANBERG, B. S., M. D., Director
W. C. U. Bldg. Quincy, Illinois
for April, 1950
4 11
9
Chloromycetin
PACKAGING
CHLOROMYCETIN ( Chlor-
amphenicol, Parke-Davis ) is
supplied in 0.25 Gm. Kap-
seals .® Descriptive litera-
ture on CHLOROMYCETIN
is available to physicians on
request
It would take
a small
excursion boat
to bring you all
the patients who represent
each of the many conditions
for which short-acting
NEMBUTAL is effective
• More than 44 clinical uses for short-acting Nembutal
have been reviewed in the literature during the 20 years the
drug has been effectively used. Some of these uses may be
applicable in your own practice.
With short-acting Nembutal, doses adjusted to the need
can provide any degree of cerebral depression — from mild
sedation to deep hypnosis. Dosage required is only about
one-half that of certain other barbiturates. Because there is
less drug to be eliminated, there is less possibility of bar-
biturate hangover and wider margin of safety.
You’ll find short-acting Nembutal available in the form of
Nembutal Sodium, Nembutal Calcium and Nembutal Elixir,
all in convenient small-dosage preparations. Write for handy
booklet, "44 Clinical Uses for Nembutal." ^ n n f
Abbott Laboratories, North Chicago, 111. CXijlJO"LL
In equal oral c/oses, no other barbiturate
combines QUICKER , BRIEFER,
MORE PROFOUND EFFECT than
NEMBUTAL
/PENTOBARBITAL, ABBOTT)
for May, 1950
4 19
*7 he PJufAteicMuL feo&kiiteifj
By JONATHAN FORMAN, M. D.
Nervous and Neurohumoral Regulations of
Intestinal Motility, by W. B. Youmans, Profes-
sor of Physiology, University of Oregon ($4.75.
Interscience Publishers, Inc., New York City),
is nne of the publisher’s monographs on the
Physiological Sciences, and stems from the au-
thor’s combined interest aroused by W. J. Meek
in his demonstration of the role that extrinsic
nerves played in the production of death by dis-
tension. A complete monograph of interest to
all students of the intestinal tract.
Histopathology of the Teeth and Their Sur-
rounding Structures, by Rudolph Kronfeld, M. D.,
D. D. S., re-edited by Paul E. Boyle, D. M. D.
($8.00. Third Edition. Lea & Febiger, Phila-
delphia), is designed to illustrate by means of
human specimens the actual tissue changes that
correspond to certain well-defined clinical ob-
servations, i. e., tissue changes following the
filling of a cavity, or the filling of a root canal,
etc.
Vital Facts of Life, by Rev. Carl H. Harman
and E. W. Marquardt, M. D. ($1.75. Concordia
Publishing House, St. Louis, Missouri), is a
straight-forward discussion of sex and life from
the viewpoint of the Lutheran Church. The
book also treats with alcoholism, the problem
of leisure time, formation of character, success
and living one’s religion.
Congenital Anomalies of the Heart and Great
Vessels — A Clinicopathologic Study of 132 Cases,
by Thomas J. Dry, M. D., and five of his associates
at the Mayo Clinic ($3.00. C. C. Thomas, Spring-
field, Illinois). Each case is demonstrated by
roentgenography, electrocardiography, diagrams
and interior photographs in black and white
with the exterior in color. Each is preceded by
a title page with a small photograph of the
part to be described and a description of the
condition from his original report. A truly
beautiful work worthy of Rochester, Minnesota.
Electrotherapy and Light Therapy, With Es-
sentials of Hydrotherapy and Mechanotherapy,
by Richard Kovacs, M. D. ($10.00. Sixth Edi-
tion. Lea & Febiger, Philadelphia), has served
for seventeen years as a standard text on Phy-
sical Therapy and has been brought up to date
to include all that was learned by, and following,
World War II.
One Half the People: Doctors and the Crisis
of World Health, by Charles M. Wilson ($4.00.
William Sloane Associates, Inc., New York City),
is a timely discussion of the 1,750,000,000 inhabit-
ants of the world who are sick today. Soon we can
expect a population of three billion with two
billion or more sick. With this concept as a
spring board the author discusses what we
can and, in his opinion, should do aboufo it.
Blood and Plasma Transfusions, by M. M.
Strumia, M. D., and John J. McGraw, Jr., M. D.
($7.50. F. A. Davis Company, Philadelphia),
is an important book for every hospital library.
Today it requires a minimum of five blood donors
per bed per year. This book brings under the
same cover both technical and clinical phases of
this remedial agent. There is very little his-
torical and none of the controversial.
Respiratory Enzymes, edited by Henry A.
Lardy ($4.50. Second Edition. Burgess Pub-
lishing Company, U%6 South Sixth Street, Min-
neapolis, Minnesota), has been written by the
staff of the University of Wisconsin. Each of
this group of experts has written a chapter
on his special interest. The subject, naturally,
deals with those enzymes catalyzing the chemi-
cal reactions which take place in respiration.
Acute Appendicitis and Its Complications, by
Frederick Fitzherbert Boyce, M. D. ($8.75. Ox-
ford University Press, New York City), is the
only book of which your reviewer knows that
limits itself strictly to this subject. The au-
thor rightly insists that we tend to be com-
placent about the improvement in the statistics
of acute appendicitis for 5,153 are said to have
died from this disease in 1947. He still puts
the emphasis on early diagnosis, prompt opera-
tion, and abstinence from purgation.
Meats and Meat Foods, by Lloyd B. Jensen,
Ph. D. ($3.75. The Ronald Press Company, Neiv
York City), explains in nontechnical language
the processes that bring meats and meat pro-
ducts into the consumer’s kitchen in sanitary
and appetitizing condition. The chief bacteri-
ologists of Swift & Company tell in the volume
from the “Humanizing Seven Series” how meat
has been made one of the safest, easiest obtained,
most nutritious of foods for the American
people.
Biochemistry in Relation to Medicine, by C. W.
Carter and R. H. S. Thompson ($5.00. Long-
mans, Green and Company, Neio York City),
discusses for the medical student and those
elders who wish to refresh themselves on only
those aspects of biochemistry which are at
420
The Ohio State Medical Journal
present significant in medicine. The section on
chemical pathology will be of particular interest
to most of us.
Introduction to Psychosomatic Medicine, by C.
Alberto Sequin, M. D., with foreword by Flanders
Dunbar ($5.00. International Universities Press,
New York City), helps a good deal to resolve
the obstacles that most of us have in looking
into the approach through use of clear under-
standable writing. If we get more discussions
on this plane, it may just happen that the dual
approach of psychosomatic considerations of the
individual’s interest may become the dominant
one. Certainly, this can never happen if our
profession becomes nationalized and each citizen
becomes a medical number; for as Dunbar says
in the introduction “it is not often that we can
apply the same methods to the engineer as to
the engine.”
Clinical Allergy, by Louis Tuft, M. D. ($12.00.
Second Edition. Lea & Febiger, Philadelphia ),
adds to the splendid first edition what we have
discussed and learned in the past ten years. It
is a book primarily for the inquiring physician
who works in other fields but who realizes that
allergy is a large component in the lives of ten
per cent or more of the people whom he sees.
The enlarged material on Fungi as allergens
and a whole new chapter on inhalant allergens
other than pollens are noteworthy.
A Review of Nursing, by Helen F. Hansen,
R. N., M. A. ($4.25. Sixth Edition. W. B. Saun-
ders Company, Philadelphia), is the modern
version of this well-known guide and teaching
device with its outlines, its notes, its questions
and answers.
Body and Mature Behaviour, by M. Feldenkrais
($3.75. International Universities Press, Inc.,
Neio York City), is a study of anxiety, sex,
gravitation and learning. It is the reworked
series of lectures given before the Association
of Scientific Workers at Fairlie, Scotland. Since
the author goes carefully into the mechanism
underlying the various mental and spiritual cures,
it is a book that will prove to be most helpful
to many of us. “While expecting hopefully
that the environment will be changed by our
collective efforts, we must also make sure that
everything amenable to human influence in each
individual is used to facilitate adaptation.”
Physiology in Diseases of the Heart and Lungs,
by Mark D. Altschule, M. D. ($5.00. Harvard
University Press, CambHdge, Massachusetts) ,
written at the request of third and fourth year
medical students. It is designed to be helpful
in the correlation of clinical medicine with basic
physiology. Many of us older men also may
wish to rework our experiences in the light of
the new knowledge.
Soil Fertility and Sewage, by J. P. J. van Vuren
(18s net. Faber & Faber, Ltd., 2U Russell
Square, London, England) , is primarily an ac-
count of pioneer work in this connection in
South Africa. Lady Howard has written the
foreword so that the work is slanted toward
the “organic school of soil fertility.” The
squandering of a great inheritance; Nature’s
revolt against man’s abuses; the havoc of ever-
spreading soil erosion; the threat of mass
starvation; the irresistible logic of the law of
return, make action long overdue. Citizens of
many cities in this country are studying this
problem.
Cancer, by Beka Doherty ($3.00. Random
House, New York City), is a popular presenta-
tion of our current knowledge and hopes about
cancer. It tells about research, clinical re-
search, and the hospital cancer centers and
diagnostic services that are nowr available,
•4
Conflict in Marriage, by Edmund Bergler,
M. D., ($2.75. Harper & Brothers, New York
City), is the story of the unhappy undivorced
by the author of “Divorce Won’t Help,” “Psy-
chic Impotence in Men,” “The Basic Neurosis,”
and other similar books. This book was written
in answer to the charge that the author has
been defending marriage on any basis. It ex-
plains how one can live in relative peace with
one’s untreated neurosis. No substitute has ever
been found for the emotions as a basis for
marriage.
More About Psychiatry, by Carl Binger, M. D.
($4.00. University of Chicago Press, Chicago ,
Illinois), is 14 chapters — majority of which
have appeared in magazines — by the man who
made the front pages in connection with the
Alger Hiss trial. In spite of that, those who
wish to follow modern medical philosophy will
enjoy this little volume. Your reviewer was
especially delighted with the essay on “What
Can We Learn from a Medical History?”
Urological Aspects of Spinal Cord Injuries, by
George C. Prather, M. D. ($3.75. Charles C.
Thomas, Publisher, Spi'ing field, Illinois), at-
tacks the problem with a full realization that
the restoration of the tract to the best phys-
iological condition, free of major disease, is the
most important single step in the management of
these patients.
Clinical Pathology — Application and Interpreta-
tion, by Benjamin B. Wells, M. D. ($6.00. W. B.
Saunders Company, Philadelphia) , brings out the
worthwhile things in the diseases of the various
anatomic system. A good book to sort out the
most important things from the great maize
of detail in the larger books.
for May, 1950
421
OAK RIDGE
SANATORIUM
GREEN SPRINGS, OHIO
FOR
DIAGNOSIS TUBERCULOSIS TREATMENT
CITUATED in the beautiful springs country of Northern Ohio, this modern Sanatorium
^offers not only up-to-date treatment for all forms of Tuberculosis but a setting of utmost
beauty and restfulness for the convalescent.
General Hospital
Facilities with
Complete Surgery
Modern
Steam-Heated
Rooms
Large Staff of
Graduate Nurses
Personal Care for
Every Patient
Natural Mineral Spring
(8,000,000 GALLONS PER DAY)
Artesian Well
PAUL M. HOLMES, M. D., Medical Director
JOHN J. GEDERT, M. D., Resident Physician
Very Reasonable Rates
Write for full Information
ALEXANDER C. JOHNSON, Pres. & Gen. Mgr.
M. M. RIDDLE, M. D., Eye, Ear, Nose ond Throat
422
The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association, a scientific society, non-profit corporation, with a definite
membership, for scientific and educational purposes.
Vol. 46 May, 1950 No. 5
Jonathan Forman, M. D., Editor
Charles S. Nelson,
Managing Editor — Bus. Mgr.
R. Gordon Moore,
Asst. Managing Editor
Present Concepts in the Diagnosis and
Treatment of Acute Pancreatitis
VINTON E. SILER, M. D„ and JOHN H. WULSIN, M, D.
The Authors
• Dr. Siler, Cincinnati, Ohio, is a graduate
of University of Cincinnati College of Medi-
cine, 1934; diplomate, American Board of
Surgery; fellow, American College of Surgeons;
attending surgeon, Children’s, Holmes, Jewish,
Bethesda, and Cincinnati General Hospitals;
and asst. prof, of surgery, College of Medicine,
University of Cincinnati.
• Dr. Wulsin, Cincinnati, Ohio, is a grad-
uate of University of Rochester School of
Medicine and Dentistry, 1944; and asst, resi-
dent in surgery, Cincinnati General Hospital.
THE clinical management of acute pan-
creatitis poses a problem that is an integral
part of the larger problem of abdominal
surgery. Because of the intimate association
of the pancreas with neighboring organs, in-
flammatory disease of the pancreas frequently
disturbs the proper functioning of surrounding
structures. The clinical diagnosis of pancreatitis
is not always easily made, and pancreatic in-
flammation is often mistaken for other clinical
entities of the upper abdomen. A review of
the literature1 reveals that much scientific
factual knowledge concerning pancreatitis is
lacking and that there is dispute about many
phases of the disease. The present concept of
the physiology and pathology of the pancreas
do not allow physicians in general and surgeons
in particular to approach with diagnostic cer-
tainty the treatment of inflammatory diseases
of this organ. The purpose of this presentation
is to discuss some of the problems involved in
the understanding and treatment of pancreatitis.
etiology of acute pancreatitis
Although the cause of pancreatitis either in
its acute or chronic form is not known, numerous
attempts have been made to solve the mystery
of its etiology both in the laboratory and at
the bedside, but non-partisan observers, even
today, generally agree that a wholly satisfac-
tory answer has not yet been given. Difficulty
in obtaining that answer may well rest in the
fact that workers are individually talking about
different phases of pancreatitis without so
Presented before the Section on Surgery at the Annual
Meeting of the Ohio State Medical Association, Columbus,
Ohio, April 19, 1949.
realizing. Each hypothesis may be true for a
small segment of facts that it covers without
actually contradicting other theories, which also
are only valid for other segments of facts. If
observers, instead of offering a comprehensive
explanation of pancreatitis, would restrict their
conclusions to the evidence they have accumu-
lated, we might one day find that the assorted
theories, when pieced together into a larger
picture, would, like the united parts of a jigsaw
puzzle, create a clear intelligible whole.
In this light each of the theories and assorted
facts bears equal importance until more is
known, and while a brief summary may seem
confusing and inconclusive, it will emphasize that
no one theory in its present stage is adequate
to account for all facts.
A number of more or less complete reviews
437
of the literature bearing on etiology are avail-
able in English. Dragstedt, Haymond, and Ellis2
(1934), Rich and Duff3 (1936), Jones4 (1943),
Rienhoff and Pickrell5 (1945) note most of the
important ideas and references. The discussion
that follows does not pretend to be all-inclusive.
It will attempt to indicate the significant points
and select work illustrating those points, with-
out cataloguing the vast amount of experimental
and clinical papers on this subject. Since our
ultimate ignorance precludes an accurate descrip-
tion of the early stages of the pathogenesis of
this disease, various authors usually tailor a
theoretical explanation of pathogenesis to fit the
particular etiological concept in question. There-
fore, in treating the origin of pancreatitis we
shall not draw a sharp line between etiology
and pathogenesis, and we shall call on any
facts that may help to substantiate or clarify
the theory at hand. A brief summary of the
theories discussed are as follows.
I. Bile flows into the pancreatic duct because
an obstruction at the ampulla of Vater
creates a common channel between the com-
mon bile and the duct of Wirsung.
The experimental injection of bile into the
pancreatic duct usually produces acute pan-
creatitis. The high incidence of cholelithiasis
in acute pancreatitis favors the supposition that
a gallstone, impacted in the ampulla, blocks the
passage of bile into the duodenum and diverts
the bile into the duct of Wirsung, but necropsies
on cases of acute pancreatitis only occasionally
disclose an impacted stone in the ampulla. Spasm
of the sphincter of Oddi can without question
be associated with the reflux of fluid from the
common duct into the duct of Wirsung, as proved
by cholangiography. The relation of sphincter
spasm to pancreatitis has not been well defined.
It is undecided whether the presence of bile in
the pancreatic ducts at physiological pressures
is harmful or innocuous. In the majority of
postmortem specimens, the terminal orifices of
the common bile duct and the duct of Wirsung
enter the ampulla of Vater in such a manner
that reflux of fluid from one duct to the other
is possible when the outlet of the ampulla is
obstructed. Variations from the normal anatomi-
cal structure may prevent communication be-
tween the pancreatic and biliary ducts.
II. Obstruction of the pancreatic ducts and auto-
digestion of the pancreas.
Experimental obstruction of the pancreatic
ducts produces fat necrosis and acute edema of
the pancreas with subsequent parenchymal
atrophy and fibrosis, but acute pancreatitis with
hemorrhage and necrosis rarely develops, even
though the gland is actively secreting at the
time of obstruction. Rich and Duff claim that
obstruction to the outflow of pancreatic juice by
gross lesions, such as tumor and stone, or by
the microscopic lesion, metaplasia of the epithe-
lium in the small ducts, ruptures the duct sys-
tem and allows pancreatic secretion to escape
into the parenchyma, where trypsin becomes
active and initiates necrosis. The concept of
autodigestion of the pancreas assumes that
trypsin is activated within the gland. A
mechanism for the activation of trypsin in
acute pancreatitis has not as yet been clearly
demonstrated. Acute obstruction of the pan-
creatic ducts is followed by a rise in serum
amylase, even though acute pancreatitis with
hemorrhage and necrosis does not develop.
III. Infection.
Experimentally the injection of bacteria into
the pancreas does not produce acute pancreatitis.
Chronic inflammation of the extrahepatic biliary
tract commonly accompanies pancreatitis, but
specific bacteria are not regularly found in
clinical cases of acute pancreatitis. Experi-
mental acute cholecystitis in cats does not cause
acute pancreatitis with necrosis. The presence
of suppuration in the pancreas implies a bacterial
infection, either primary or secondary.
IV. Vascular Factors.
Because of the rich blood supply of the pan-
creas, experimental infarction is not easily pro-
duced. The experimental production of em-
bolus or thrombosis in the pancreatic vessels
does not cause a spreading hemorrhagic necrosis,
similar to that in acute pancreatitis. It has been
suggested that vasoconstriction in the pancreatic
vessels may initiate ischemic necrosis. Necropsy
studies of acute pancreatitis have failed to reveal
a consistent primary lesion of the pancreatic
blood vessels.
V. Trauma.
Acute pancreatitis occasionally follows me-
chanical injury to the pancreas from contusions
and perforating wounds of the upper abdomen
or from surgical procedures on or near the
organ. After pancreatic injury the serum
amylase frequently rises although acute pan-
creatitis does not develop clinically.
VI. Miscellaneous.
a) Reflux of duodenal contents into the
pancreatic ducts. The passage of duodenal
contents into the pancreatic ducts may oc-
cur on rare occasions, but it is infrequently
associated with acute pancreatitis.
b) Alcohol. Clinical observations indicate
that alcoholism is frequently associated with
acute pancreatitis. An experimental ex-
planation of this association is lacking.
c) Anaphylaxis. The concept of an ana-
438
The Ohio State Medical Journal
phylactic origin of acute pancreatitis is for
the most part still theoretical.
CLINICAL FEATURES OF ACUTE PANCREATITIS
According to Fitz6 (1889) Classen (1842) was
the first to establish the clinical entity of acute
pancreatitis. Fitz in his own study differentiated
three types of the disease: hemorrhagic, gangren-
ous, and suppurative. More recent observations,
particularly those of Zoepffel7 (1922) and El-
man8’ p (1933, 1942), have emphasized a milder
form of acute pancreatitis, acute edematous or
acute interstitial pancreatitis.
Acute pancreatitis as a clinical entity includes
all the pathological varieties of acute pancreatic
inflammation. It may be subdivided into three
categories. (1) Acute edematous (interstitial)
pancreatitis refers to the benign form in which
the chief pancreatic lesion is edema. (2) Acute
pancreatic necrosis and acute hemorrhagic pan-
creatitis are generally used interchangeably to
denote pancreatitis characterized by hemorrhage
and necrosis. (3) Acute suppurative pancreatitis
implies the presence of purulent exudate within
the pancreas. Since the various pathological
subdivisions of acute pancreatitis cannot be dis-
tinguished clinically at the onset of the disease,
physicians are justified in retaining the general
term acute pancreatitis until the subsequent
course of the disease clarifies its pathological
nature. Wherever possible, the specific termi-
nology should be used.
SYMPTOMS
Clinically, acute pancreatitis begins in the
upper abdomen with a relatively sudden pain
which arises in the mid-epigastrium, occasionally
in the right upper quadrant, and radiates to the
back or to the left flank. When it originates
in the region of the gallbladder, the pain pri-
marily suggests cholecystitis and may mis-
lead the physician, but if it spreads to the
left lumbar area and to the left flank, this
symptom points to pancreatitis and, in par-
ticular, to irritation within the lesser peri-
toneal cavity. Less commonly it radiates trans-
versely in the epigastrium or becomes generalized
in distribution. Pain is the most prominent
single symptom of the disease and only rarely
is absent. The severity of pain is a rough index
of the degree of pancreatic damage. In mild
cases of edema the pain may be no more than
slight epigastric distress, and as the pathologi-
cal lesion progresses, the pain increases until it
attains excruciating proportions in the event of
marked edema or necrosis of the gland. Char-
acteristically, the pain is steady, unrelenting,
and uninfluenced by vomiting. Even morphine,
which eases the pangs of biliary colic, affords
only slight relief.
Nausea and vomiting promptly follow the pain.
Although in the mildest instances only nausea
is noted, usually vomiting of a reflex nature is
conspicuous and persistent. Continuous gagging,
retching, or vomiting of bile despite an empty
stomach dehydrate and exhaust the patient.
Fever is mild or absent, and chills do not
occur. Much emphasis has in the past been
placed on the dramatic development of shock
as an indication of acute pancreatitis. In those
occasional instances when shock is found within
the first twenty-four hours of the disease, the
pancreas is always severely damaged by massive
hemorrhage or necrosis, and death may follow
promptly. The large majority of patients do
not lapse into shock unless dehydration and un-
controlled pain cause a fall in blood pressure
several days after the onset of the disease.
PHYSICAL FINDINGS
In contrast to the alarming nature of the
symptoms the physical examination reveals few
abnormalities. The patient is rarely in shock,
although he often exhibits an anxious weariness,
common with any severe abdominal pain. When
present, shock is usually severe, and the patient
appears moribund. A peculiar ashy cyanosis of
the extremities and face with pallor about the
lips, marked hypotension, a rapid, weak pulse,
and semi-coma may be observed but are not
diagnostic of acute pancreatitis in the absence
of further information. Patients in this condi-
tion rarely survive more than a few hours, and
unless the serum amylase is determined the
diagnosis is made only at necropsy. On the other
hand, subclinical shock, suggested by thirst,
pallor, and restlessness, is present in most of
the moderately severe cases. Although the
blood pressure remains near normal limits and
the pulse does not become exceedingly fast, im-
pending collapse can be detected by signs of
dehydration. Sudden shock early in the disease
generally signifies massive hemorrhage from the
pancreas into the abdomen or retroperitoneal
tissues. The gradual appearance of shock after
a day or two of illness can probably be ex-
plained in two ways. The more obvious cause
consists in a depletion of blood volume by bleed-
ing from the pancreas, by persistent vomiting,
and by the development of large collections of
fluid exudate in the greater and lesser peritoneal
cavities. The total of fluid by these various
routes may amount to several or more liters
in the course of even one day. In addition to
a depletion of blood volume, shock may result in
an ill-defined manner from toxic products which
are liberated by the damaged pancreas, espe-
cially in instances of marked necrosis.
In the moderately ill patient the temperature
is normal or only mildly elevated, while the
pulse is increased to about 100. With impending
or actual shock the temperature falls to between
35° to 36.5° centigrade. Significant physical
for May, 1950
439
findings, if available, center about the upper ab-
domen. Spasm of the abdominal muscles is not
as a rule present in mild cases, a helpful negative
finding, although voluntary guarding in the epi-
gastrium commonly occurs. In the early typical
case peristalsis is normal or slightly hypoactive
to auscultation and the abdomen is not distended
with fluid or gas. Diarrheal stools occurring at
this point of the illness indicate a reflex irrita-
tion of the colon prior to the onset of paralytic
ileus. In a general way, therefore, the over-all
absence of striking abdominal findings distin-
guishes acute pancreatitis in its earlier stages
from other upper abdominal emergencies.
After the first day or two of a moderately
severe illness, or promptly in extreme cases,
examination of the abdomen reveals signs of
greater significance. The irritation which arises
from a serious pancreatic lesion, whether edema-
tous, necrotic, or suppurative, produces both a
reflex paralysis of the bowel and a chemical
peritonitis. A general peritoneal effusion, col-
ored a typical “prune juice” shade by hemolyzed
blood, produces diffuse abdominal tenderness
and shifting dullness in the flanks. Clotted blood
does not move about in the peritoneal cavity,
and, when collected in the lumbar gutter, may
cause only an increased dullness and tenderness
in the flank. An effusion within the lesser peri-
toneal cavity is almost impossible to detect in
its early stages by physical examination, but
operative and postmortem examinations have
established that it occurs with great frequency
in acute pancreatitis.
Much clinical emphasis has been placed on the
appearance of ecchymosis about the umbilicus
(Cullen’s sign) or in the flanks, particularly
on the left (Turner’s sign), since these discolor-
ations are almost pathognomonic of acute pan-
creatitis. Cullen’s sign may, however, as origi-
nally described, accompany a ruptured tubal
pregnancy. Both of these signs in pancreatitis
depend on the extravasation of blood into the
retroperitoneal tissues from a marked hemor-
rhage in the pancreas. The blood dissects for-
ward to the flanks and may proceed to the
umbilicus where it collects because of a peculiar
arrangement of the fascia. These signs are
rarely observed and, if present, indicate severe
hemorrhagic pancreatitis. Their usefulness in
establishing a diagnosis is further diminished
by their relatively late appearance in the illness,
generally from the third to the tenth day.
Patients with acute pancreatitis often present
some misleading symptoms and signs which may
result from secondary effects of the primary
disease but which in other instances cannot be
logically explained. These are: (1) Gastro-
intestinal hemorrhage, in the form of bloody
vomitus or bloody diarrhea, may be seen in
severe instances of pancreatic hemorrhage and
necrosis. (2) Jaundice in the absence of gall-
stones has occasionally been reported in acute
pancreatitis, but not nearly as frequently as in
chronic pancreatitis. (3) The presence of hyper-
tension in patients with acute pancreatitis has
recently been stressed by Paxton and Payne,10
who observed elevated blood pressures in 20 per
cent of 307 cases.
LABORATORY FEATURES
The results of laboratory tests in a case of
acute pancreatitis may be divided into findings
Avhich are specific and those which are charac-
teristic. A brief discussion of the routine tests
will precede the description of the more diag-
nostic features.
In the early stages of the illness, when dehy-
dration is common, the blood reveals a normal or
high number of red cells associated with normal
or elevated values of hemoglobin and hematocrit.
Once dehydration has been corrected, mild anemia
may appear, and a low red cell count indicates
extensive hemorrhage from the pancreas. By
following the level of red blood cells the physi-
cian is aided in deciding when to use blood
transfusions and what the prognosis may be.
Moderate leukocytosis (10,000 to 15,000) usually
is found. Necrosis may elevate the white
blood cell count to 25,000. If the level of leu-
kocytes in the course of acute pancreatitis sud-
denly rises, the onset of suppuration in the
gland must be suspected. The urine is usually
concentrated, reflecting dehydration, and in
moderately severe cases albuminuria is common,
accompanied at times by granular casts and an
occasional red cell. Glycosuria is also frequent.
The aid of the clinical laboratory is necessary
to make a positive diagnosis of acute pan-
creatitis. It must be emphatically stated that
no laboratory tests are available at the present
time which will unequivocally make this diag-
nosis. The various clinical laboratory features
of acute pancreatitis are: (1) Elevated blood
amylase; (2) elevated urinary amylase; (3)
elevated blood sugar and sugar in the urine;
(4) low blood calcium; (5) roentgenologic find-
ings; (6) electrocardiographic changes.
COURSE AND COMPLICATIONS
Acute pancreatitis in its early stages cannot
be clinically differentiated into pathologic types
as previously stated, but as the disease pro-
gresses, certain features appear which tend to
identify the particular form.
(1) Acute edematous (interstitial) pancreatitis
is present in two-thirds to three-quarters, and
perhaps more, of all cases with acute pancreatitis.
In mild instances of edematous pancreatitis re-
covery usually begins two to three days after
the onset of the illness. Pain disappears; ap-
petite returns; and soreness gradually leaves
the epigastrium. Within a week or less the
440
The Ohio State Medical Journal
patient is ready to resume a normal life. Even
in a moderately severe case the course rarely
lasts more than two weeks. In many instances
the acute edematous variety tends to recur over
a period of many years. A patient with acute
edematous pancreatitis illustrating its tendency
to recur is demonstrated in the following case
history.
CASE REPORT
Case 1. H. B. (C. G. H. #156545). This 18-
year-old colored female was admitted to the
surgical service of the Cincinnati General Hos-
pital on June 18, 1944, with complaint of upper
abdominal pain, nausea, and vomiting. She had
been a patient on the obstetrical service in
April, 1944, when she had delivered spontaneously
a full term infant. During the puerperium, com-
plicated by mild fever, she noted for the first
time some mild indigestion, which continued in
intermittent fashion until a month before ad-
mission, when she experienced a sudden attack of
severe dull epigastric pain radiating around below
the right breast to the right mid-axillary line.
The pain persisted for several days, increasing
after meals but not accompanied by nausea or
vomiting. Bowel movements were regular and
normal. The patient claimed that fatty foods
tended to cause epigastric discomfort. Alkaline
medication by mouth afforded moderate relief.
During the month preceding admission she ex-
perienced many less severe episodes of epigastric
pain. On June 8, 1944, she was seen as an out-
patient in the medical clinic, where epigastric
tenderness and a large tender liver Avere noted.
An oral cholecystogram on June 15, 1944, re-
vealed a poorly visualized gallbladder Avithout
evidence of stones. Following ingestion of the
dye for gallbladder visualization the patient
noted that the mild epigastric pain became more
severe, especially in the right upper quadrant,
and radiated around both costal margins to the
back and to the angle of the right scapula.
Anorexia, nausea, and vomiting accompanied the
pain.
On admission, June 18, 1944, the patient was
running a high fever, 104° F, with pulse 100, re-
spirations 20, and blood pressure 120/80. She
was obese, toxic, and complaining of pain in the
right upper quadrant. The breasts were lactat-
ing. The abdomen was not distended. Diffuse
tenderness was evident, most marked in the
right upper quadrant with spasm in that area.
The liver, palpable two finger breaths below the
costal margin was tender. The initial laboratory
findings included hemoglobin 9.5 gm.; Avhite blood
cells 14,900; urine, no albumin, no sugar, three
plus bile. The admission diagnosis favored acute
hepatitis over a possible cholecystitis.
The patient was treated conservatively and
observed. Her temperature dropped to normal
in four days. Oral intake was withheld, and
intravenous fluids were administered for several
days until the abdominal pain, nausea, disap-
peared. Jaundice, although not apparent clini-
cally, was revealed by an icterus index of 20
on June 19, 1944, the second hospital day, but
two days later the icterus index was 9. A serum
amylase of 1049 units, drawn on the second hos-
pital day, indicated that there was acute pan-
creatitis. Subsequent determinations included
462 on June 21, 1944, 304 on June 22, 1944, 187
on June 27, 1944. Roentgenological studies of
the upper gastrointestinal tract re\Tealed chronic
gastritis without evidence of peptic ulcer. A
gastric analysis after histamine found no free
HCL. Following recovery from her acute attack
the patient submitted to an elective cholecystec-
tomy on July 15, 1944. The head of the pancreas
was considered normal by the surgeon, and no
fat necrosis was seen. No sign of a peptic
ulcer was present. The gallbladder was thick-
ened but contained no stones. The common duct
was not enlarged and contained no palpable
stones. The gallbladder was removed and the
area drained, the postoperative course was benign
for the first nine days. Transient mild jaundice
was observed, but on the third postoperative
day the serum amylase was normal, 123 units.
On July 24, 1944, the ninth postoperative day,
a sudden attack of epigastric and right upper
quadrant pain accompanied by an elevated tem-
perature, pulse, and serum amylase (822 on July
28, 1944) indicated a recurrent bout of acute
pancreatitis. The pain was boring, intense and
uninfluenced by atropine. The attack subsided
spontaneously in several days, and the patient
was discharged on August 7, 1944, twenty days
after cholecystectomy.
The patient was followed closely in the out-
patient department. She continued to have at-
tacks of epigastric pain which radiated straight
through to the back, but no longer radiated around
the costal margins. Oral hydrochloric acid gave
more relief than pancreatin, while nitrites had
no effect on the pain. The attacks gradually
became milder and finally disappeared about
nine months after cholecystectomy. She has been
seen at regular intervals up until May, 1948,
and has been completely free of indigestion.
❖ ❖ ❖
(2) Acute pancreatic necrosis or acute hemor-
rhagic pancreatitis is found in one-third to less
than one-quarter of cases Avith acute pancreatitis.
In fatal cases death usually occurs before the
fourth day, but at times it may be postponed
for tAvo or three weeks until precipitated by
secondary infection or pneumonia. Collections
of inflammatory fluid and secretion within the
pancreas (pseudocyst) frequently result three to
four weeks following the attacks of pancreatic
necrosis, and occasionally earlier. When bacteria
become established in the inflammatory masses,
the organisms evoke a purulent exudate and
change the pseudocyst into an abscess. Pseudo-
cysts often rupture into the lesser peritoneal
cavity, or may dissect ventrally between the
leaves of transverse mesocolon, and occasionally
discharge their contents into the colon or ad-
herent loops of small intestine. In many in-
stances of acute pancreatic necrosis the onset
is severe and death may follow within a very
short period of time. This is illustrated in an-
other patient in which the diagnosis of acute
hemorrhagic pancreatitis was proven by necropsy.
Case 2. L. B. (C. G. H. #155349). This 29-year-
old unmarried colored female claimed that she
had always been perfectly well until noon on
December 6, 1947. She denied ever having noted
previous indigestion, abdominal pain, or jaundice.
The night before she had had “a few (2)
drinks.” After arising in the morning she
vomited tAvice and had a normal bowel move-
for May, 1950
44 1
ment, but she neither considered herself sick
nor experienced any pain until three hours be-
fore admission. About noon, December 6, 1947,
while riding on a streetcar she was suddenly
seized with a severe epigastric pain, which was
dull and constant. It radiated around the left
rib margin and directly through the abdomen
to the back and left flank and in addition spread
diffusely over the entire abdomen. After the
onset of the pain the patient noted no nausea or
vomiting. Her pain was slightly relieved if the
patient sat upright.
When first seen in the Receiving Ward, the
patient complained of severe abdominal pain, but
she showed no signs of shock. She preferred
to sit up during examination. Her temperature
by mouth was 96; pulse 86; respirations 22; and
blood pressure 120/80. She was not obese and
appeared well-developed. Her abdomen was
scaphoid and was markedly tender and rigid
throughout, especially in the epigastrium. No
masses could be felt, and no peristalsis was heard.
Examination of the pelvic organs and rectum
revealed diffuse tenderness which was referred
to the region of the umbilicus.
Emergency laboratory studies showed that the
white blood cell count was 10,380, that the
urine contained 1+ albumin and no sugar, bile,
or microscopic elements. A serum amylase deter-
mination, made shortly after admission, was
read at 680 units (normal 50-200 u.).
The admission diagnosis was acute pancreatitis,
and the patient was sent to a surgical ward.
While being examined in bed by an intern, nine
hours after the onset of pain, the patient sud-
denly sank back; her eyes rolled up and after
two brief clonic movements she expired. Prior
to this terminal episode she had been conscious
and alert.
A postmortem examination performed two
hours after death confirmed the clinical impres-
sion. Acute hemorrhagic pancreatitis with focal
fat necrosis was found. There were 150 cc. of
cloudy sanguinous fluid in the pelvis, and the
lesser omental bursa contained a small amount
of cloudy, sero-sanguinous fluid. The retroperi-
toneal tissues about the pancreas were edematous
and hemorrhagic; and fat necroses were scattered
over the surfaces of the pancreas and neighbor-
ing omentum and mesenteries. The pancreas,
firm and slightly enlarged, contained many small
coalescent focal hemorrhages and fat necroses.
The pancreatic ducts were dilated, injected, and
edematous, but no point of obstruction could be
found. The following points are of etiological
interest: the main pancreatic duct entered the
duodenum separately from the common bile duct;
no lymphadenopathy in the region of the pan-
creas or extrahepatic biliary tract; normal gall-
bladder and common duct without evidence of
cholelithiasis; slight edema and congestion of
the mucosa in the second portion of the duo-
denum; no evidence of thrombosis in the large
pancreatic blood vessels. The microscopic sec-
tions revealed focal areas of pancreatic necrosis
with thromboses of neighboring small vessels.
There were also foci of organizing and mature
connective tissue in the pancreas. Marked fatty
infiltration of the liver wfithout evidence of cir-
rhosis was noted.-
• ^ >;: %
(3) Suppurative pancreatitis may occasionally
result from a primary bacterial invasion of the
gland, such as multiple metastatic abscesses
transmitted by the blood stream or lymphatic
vessels, or as suppuration extending directly
from a neighboring purulent focus. In these
instance, the purulent inflammation within the
pancreas is usually only a manifestation of a
generalized infection, and symptoms of pan-
creatitis, such as epigastric pain and vomiting,
are masked by those of marked systemic toxicity.
Acute suppurative pancreatitis commonly re-
fers to the supervention of bacterial organisms
on the lesions of pancreatic necrosis and, oc-
casionally, edema. Unless a febrile episode
occurs in the course of convalescence, no clear-
cut signs mark the beginning of suppuration,
which can be identified mainly by an abnormal
rise in fever and increased leukocytosis. The
large pseudocysts of pancreatic necrosis un-
fortunately tend to become infected, and under
such circumstances they create the serious prob-
lem posed by an intra-abdominal abscess. With
virulent infection the subsequent course is stormy
and frequently fatal, whereas a mild infection
can often be effectively handled by the bodily
defenses. These principles are well illustrated
in another case with acute hemorrhagic pan-
creatitis which led to suppurative pancreatitis
and a large retroperitoneal abscess on the right
side.
Case 3. C. H. (C. G. H. #210690). This 73-year-
old white male was admitted to the surgical
service of the Cincinnati General Hospital on
February 2, 1946, complaining of crampy ab-
dominal pain. For about seven years prior to
admission the patient had experienced inter-
mittent attacks of sudden, steady, epigastric
pain which lasted one to two hours before quickly
disappearing. The attacks bore no relation to
meals, were not associated with nausea and
vomiting, and were separated by intervals of
good health, varying from one month to a year.
Bowel movements were regular and normal. All
foods had agreed with the patient, especially
fatty foods. The last attack began six days
before admission with sudden generalized crampy
abdominal pain. The patient vomited once be-
fore consulting his physician, who administered
“a shot,” which partially relieved the symptoms.
The pain persisted as a colicky, non-radiating
discomfort in the upper abdomen without as-
sociated vomiting. A daily “shot” from the
physician tended to ease the pain without curing
it. The patient had little desire for solid food
but continued to drink liquids without difficulty.
The bowels moved regularly until two days
before admission, but flatus continued to be ex-
pelled. No fever or chills had been noted.
On admission, February 5, 1946, the temper-
ature was 98, pulse 80, respirations 20, and
blood pressure 140/68. The patient, a slightly
obese, elderly white male, complained of moder-
ately severe upper abdominal pain but was not in
shock. The skin was warm and moist. The
abdomen, slightly distended, presented a faint
bluish discoloration, suggestive of a hematoma,
about the umbilicus. Moderate tenderness with-
out spasm or rebound tenderness was found
in the epigastrium, especially over an ill-defined
442
The Ohio State Medical journal
mass in the right upper quadrant which extended
across the midline to the left and interiorly as
far as the umbilicus. No tenderness was elicited
in either costo-vertebral angle or along the lower
ribs. Peristalsis was active, although moderate
tympany was noted. The initial laboratory work
revealed a hemoglobin of 13.5 grams and white
blood count of 12,300. The urine contained a
trace of albumin, no sugar, and one white blood
cell per high power field. The stool was green
brown and gave a 1+ guaiac reaction. The serum
amylase was read at 235 units. The blood sugar
was normal, 108 mgm. per cent. The admission
roentgenograms of the abdomen suggested the
presence of a right subphrenic abscess containing
a small pocket of air. The tentative admission
diagnosis was cholelithiasis with hydrops of
the gallbladder. On the basis of the roentgen-
ographic findings a perforated peptic ulcer with
subphrenic abscess was considered the second
most likely condition, while the diagnosis of
acute pancreatitis with pseudocyst was also dis-
cussed. A barium enema the day after admission
revealed downward displacement of the right half
of the transverse colon.
The patient was given nothing by mouth and
intravenous fluids. The temperature rose to
100°. Twenty-four hours after admission he
was taken to the operating room. Under local
anesthesia the abdomen was explored through
a short, upper right rectus, paramedian incision.
The mass, noted on admission, consisted of
matted omentum flecked with fat necroses. The
gallbladder was thought to be normal and free
of stones. Through an opening in the gastro-
colic ligament, the head of the pancreas ap-
peared enlarged, swollen, and injected. By pal-
pation it was markedly indurated and twice
normal size. The capsule was incised, revealing
soft, dark, necrotic pancreatic tissue. Three
cigarette and three Penrose drains were inserted
into the pancreatic substance and brought out
through the main incision. The abdominal
wound was closed with two through-and-through
steel wire stay sutures. The postoperative diag-
nosis was acute hemorrhagic pancreatitis with
necrosis. Staphylococcus albus was cultured
from the necrotic pancreas.
Following operation the patient’s fever rose
to 103°, and he became disoriented. Penicillin
was begun on the second postoperative day and
continued for thirteen days, 15,000 units every
three hours. Improvement followed gradually.
At first the drainage from the wound was only
slight, but after changing to a sanguino-purulent
discharge it became profuse and frankly purulent
within two weeks after operation. The patient
was discharged on the twenty-fourth postopera-
tive day, at which time the wound was still drain-
ing and a mass was still palpable in the right
upper quadrant.
After discharge the patient was followed
closely in the surgical out-patient clinic. On
April 1, 1946, he was readmitted to the hospital
to secure better drainage of a large intra-
abdominal abscess. On April 2, 1946, the pa-
tient was taken to the operating room, where
an exploration of the abdominal sinus tract was
carried out under local anesthesia. A large
amount of friable, black and white material was
removed from the abscess. Postoperative diag-
nosis was pancreatic abscess.
Following the second operation the patient de-
veloped a shaking chill and subsequently a fever
of 101°. The wound drained large pieces of
necrotic tissue and profuse sanguino-purulent
fluid. The skin of the abdominal wall became
excoriated. On the seventeenth postoperative
day he complained of pain and weakness in
the right hip. On the twenty-first postoperative
day there was a sudden onset of severe abdominal
pain, rigidity, and absent peristalsis, followed by
frequent vomiting of coffee ground material.
The patient lapsed into coma and expired fifteen
hours later. The discharge diagnosis was acute
suppurative pancreatitis secondary to pancreatic
abscess.
A postmortem examination performed nine
hours after death revealed an acute suppurative
peritonitis, secondary to the retrocecal rupture
of a large peripancreatic abscess, containing
about 1000 cc. of pus. This abscess, which com-
municated with the sinus draining onto the ab-
dominal wall had dissected behind the right
half of the transverse colon and had traveled
downwards behind the ascending colon to the
retrocecal region before perforating into the
general peritoneal cavity. The head of the
pancreas appeared normal, while the remainder
was replaced by necrotic, dark green material,
which was in continuity with the retroperitoneal
abscess. The gall bladder and common duct both
contained innumerable small stones, although
there was little evidence of inflammation. The
common duct was patent. Marked coronary
sclerosis was also present.
DIFFERENTIAL DIAGNOSIS OF ACUTE PANCREATITIS
It becomes obvious that the differential diag-
nosis of acute pancreatitis is a most important
problem to the clinician. Time is important
since unnecessary delay may for a specific surgi-
cal lesion invite disastrous results. In this re-
gard there are a number of upper abdominal
and even lower abdominal surgical conditions
of the acute variety which make the clinical
diagnosis of acute pancreatitis very difficult.
Some of the more common are acute cholecystitis,
perforated peptic ulcer, acute intestinal obstruc-
tion, acute appendicitis, acute diffused gen-
eralized peritonitis, acute mesenteric thrombosis,
and renal colic. On the other hand there are
a few medical conditions which also simulate
the classical picture of acute pancreatitis and
which will require consideration before a dif-
ferential diagnosis can be made. Some of these
conditions are biliary colic and common duct
stone, acute coronary disease, pneumonia, dis-
secting aneurysm of the aorta, and tabetic crisis.
There are other conditions which may, under
certain circumstances, be confused with the diag-
nosis of acute pancreatitis. Some of them are,
diaphragmatic hernia with incarceration, the
early development of herpes zoster on the left
side, acute arthritis of the thoracic spine, trau-
matic rupture of the aorta, and, rarely, the crisis
associated with advancing hemachromatosis.
TREATMENT OF ACUTE PANCREATITIS
Until recently acute pancreatitis was con-
sidered a surgical emergency, and either multiple
incisions into the pancreas with drainage or drain-
for May, 1950
443
age of some portion of the extrahepatic biliary
tract (cholecystostomy or choledochostomy) were
performed. On rare occasions surgeons have
advocated drainage of both the pancreas and ex-
trahepatic biliary tract. Many observers be-
lieved that surgical treatment of acute pan-
creatitis was unjustified and gradually a more
conservative approach has evolved. This change
of attitude was not abrupt, and there are still
a few who advise surgical intervention. In
general, surgical drainage of the pancreas or
of the bile ducts during the acute stage of the
disease has carried a mortality rate of about
50 per cent; whereas conservative attitude in
the management of pancreatitis has reduced
the mortality.
Since the serum amylase test usually confirms
the correct diagnosis, failure to diagnose emer-
gencies requiring surgery is less apt to occur,
and therefore conservative therapy is not a
dangerous program. ’ Currently, conservative
measures are advocated until complications which
require surgical intervention, such as pancreatic
pseudocyst, intra-abdominal abscess, or collec-
tions of pancreatic fluid arise. Associated regional
gastro-intestinal or biliary tract lesions can be
treated after the patient has recovered from the
acute pancreatic episode.
NONOPERATIVE OR CONSERVATIVE THERAPY
Because no clinical method is available to dif-
ferentiate acute edematous pancreatitis from
acute hemorrhagic pancreatitis, the clinician must
practice conservative measures on each patient
entering the hospital. A period of close observa-
tion should indicate the general behavior of the
disease, and usually with four to six days the
clinical course becomes fairly well established.
Conservative treatment is specifically con-
cerned with two problems: (1) To institute
measures which will diminish exocrine pancreatic
secretion; and (2) to allay spasm of the sphincter
of Oddi.
(1) Since food in the stomach stimulates pan-
creatic secretion, the patient, at bed rest, should
receive nothing by mouth. In order to prevent
gastric juice (chiefly hydrochloric acid) from
affecting pancreatic secretion, continuous gastric
aspiration should be instituted early and main-
tained as long as indicated, changing the Levine
tube periodically. Since both hyperglycemia
and hypoglycemia may affect pancreatic excretory
function, control of the blood sugar level by
the combined use of intravenous glucose and ad-
ministration of insulin is important. Pain is best
controlled by the use of demerol which has an
atropine-like action and therefore does not stim-
ulate the vagus nerve. Atropine paralyzes
the cholinergic nerve fibers, which excite pan-
creatic secretion. Ephedrine also will diminish
pancreatic secretion (Craft).11 Morphine should
be avoided when possible because it usually fails
to control pain and stimulates pancreatic secre-
tion (Elman12 and Popper13).
(2) Antispasmodics such as atropine and nitro-
glycerine may aid in reducing spasm of the
sphincter of Oddi. Novocainization of the para-
vertebral sympathetic ganglia may diminish
pancreatic function and may also inhibit the
spastic contractions of the sphincter of Oddi.
Several authorities have advocated this pro-
cedure early in the course of the disease (Popper14
and Gage15).
Water and electrolyte balance can be main-
tained by the parenteral administration of phy-
siological salt solution, blood plasma, and whole
blood if indicated. Landsteiner16 (1900) referred
to the fact that an antitryptic factor was
present in the albumin fraction of blood. One
might assume that large quantities of blood
plasma, or more specifically the albumin frac-
tion, may prove beneficial in those patients
who develop hemorrhagic (necrotic) pancreatitis.
Random administration of solutions of glucose is
contraindicated since hyperglycemia may stim-
ulate pancreatic secretion. Calcium salts may be
given intravenously to control tetany. Chemo-
therapy should be given to all cases of acute
pancreatitis on a prophylactic basis.
As yet no analytical figures are available which
indicate the effect of modern chemotherapy upon
pancreatitis. For the prevention of suppurative
disease of this organ we believe chemotherapy
should be used in the treatment of acute pan-
creatitis.
Penicillin may be given at the rate of 300,000
units daily. The method and site of administra-
tion may be decided by the individual clinician.
Streptomycin given intramuscularly at the rate
of 0.5 gm. twice daily may be administered.
Sulfa derivatives may be given intravenously
in doses of 2.5 to 5 gm., but should not be
given by mouth. Although in a majority of
cases with acute pancreatitis bacterial cultures
of the diseased tissue cannot be obtained, the
condition is so serious that administration of
chemotherapeutic agents remains practical and
is justified.
OPERATIVE TREATMENT
Although most observers (Elman,17 Abell,18
Cole,19 Morton,20 Popper,21 and others) agree on
nonoperative treatment in the milder forms of
acute pancreatitis (edematous variety), there is
no universal agreement about the exact manage-
ment of acute necrotic pancreatitis. In general,
the consensus of opinion indicates that operative
procedures are less favored now than in former
years. Surgery is indicated when a localized
collection of fluid becomes manifest, when an
intra-abdominal abscess is apparent, when a
pancreatic pseudocyst becomes palpable, or when
an abscess develops in the lesser peritoneal
444
The Ohio State Medical Journal
cavity. If indicated, operation should assure suf-
ficient and adequate drainage of the complication
but exploration should not be extensive. An abs-
cess of the lesser peritoneal cavity is more dif-
ficult to diagnose and more difficult to drain
adequately that one in the greater peritoneal
cavity. Operative procedures should not replace
the good therapeutic measures of conservative
management. Gastric aspiration, transfusions
of whole blood or plasma, and chemotherapy
should be continued postoperatively.
Some observers state that cholecystectomy may
reduce biliary pressure. Other groups argue
that cholecystectomy should be done primarily,
after which choledochotomy associated with pro-
longed drainage of the common bile duct (chole-
dochostomy) is indicated (Mayo,22 Archibald,23
Judd24).
According to recent opinion, operations upon
the neighboring gastrointestinal and extrahepatic
biliary tracts in the presence of acute pancreatitis
are inadvisable. Those holding this opinion
prefer to wait for the pancreatic process to
subside and, assured of this, to evaluate the
status of- the gallbladder, liver, stomach, and
duodenum for the presence of such conditions
as cholecystitis, cholelithiasis, choledocholithiasis,
and penetrating peptic ulcer, which should then
be corrected by surgical methods.
Cholangiograms obtained at operation (chole-
dochotomy) may be used advantageously to dem-
onstrate common duct obstruction, spasm of
the sphincter of Oddi, and the common channel
into the pancreatic duct system. When cholan-
giograms demonstrate spasm or obstruction of
the sphincter of Oddi associated with a reflux
of radio-opaque material into the pancreatic duct,
section of the sphincter has been advised (Colp,25
Doubilet,26 Mulholland27). More work should be
done in this field before we can draw final con-
clusions.
From this discussion it is apparent that
definite rules regarding therapy cannot and
should not be made. A logical approach to this
problem may be found in the integration of the
history, physical and laboratory findings, response
to therapy, and clinical course of the individual
patient. Careful observation of the patient will
determine the best therapeutic course.
PROGNOSIS
The prognosis of acute pancreatitis can be
considered grave. Any patient surviving the
initial attack cannot be assured that future
episodes will not occur. Recurrent attacks are
observed in seven to 30 per cent of cases of acute
pancreatitis. In pancreatic abscess or cyst
formation, a persistent pancreatico-cutaneous
fistula may occur. The islands of Langerhans
may be so extensively damaged that diabetes
occurs in about 11 per cent of the cases. Some
patients suffer pancreatic asthenia (Whipple,23
1924) and die within a’ few weeks of the onset
of acute pancreatitis. Liver disease, particularly
fatty degeneration, may be a sequel of this syn-
drome.
Acute pancreatitis may be the precursor of
chronic relapsing pancreatitis, of which the
prognosis is poor. Chronic disability and in-
validism fr«m the severe persistent pain of this
disease are the chief concern. Rehabilitation
of these patients offers a challenge to the medi-
cal profession.
BIBLIOGRAPHY
1. Siler, V. E., and Wulsin, J. H. : Pancreatitis. Nel-
son’s Surgery, (In Press).
2. Dragstedt, L. R., Haymond, H. E., and Ellis, J. C. :
Pathogenesis of Acute Pancreatitis (Acute Pancreatic
Necrosis). Arch. Surg., 28:232, 1934.
3. Rich, A. R., and Duff, G. L. : Experimental and
Pathological Studies on the Pathogenesis of Acute Hemor-
rhagic Pancreatitis. Bull. Johns Hopkins., 58 :212, 1936.
4. Jones, R., Jr.: The Etiology and Pathogenesis of
Acute Hemorrhagic Pancreatitis. Am. J. Med. Sci., 205 :277,
1943.
5. Rienhoff, W. F., and Pickrell, K. L. : Anatomic Study
of Pancreatic and Extrahepatic Biliary Systems. Arch.
Surg., 51:205, 1945.
6. Fitz, R. H. : Acute Pancreatitis. Med. Rec., 35:197,
225, 251, 1889.
7. Zoepffel, H. : Das akute Pankreasodem, eine Vorstufe
der akuten Pankeasnekrose. Deutsche Ztschr. f. Chir.,
175:301, 192.
8. Elman, R. : Acute Interstitial Pancreatitis, a Clinical
Study of 37 Cases Showing Edema, Swelling and Induration
of the Pancreas But Without Necrosis, Hemorrhage, or Sup-
puration. Surg. Gynec. Obst., 57 :291, 1933.
9. Elman, R. : Surgical Aspects of Acute Pancreatitis
with Special Reference to Its Frequency as Revealed by
Serum Amylase Test. J. A. M. A., 118 :1265, 1942.
10. Paxton, J. R., and Payne, J. H. : Acute Pancreatitis,
a Statistical Review of 307 Established Cases of Aoute Pan-
creatitis. Surg. Gynec. Obst., 86 :69, 1948.
11. Craft, C. B. : Effect of Ephedrine on Pancreatic
Secretion, Method of Management of Patients Having
Fistula, Surgery, 4 :64, 1938.
12. Elman, R. : Surgery in Acute Pancreatitis. Gastroen-
terology, 7 :656, 1946.
13. Popper, H. L., Necheles, H., and Russel, K. C. :
Transition of Pancreatic Edema into Pancreatic Necrosis.
Surg. Gynec. Obst., 87 :79, 1948.
14. Popper, H. L. : Paravertebrale Injektion bei Pan-
kreatitis. Zentralbl. f. Chir., 60 :2050, 1933.
15. Gage, M. : Personal Communications, 1948.
16. Landsteiner, K. : Zur Kenntnis der anti-fermentiven,
lytischen, und agglutinierenden Wirkungen des Blutserums
und die Lymphe. Zentr. Bakt., 27 :357, 1900.
17. Elman, R. : Surgical Aspects of Acute Pancreatitis.
J. A. M. A., 118:1265, 1942.
18. Abell, I. : Acute Pancreatitis. Surg. Gynec. Obst.,
66:348, 1938.
19. Cole, W. H. : The Treatment of Acute Pancreatitis.
Intemat. Abstr. Surg., 67 :31, 1938.
20. Morton, J. : Acute Pancreatitis. Surgery 17 :475,
1945.
21. Popper, H. L. Necheles, H., and Russel, K. C. :
Transition of Pancreatic Edema into Pancreatic Necrosis.
Surg. Gynec. Obst. 87 :79, 1948.
22. Mayo, C. H. in F. Christopher : Textbook of Surgery.
W. B. Saunders Co., 3rd ed., Philadelphia, 1942.
23. Archibald, E. W., and Kaufman, M. : In Lewis, D.,
Practice of Surgery. Hagerstown, W. F. Prior Co., 1929.
24. Judd, E. S. in F. Christopher : Textbook of Surgery.
W. B. Saunders Co., 4th ed., Philadelphia, 1945.
25. Colp, R., and Doubilet H. : The Clinical Significance
of Pancreatic Reflux. Ann. Surg. 108 :243, 1938.
26. Doubilet, H., and Colp, R. : Resistance of Sphincter
of Oddi in the Human. Surg. Gynec. Obst., 64 :622, 1937.
27. Doubilet, H., and Mulholland, J. H. : Recurrent Acute
Pancreatitis: Observations on Etiology and Surgical Treat-
ment. Ann. Surg. 128 :609, 1948.
28. Whipple, A. O. : Pancreatic Asthenia as a Post-
operative Complication in Patients with Lesions of the
Pancreas. Ann. Surg., 78:176, 1924.
for May, 1950
445
Medical Treatment of Hyperinsulinism: With
Report of A Case
HENRY J. JOHN, M. D.
The Author
• Dr. John, Cleveland, Ohio, is a graduate
of Western Reserve University School of Medi-
cine, Cleveland, 1916; fellow, American Col-
lege of Physicians; member, American Dia-
betes Association; and visiting physician. Uni-
versity, St. Luke’s and Huron Road Hospitals.
THE clinical entity of hyperinsulinism may
be classified either as functional, in which
there is derangement of the regulatory
mechanism of blood sugar, owing to various
causes, largely unknown, or it may be anatomic,
the result of a pancreatic tumor involving the
islet tissue. The first type can be treated medi-
cally; the second requires surgery. For that
reason, it is essential in each case to ascertain
whether the symptoms are on a functional or
anatomic basis, so that useless and damaging
surgery may be avoided.
The case I am using to illustrate the value
of this differentiation is extremely interesting in
that the patient, a boy who is now seven years
and nine months old, developed hyperinsulinism
when he was only three years of age.
CASE REPORT
In 1943, at aged three, a boy began to have
attacks of vomiting, followed by unconsciousness
and then convulsions. During the following three
years, he had five such severe attacks. The
diagnosis of hyperinsulinism was made by the
family physician, in 1946, when the blood sugar
was found to be only 21 milligrams per cent
in one of these attacks. A glucose tolerance
test shortly afterward showed a normal blood-
sugar curve. A galactose tolerance test re-
vealed no glycosuria. The basal metabolic rate
was -7 per cent.
The child was placed on a high carbohydrate
diet, a serious error in treatment, since carbo-
hydrate stimulates the endogenous insulin produc-
tion, which in turn produces more hypoglycemia,
and thus a vicious circle is established. This is
apparently exactly what happened in this case,
for after five days on the high carbohydrate diet,
he went into hypoglycemic coma, with a blood
sugar of 23 milligrams per cent (Chart 1). He
was seen the following day by a medical con-
sultant who advised operation on the pancreas.
This naturally upset the family and they took
the child to the Mayo Clinic, where he was
studied for five days. There, two blood-sugar
determinations made after a fifteen-hour fast
were both below 40 milligrams per cent. These
reactions were controlled by intravenous admin-
istration of 10 cubic centimeters of 50 per cent
glucose solution. The adrenalin test yielded a
normal hyperglycemic curve. A diagnosis of
hyperinsulinism was made, and exploratory
operation advised, with the recommendation that
if an islet tumor were not found, half or more
of the pancreas should be resected.
This confirmation of the previous diagnosis and
advice disturbed the family still more, but they
promptly returned home to Cleveland with the
patient. For the next two and one-half weeks,
the child was in and out of the hospital every
few days because of convulsions and unconscious-
ness. Glucose given intravenously would restore
Submitted May 25, 1949.
consciousness, but in a day or two, the same
condition would be encountered.
It was at this point that I first saw the pa-
tient. He was then aged five years and eight
months. His mother described the symptoms
to me as follows: “He gets spells of vomiting
or gagging when he awakes in the morning'
and then he slips away into sleep for a few
minutes. Then he awakes and has spells of
muscular contractions verging on convulsions
and then I rush him to the hospital. The first
time he was unconscious all day and was treated
symptomatically. When I give him orange juice
early enough, this usually brings him out of it.
The blood sugar was taken only once during
the attack and it was 21 milligrams per cent.”
The first day I saw him, I checked the blood
sugar three times, once before each meal. It
was 40, 73 and 78 milligrams per cent, respec-
tively. There were no symptoms on that day.
From the history and the previous findings it
Table 1.
CASE OF HYPERINSULINISM : TREATMENT
IN HOSPITAL
Date
Jarbohydrate
Grams
Protein
Grams
Fat
urams
Calories
Body Weight
Pounds
August
27
140
80
124
2000
37.8
28
115
71
130
1914
29
141
68
154
2222
30
153
68
153
2261
31
148
80
122
2010
September
1
164
91
141
2289
2
111
52
107
1615
3
135
67
112
1816
4
75
42
70
1098
5
133
70
135
2027
6
114
53
119
1739
7
154
56
81
1569
8
117
69
121
1833
9
133
71
97
1689
10
166
92
144
2328
11
170
103
136
2316
12
177
89
111
1663
40.0
13 (Discharged from
Hospital)
seemed clear that the case was one of hyperin-
sulinism, and so the patient was admitted to the
hospital for further study and treatment. I gave
him a diet consisting of 140 grams of carbohy-
drate, 80 grams of protein and 124 grams of
fat, with a total of 2000 calories. Accurate cal-
culation was made of the food actually consumed;
what he left on his tray was calculated and
charted (Table 1). In addition 'to this diet, he was
446
The Ohio State Medical Journal
was given ice cream or cream in ginger ale be-
tween meals, at 10 a. m., and at 2:30 and 9 p. m.
This furnished an additional supply of fat in a
form which was pleasant for the child to take.
He stayed in the hospital for eighteen days
(Chart 1). During this period his blood sugar,
CHART 1
which was checked three times a day, before
each meal, stayed well within normal limits,
largely as the result of between-meal feedings.
He received insulin only on the first day, when
I gave him 6 units three times, after meals,
when the noon blood sugar dropped to 29 milli-
grams per cent. Then insulin was discontinued,
and the patient was treated by diet alone.
His progress was smooth. There wasn’t a
single hypoglycemic episode during his stay in
the hospital, and none has occurred during the
two years since. He began to gain weight and
has developed normally (Table 2). He is now
Table 2.
CASE OF HYPERINSULINISM : FOLLOW-UP
EXAMINATIONS
Date
Age
Weight
Height
Develop'
mental
Level
8-23-46 5 yr. 8 mo.
First Examination
41 lb.
44 in.
34
9-11-46
6 yr. 9 mo.
40 lb.
44 in.
32
12- 2-46
5 yr. 11 mo.
42 lb.
45 in.
37
7-20-48
7 yr. 7 mo.
52 lb.
49.5 in.
61
a freckled youngster, normal in all respects, go-
ing to school and partaking of all the activities
of a youngster of his age.
In this instance, dietary management solved
the problem, and I believe it is safe to say now
that the case is one of functional hyperinsulinism
and not a tumor of the islands of the pancreas.
DISCUSSION
We have been using the term hyperinsulinism
to designate a clinical condition of nervousness,
hunger, sweating, in the presence of a low
blood sugar. Sometimes there is also muscular
twitchings and convulsions and a drift into an
unconscious state, as in the present case. The
term hyperinsulinism is not accurate, since this
means overfunction of the islands of Langerhans,
that is, too much insulin in the blood stream
owing to overproduction; often the symptoms
are due rather to a derangement of the regula-
tory mechanism. However, clinically this term
has come to denote a certain symptom complex,
and it is likely that it will continue to be used.
The clinical picture suggests the diagnosis;
blood sugar determination either confirms or
eliminates it. When a clinical diagnosis of hy-
perinsulinism is made, then it becomes necessary
to determine whether it is being caused by a
functional disturbance or a tumor of the islands
of Langerhans. On the basis of my own ex-
perience, I believe that the differentiation can
be made by a trial of medical treatment with a
moderate carbohydrate, high fat content, with
or without supplementary insulin, as indicated
in the individual case.
The first case of hyperinsulinism I observed
was reported in 1925.1 The patient had taken
too much insulin, which produced a clinical pic-
ture resembling that of hyperthyroidism. When
the insulin was properly adjusted, all symptoms
disappeared. In 1931, 2 I reported a case in a
physician, aged sixty-one years. About two
years earlier, he had had a severe loss of weight
(41 per cent) owing to diabetes and he also had
hyperthyroidism, septic teeth and tonsils and hy-
pertrophic cirrhosis of the liver. Under treat-
ment, his diabetic condition improved rapidly;
after sixteen months, all insulin was discontinued
and his blood sugar remained normal on a liberal
diet. Later, he began to suffer from attacks of
hypoglycemia and finally was brought to the
hospital in an unconscious state. His blood sugar
was 30 milligrams per cent, and he died that
same day, despite liberal intravenous administra-
tion of glucose solution. The autopsy showed
hypertrophy of the islands of Langerhans. In
this case, there was an extreme shift from dia-
betes to spontaneous hyperinsulinism.
About this time, with the increasing recogni-
tion of hyperinsulinism as a clinical entity, many
physicians in this country developed great en-
thusiasm for surgical treatment of all types of
cases of moderate to severe hypoglycemia with
some symptoms resembling those of hyper-
insulinism. This, I believed, was a dangerous
teaching, for operative mortality in surgery of
the pancreas naturally would be high in the
hands of surgeons lacking experience in this
special field, and thus many lives would be sacri-
ficed. Recognition of this danger led me to
try to find some other answer to this problem.
Out of this study came my publication3 on the
medical treatment of this condition with a rel-
atively low carbohydrate and high fat diet,
along with administration of insulin a half-hour
after each meal. The underlying principle of
this treatment is to supply exogenous insulin
for May, 1950
44 7
which decreases the need for endogenous insulin
and thus puts the overworked islets of the pan-
creas at rest. In the first case in which this
method of treatment was used, a complete restitu-
tion of normal function was achieved in a pa-
tient whose symptoms were severe and of long
duration. On the basis of this satisfactory re-
sult, I carried out further studies along this
line and published subsequent reports in 19344
and 1935.5
Thus far, I have observed twenty-five cases
that I have treated medically, with no failure.
I believe that the anatomic type of hyper-
insulinism will not respond to medical treatment,
but I have not been able to prove this point
myself, since in all the years of work on this
subject, I have not as yet encountered a case with
island tumor. It remains for others to supply
this information. If it should be proved that the
anatomic type of hyperinsulinism will not respond
to medical treatment, then medical treatment
of the type I have used will provide a differen-
tial diagnosis of these two conditions, and should
eliminate much unnecessary and dangerous ex-
ploratory surgery.
The symptoms of hyperinsulinism may con-
tinue for several years and remain fairly constant
or they may gradually become more severe.
Just because they become more severe is no
proof that an island tumor is present. In two
cases I have studied, the symptoms became
more severe with time, and yet both were of the
functional type. However, if symptoms should
increase in severity rapidly, I should feel that
this is presumptive evidence for a tumor, but
it still would have to be proved before operation
is advised.
The importance of a conservative approach
to the problem of hyperinsulinism is well il-
lustrated in the case reported here, which is
typical of many others throughout the United
States. Very able physicians with much clinical
experience diagnosed his condition as probably
due to a tumor of the islands of Langerhans
and advised operation. His clinical course sub-
sequently indicates that he did not have an
island tumor, for his recovery was complete on
medical treatment alone. It furnishes food for
thought to wonder what his status would be
today had he been subjected to operation, and
if no tumor were found, half or more of his
pancreas had been resected.
SUMMARY
A case of functional hyperinsulinism is de-
scribed in a little boy who was three years of
age when he began to have the typical symptoms
of this condition. I saw him first when he was
five years and eight months old, at which time
his symptoms were severe, consisting of mus-
cular twitchings, convulsions and unconscious-
ness. These symptoms were so severe and so
frequent that he was constantly in and out of
the hospital and when at home was under the
care of three special nurses. Two different
medical consultants advised operation for a
tumor of the islets of Langerhans, with the
recommendation that if no tumor were found,
half or more of the pancreas should be resected.
On medical treatment with a diet of moderate
carbohydrate, high fat content, the patient re-
sponded perfectly, all the symptoms subsided
and two years later he is entirely well, normal
in every way.
BIBLIOGRAPHY
1. John, H. J. : Hyperinsulinism. O. S. M. J., Vol. 21,
Feb., 1925.
2. John, H J. : Hyperinsulinism : Report of a Case.
J. A. M. A., 83 :729, 1924.
3. John, H. J. : A Case of Hyperinsulinism Treated with
Insulin: Preliminary Report. Endocrinology, 17:583, 1933.
4. John, H. J. : Hyperinsulinism. Med. Clin. North
America, January, 1934.
5. John, H. J. : Further Observations on the Treatment
of Hyperinsulinism with Insulin. Endocrinology, 19 :689,
1935.
An American Experience
During my tour of the United States, I went
into one large department and was shown
the latest and most expensive equipment operated
in conjunction with a photo-electric cell, the
latter replacing the brain of the technician.
The films were processed in an automatic develop-
ing unit, from which they issued as a .finished
product. I asked to be shown the next unit,
and in reply to the question, “What is that?”
was given the answer. “The machine for turning
out the reports.” “Take a seat and wait a few
minutes,” I was instructed; “I think we can
show you that.” A junior member of the staff
appeared a few minutes later, took out a stamp-
ing machine from a cupboard, and began to
stamp a large pack of reports. One of these
was handed to me with the remark, “Does that
satisfy you?” The report sheet with the name
of the patient had been stamped with the re-
port “Normal” and the radiologist’s signature.
On inquiry I was told that about 80-90 per cent
of the reports were of this nature. I said,
“Now, this is interesting for I have just come
from San Francisco, where the President of the
North American Radiological Society gave an
address in which he said that three of the lead-
ing radiologists of America had examined a
large series of radiographs and their reports
showed a difference of opinion amounting to
something like 30 per cent.” I asked whether
it would not be better simply to stamp all the
reports “Normal,” for then we should have a
discrepancy of only between 10 and 20 per cent;
or would it not be advisable to avoid radiology
entirely owing to its expense: probably the
best thing would be for clinicians to use radiology
intelligently and thus cut down hospital ex-
penses and treatment of the patient. — James F.
Brailsford, M. D., British Medical Journal, No.
4630, October 1, 1949.
44 8
The Ohio State Medical Journal
New Modified Protamine Zinc Insulin (NPH-50)
THOMAS P. SHARKEY, M. D., and HARRY E. KING, M. D.
The Authors
• Dr. Sharkey, Dayton, Ohio, is a graduate
of University of Cincinnati College of Medi-
cine, 1930; life member. Am. College of Phy-
sicians; member, Council of the Am. Dia-
betes Assn., Am. Soc. for Advancement of
Science; consultant in metabolic diseases,
Miami Valley Hospital; consultant, Dayton
State Hospital; and asst. prof, of clinical
medicine, College of Medicine, Ohio State
University.
• Dr. King, Dayton, Ohio’ is a graduate of
Western Reserve University School of Medi-
cine, 1936; associate of American College of
Physicians; member, American Diabetes
Assn.; and member of staff, internal medicine,
Miami Valley Hospital, Dayton.
WHEN protamine zinc insulin was in-
troduced in 1937 it marked an impor-
tant advance in the treatment of dia-
betes. It eliminated the necessity for multiple
injections of insulin, afforded better control in
most cases, improved the general health of the
patient and caused almost complete disappearance
of retardation of growth and hepatomegaly.1
Protamine zinc insulin, however, had certain
deficiencies. In most children and in patients
with severe diabetes, it did not control the
glycosuria and hyperglycemia throughout the
day, especially after meals. The use of protamine
zinc insulin is not without potential hazards be-
cause of the insidiousness of the onset of hypo-
glycemia. When soluble insulin was added to
protamine zinc insulin in the production of an
insulin mixture, larger doses of soluble insulin
than protamine zinc insulin were necessary be-
cause of the excess of protamine in protamine
zinc insulin. While good diabetic control could
be maintained in many patients on such mixtures,
premixed solutions are not stable for any length
of time2 and the resultant difficulties arising
from the mixing of the insulins cannot be
mastered by all patients.
During the past few years modified forms
of protamine insulin have been studied. Mac-
Bryde3 reported good results with the use of
such an insulin prepared by Eli Lilly and Com-
pany, and which is designated “NP-50.”
Krayenbuhl and Rosenberg,4 in Hagedorn’s
laboratory, developed the method of preparing
crystals of protamine zinc insulin. This new
modified insulin has been prepared by Eli Lilly
and Company as previously reported by Peck.2
This new modified protamine insulin has been
designated “NPH-50.” “N” refers to the neutral
reaction (pH 7.2), “P” to protamine, “H” to
Hagedorn and “50” to the amount of protamine.
The amount of zinc is relatively small. As now
prepared the amount of protamine used per 100
units of NPH-50 insulin is 0.50 mg. The prep-
aration of protamine zinc insulin now being
marketed contains 1.25 mg. of protamine in 100
units of insulin.
Through the courtesy of Dr. F. B. Peck of Eli
Lilly and Company, we have had an opportunity
to study the action of this new insulin for the
past 18 months. To date we have used this
insulin on 28 patients. The ages varied from
6 to 73 years, wdth a mean of 48.2 years. The
duration of diabetes varied from 0.1 years to 21.1
years with a mean of 6.9 years.
All patients were considered to have severe
Submitted December 20, 1949.
or labile diabetes as manifested by excessive
hyperglycemia and glycosuria, or by frequent
severe hypoglycemic reactions. (All had pre-
viously been regulated in the hospital on other
types of insulin.) These same patients were
again regulated in the hospital with NPH-50
insulin and have since been followed at frequent
intervals in the office. The diet was a fixed weighed
diet averaging 178 grams of carbohydrate, 94
grams of protein and 102 grams of fat, with an
average caloric value of 2006 calories. Qualita-
tive urinalyses were performed every two hours
from 6:30 a. m. to 9:30 p. m. The 24-hour speci-
men of urine was measured and a quantitative
sugar determination together with acetone and
diacetic acid levels were computed daily. The
daily quantitative amount of glycosuria was
also computed. Frequent blood sugar determina-
tions, both venous and capillary, were done
throughout the day and occasionally at night.
Upon returning to the office, the patients pre-
sented a record of four urine tests daily for
the first week out of the hospital and in some
cases for a longer period of time. Following this
a daily staggered urinalysis was recorded, as well
as the time of any hypoglycemic reactions. A
true blood sugar determination by the Somogyi-
Nelson method and a urinalysis was always made
during each office visit.
GENERAL ACTION
As can be seen by Chart I, the action of
NPH-50 insulin extends through 24 hours. It is
an advantage that NPH-50 insulin does not
have the marked overlap of action characteristic
for May, 1950
449
yC OsfuRU <r*
7fyry
PM.
7 yff.
/»»*//*
* f V. CZ9
trv rz^
At.* 7ii/ bRM t»
of protamine zinc insulin. It begins to exert its
effect much sooner than protamine zinc insulin
and the effect of NPH-50 insulin on the blood
sugar can be noted within 2 to 4 hours after
it is injected. Its maximum effect appears to
occur from 12 to 24 hours after injection but a
distinct hypoglycemic effect can be discerned
in 6 to 8 hours after it is given. The weakest
point of action of NPH-50 insulin is within the
first four hours after injection, namely, from
the period following breakfast until noon.
Of the 28 patients, 16 were controlled follow-
ing a single dose of NPH-50 insulin. The aver-
age daily dose of NPH-50 insulin was 25 units.
Of the 16 patients eight had previously taken
an average of 12 units of crystalline zinc
insulin and an average of 13 units of protamine
zinc insulin by separate injections before break-
fast, or a total average of 25 units of the two
kinds of insulin daily. For these eight patients
the average dose of NPH-50 insulin was 26
units. Of the other eight patients controlled by
a single dose of NPH-50 insulin, one had pre-
viously taken protamine zinc insulin, while two
had taken multiple doses of crystalline zinc in-
sulin, and five had not taken any insulin pre-
viously. The control of the diabetes was better
and there were fewer reactions when NPH-50
insulin was employed than on their previous
insulin program.
As with protamine zinc insulin all patients
cannot be regulated by a single dose of NPH-50
insulin. The action of NPH-50 insulin closely
simulates the action of mixed protamine zinc
insulin and crystalline zinc insulin except for
a lag-period from breakfast until noon when
NPH-50 insulin is used. Some patients who
reveal excessive hyperglycemia and glycosuria
particularly during this period may require ac-
cessory crystalline zinc insulin or regular in-
sulin. One distinct advantage of NPH-50 insulin
over protamine zinc insulin is that since there
is a smaller amount of protamine in NPH-50
insulin, less regular or crystalline insulin is
adsorbed when the two are mixed.
REGULAR OR CRYSTALLINE ZINC INSULIN ADDED
In those patients showing excessive hyper-
glycemia and glycosuria before noon, regular or
crystalline zinc insulin can be added to NPH-50
insulin in sufficient amounts to prevent such
excesses. We found in our group of patients
that 12 could not be controlled by NPH-50 in-
sulin alone but required the addition of crystal-
line zinc insulin. Of these 12 patients, six had
previously taken an average of 9 units of
crystalline zinc insulin and 13 units of protamine
zinc insulin given separately. They were con-
trolled on a mixture of crystalline zinc insulin
averaging 12 units and NPH-50 insulin averag-
ing 21 units. The other six patients had not
taken insulin previously and were controlled on
an average of 11 units of crystalline zinc in-
sulin and 13 units of NPH-50 insulin given in
a single injection. During the past 18 months
we have found it much simpler to adjust any
450
The Ohio State Aledical Journal
changes in the insulin mixture of crystalline
zinc insulin and NPH-50 insulin than was the
case with the mixture of crystalline zinc insulin
and protamine zinc insulin. In the former mix-
ture the crystalline zinc insulin dosage has varied
to control the period from breakfast until noon,
and sufficient NPH-50 insulin was given to con-
trol the rest of the day and night. During in-
fections and other complications the mixture of
crystalline zinc insulin and NPH-50 insulin was
more easily varied.
REACTIONS
The reactions to NPH-50 insulin are not so
insidious as are those which occur with protamine
zinc insulin. When using NPH-50 insulin reac-
tions occur most frequently in the afternoon and
early morning hours. These reactions can be
largely prevented by giving a mid-afternoon feed-
ing and a bedtime feeding.
A mid-afternoon feeding of 100 to 150 grams
of orange or its equivalent should be given
because of the tendency for NPH-50 insulin to
produce hypoglycemia at this time. A bedtime
feeding should always be given to avoid hypogly-
cemia through the night. When taking NPH-50
insulin it may be necessary to give from
20 to 40 grams of carbohydrate combined with
protein at the bedtime feeding to offset nocturnal
hypoglycemia.
When compared to the reactions of protamine
zinc insulin, those due to NPH-50 insulin are
not so severe or so prolonged. In our experi-
ence less carbohydrate has been necessary to
alleviate the reactions due to NPH-50 insulin
than is required to overcome those due to pro-
tamine zinc insulin.
Contrary to the observations of other authors
we have not been able to control the great
majority of our patients with a single dose of
NPH-50 insulin. This may be due in part to
our selection of patients. Mild diabetic pa-
tients may be controlled by a single dosage of al-
most any kind of insulin and an evaluation
limited to such a group of patients would be
futile.
In our experience with some individuals the
dosage of NPH-50 insulin was greater than the
amount of insulin that they had taken previously.
The better control of the diabetes and more uni-
form absorption of the NPH-50 insulin com-
pensated for this fact however.
THE DIET
At times it is necessary to redistribute the
carbohydrate of the diet of patients employing
NPH-50 insulin because of the relatively slower
absorption of NPH-50 insulin between breakfast
time and noontime. It may be necessary to
reduce the carbohydrate of the breakfast meal,
or to transfer some of the carbohydrate to an-
other meal. Variations in diet and exercise exert
the same effect with NPH-50 insulin as with other
insulins.
SUMMARY AND CONCLUSIONS
1. During the past eighteen months we have
studied the effect of NPH-50 insulin on 28 dia-
betic patients both in the hospital and in office
practice.
2. While NPH-50 insulin is not yet the ideal
insulin, since it will not control all diabetic
patients without the use of accessory insulins,
it does appear to afford better control than pro-
tamine zinc insulin.
3. The absorption of NPH-50 insulin when
used alone is relatively slow between breakfast
and noontime, reaches its maximum effect in
the afternoon and night and lasts through twenty-
four hours.
4. In our series of patients, NPH-50 insulin
controlled satisfactorily 16 patients wffien used
alone. It was necessary to add crystalline zinc
insulin in 12 cases.
5. The control of the diabetic state was bet-
ter when NPH-50 insulin was used alone or
mixed with crystalline zinc insulin than had been
noted previously when crystalline zinc insulin
and protamine zinc insulin were used.
6. Insulin reactions to NPH-50 insulin or
to the mixture of crystalline zinc insulin and
NPH-50 insulin were not so severe or so pro-
longed as those noted with the same patients
who had used crystalline zinc insulin and pro-
tamine zinc insulin previously.
7. A mid-afternoon feeding and a bedtime
feeding should be given to patients taking
NPH-50 insulin. Only occasionally is it necessary
to give a mid-morning feeding to patients taking
mixtures of crystalline zinic insulin and NPH-50
insulin.
8. It is often necessary to redistribute the
carbohydrate of the diet in patients taking
NPH-50 insulin.
9. It is easier to adjust the dosages of mix-
tures of crystalline zinc insulin and NPH-50
insulin than it is to regulate the dosages of
mixtures of crystalline zinc insulin and protamine
zinc insulin. This is a valuable asset when in-
fections or other complications occur.
BIBLIOGRAPHY
1. Gabriele, A. J., and Marble, A.: Clinical Experience
with a New Modified Protamine Insulin (NPH-50). Ameri-
can J. Digestive Diseases, 16:197-206, 1949.
2. Peck, F. B. : Insulin Mixtures and Modifications, Proc.
American Diabetes Assn., 6:275-300, 1946.
3. (a) MacBryde, Cyril M., and Roberts, Harold K. : A
New Modified Protamine Zinc Insulin : Comparison with
Histone Zinc Insulin, Clear and Standard Protamine Zinc
Insulin, J. Clinical Investigation, 22 :791-797, 1943.
(b) Ibem : Modified Protamine Zinc Insulin: Improve-
ment on Standard Protamine Zinc Insulin, Comparative
Studies on 62 Diabetic Patients. J. A. M. A., 122:1225-1231,
1943.
4. Krayenbuhl, C., and Rosenberg, T. : Crystalline Pro-
tamine Insulin. Rep. Steno. Memorial Hospital, 1 :60-73,
1946.
for May, 1950
451
A Summer Camp for Diabetic Children
E. PERRY McCULLAGH, M. D., PHILIP W. RUSSELL, M. D., and R. E. SCHNECKLOTH, M. D.*
The Authors
• Dr. McCullagh, Cleveland, Ohio, is a grad-
uate of the University of Manitoba Faculty of
Medicine, 1924; diplomate, American Board
of Internal Medicine; member, American Dia-
betes Association, American Goiter Associa-
tion, Central Society of Clinical Research,
American Association for Study of Internal
Secretions, American Federation for Clinical
Research, American College of Physicians;
Head of Section of Endocrinology and Metab-
olism, Cleveland Clinic.
• Dr. Russell, Cleveland, Ohio, is a grad-
uate of the University of Kansas School of
Medicine, 1944; fellow of Internal Medicine,
Cleveland Clinic Foundation, Cleveland.
• Dr. Schneckloth, Cleveland, Ohio, is a
graduate of the University of Nebraska School
of Medicine, 1945; fellow of Internal Medicine,
Cleveland Clinic Foundation, Cleveland.
THE management of diabetes mellitus in
children at home is frequently a confusing
and discouraging problem for the child and
Ms parents. A summer camp alleviates this
problem, and provides an ideal situation for the
regulation of diabetes. Careful medical direction
of the normally active child at camp enables a
more accurate adjustment of insulin and diet
than can be accomplished at home or in the
'hospital. The diabetic child also profits from
the recreational advantages of an outdoor life,
which might otherwise be denied. The oppor-
tunity to form friendships with other diabetic
children promotes the growth of a mature ac-
ceptance of his disease. In addition, his parents
are permitted a well-deserved and often ex-
pressed, relief from their medical responsibility.
In 1929, Dr. Henry J. John established Camp
Ho Mita Koda on a 40-acre wooded tract, 30
miles east of Cleveland, near Newbury, Ohio.
The camp is incorporated as a nonprofit organiza-
tion, and is supported in part by interested or-
ganizations. Accommodations are available for
60 children, who may spend one to two months
in camp.
Campers are assigned to one of six screened
cabins, accommodating 10 children according to
age and sex. The cabins are arranged on either
side of a landscaped plot, within 50 yards of the
central lodge. This contains the “Great Hall,”
the center for indoor activities, as well as a
library, kitchen, dining hall, laboratory, and
infirmary. The recreational area provides a
swimming pool, craft shop, baseball diamond,
tennis court, volleyball court, archery range, out-
door theater, and several camping sites. Com-
plete electrical and sanitary facilities are avail-
able.
The nonmedical personnel includes the camp
director, seven counselors, two cooks, and the
maintenance staff. The medical staff consists
of a medical director who visits the camp
daily, a resident camp physician, two reg-
istered nurses, and two dietitians. The in-
firmary is completely equipped for medical and
minor surgical emergencies. Seriously ill pa-
tients are transferred immediately to a hospital
in Cleveland.
During the summer of 1949, 58 children, 28
boys and 30 girls, were at camp. Their ages
ranged from 5 to 16 years. Forty-six children
stayed four weeks, while 10 remained for both
camp sessions. Two children departed after two
weeks because of homesickness.
The daily medical program began with “in-
* The authors were medical director and resident physi-
cians of Camp Ho Mita Koda, respectively.
sulin parade” at 7:30 a. m., when insulin was ad-
ministered by the nurses. Urine specimens were
examined for sugar and acetone before breakfast,
supper, and bedtime. Fasting and preprandial
blood specimens were drawn when necessary.
Close supervision by camp counselors enabled
prompt treatment of daytime insulin reactions.
Visits to each child’s bedside by a nurse or the
physician at midnight, 3 a. m., and 6 a. m.,
minimized the threat of night insulin reactions.
The recreational program offered a daily choice
of activities to each child. The regulation of the
child’s diabetes altered to some degree the final
selection of his daily activities. Group participa-
tion under constant counselor supervision pro-
vided the means for modifying somewhat the
amount of each child’s exercise.
CLINICAL EXPERIENCE AT CAMP
Hyperglycemia. The modified Myer-Bailey
method was used to determine venous blood
sugar levels. Approximately 25 determinations
were made daily by the camp physician. Pre-
prandial blood specimens were obtained when
necessary for control. Individual campers
sustained 3 to 33 venipunctures during their
camp stay; an average of 11 venipunctures per
camper were performed during the camp period.
During the first three days of camp, 35 chil-
dren had fasting blood sugar levels above 200
mg. per cent. The average highest blood sugar
level during this period was 267 mg. per cent.
452
The Ohio State Medical Journal
Five children entered camp with fasting levels
exceeding 500 mg. per cent. The average of
the highest level during each child’s last week
in camp was 195 mg. per cent.
Urine tests. “Clinitest” tablets were used for
qualitative estimation of urine sugar on speci-
mens collected before breakfast, supper, and
bedtime. Additional noon specimens were ob-
tained from children requiring closer control.
The Rothera method for acetone was performed
on all specimens. Acetonuria was present during
the first three days in 24 campers, while 11 gave
isolated positive tests for acetone at some time
during the remainder of their camp stay. Urin-
alyses on all children revealed no evidence of
albuminuria.
INSULIN
The average insulin doses on admission and
discharge are tabulated below (Table I). Insulin
TABLE I
a
o <D
S3 S3
•g a
I S
to
U
o3
qj
£
oc
O V
••g-S
03 o
si
QQ
INSULIN (Total units)
S
<3
V
M
cS
JS
w
5-6.9
3
2.8
19
25
7-8.9
10
3.2
26
35
9-10.9
11
3.4
29
39
11-12.9
14
4.4
33
46
13-14.9
16
4.2
55
60
15-16.9
4
5.9
53
55
requirements of many younger children were in-
creased at camp despite their increased exercise.
This change reflects improved control of their
diabetes. It is possible that camp observation
offered an opportunity to establish the increase
in insulin requirements that ordinarily occurs
with growth of the child.
All but two children had been treated at home
with protamine zinc and regular insulin; these
exceptions had received globin and regular in-
sulin. At camp it became apparent that a single
injection of mixed protamine zinc and regular
insulin before breakfast was most effective, and
41 children received this regimen. Thirteen chil-
dren received protamine zinc and regular insulin
by separate injections before breakfast, and four
got protamine zinc insulin alone.
The medical aim at camp was to maintain
normal fasting blood sugar levels without in-
ducing insulin reactions. Satisfactory control
consisted of fasting levels of 80 to 160 mg. per
cent, and was achieved in 26 children during
their last week in camp. Urine specimens show-
ing a blue or green test throughout the day were
considered satisfactory, and the average number
of yellow, orange, or red urine tests among the
last 20 urine specimens of each child was seven.
Determination of the optimal dose of protamine
zinc and regular insulin to be given before
breakfast was achieved by altering the amount
of regular insulin to control afternoon glycosuria,
and the amount of protamine zinc to control
fasting hyperglycemia. The insulin dose was
manipulated cautiously, for many children were
sensitive to an increase of only two to four in-
sulin units. Whenever a sustained increase in
glycosuria was observed in a child, an additional
two to five units of regular insulin was given
to him before each meal, at the time when a
yellow, orange, or red urine test was obtained.
These children provided an extra urine specimen
before lunch, and continued to receive additional
preprandial insulin until better control was estab-
lished. Thirty-six children were controlled in
this manner during short periods of their camp
stay, as they exhibited the \vide fluctuations
characteristic of juvenile diabetes.
Six months after camp, response from 45 chil-
dren indicates that 21 children are still receiving
the same total dose of insulin prescribed at
camp. Eleven children whose insulin was increased
at camp are receiving even higher doses. The
insulin doses of 13 children have returned to
that prescribed before camp. Although camp
diets increased the daily available glucose of
28 children by an average of 48 Gm., the
present diets cannot be evaluated. The above
data suggest that the anticipated yearly in-
crease in insulin doses of growing children can
be effectively established during a summer camp
season.
DIETS
There was great variation in diets that had
been prescribed before camp. Seventeen children
had been receiving unrestricted diets. Many
children, who had received calculated diets at
home, admitted that extra food was frequently
consumed, at times surreptitiously but often
with the tacit approval of their parents. It was
not unusual to find food and candy in packages
sent to children from home.
Past experience at camp had shown the im-
practicability of serving diets separately cal-
culated for each child. One of five camp diets
was selected for each child, approaching as nearly
as possible his basal requirement plus 50 to
100 per cent for activity. The percentage of
available glucose present in the home diet was
a minor factor in the selection of the camp diet,
inasmuch as there was a wide range of calories
per kilogram in the home diets of every age
group.
Sample trays of each diet were carefully
weighed at every meal. Duplicate trays were
closely approximated. The caloric value of un-
eaten food was replaced by bread or graham
crackers; ice cream, soft drinks, nuts, popcorn,
and candies were given on special occasions and
calculated into the diet.
Interval feedings consisting of milk and
graham crackers were given at 3 p. m. and
for May, 1950
4 53
bedtime. An additional 10 Gm. of carbohydrate,
in the form of graham crackers, was given to
those campers who showed blue or green urine
tests at bedtime. This procedure significantly
lowered the number of insulin reactions at night,
which had been a primary problem during camp
sessions in previous years.
In order to satisfy the energy and appetite re-
quirements, from an increase in physical activity,
the caloric intake and bulk of food was often
augmented early in the camp stay. On discharge
the total caloric content of diets ranged from
1999 to 3390, or 40 to 60 calories per kilogram.
The amount of protein ranged from 87 to 131 Gm.,
and approached 3 Gm. per kilogram. Carbohy-
drate to fat ratios varied from 1.75:1 to 2:1,
and the total amount of carbohydrate ranged
from 180 to 325 Gm.
Insulin reactions. The management of insulin
reactions was a major problem at camp. In
those children with labile diabetes, the preven-
tion of reactions was discouraging. The effect
of physical activity on such campers made stable
control extremely difficult. Many mild reactions
during play were quickly treated with oral
glucose by an alert counselor. A total of 172
moderately severe reactions were recorded dur-
ing the two-month camp period. Four reactions
required intravenous glucose, and one responded
to an injection of epinephrine. Nineteen reac-
tions occurred at night or before breakfast, but
only two of these required intravenous glucose.
The recognition of sham reactions was oc-
casionally a source of confusion. The absence
of hypoglycemia in blood specimens obtained
at such times quickly clarified this issue.
PHYSICAL FINDINGS
Upon examining all campers on admission,
one boy was found to have hepatomegaly, prob-
ably caused by fatty infiltration of the liver.
Three children entered camp with symptoms and
laboratory findings indicating diabetic ketosis;
these were controlled adequately during the first
week. One boy who was convalescing from
trichinosis had hepatomegaly and splenomegaly.
Funduscopic examinations of all campers by Dr.
Roscoe J. Kennedy revealed two pinpoint retinal
hemorrhages in a 13-year old boy who had had
diabetes for 11 years. No other campers had
evidence of diabetic retinopathy.
The admission and discharge height and weight
of each child were plotted graphically on a
Wetzel grid. This procedure indicates which
Grid channel of growth the child is following,
and permits early recognition of deviations from
normal growth and development during succeed-
ing years. The distribution of campers between
the obese channel A4 and the underweight chan-
nel B4 is tabulated in Table II. The growth
channels of 14 children were changed while at
camp. Six of these children were below their
estimated ideal weights, and gained an average
of 6 lbs. to attain a more satisfactory channel.
Two children above their ideal weights lost an av-
erage of 4.5 lbs. shifting to their proper channels.
Six children who were initially above their ideal
TABLE II
Admission
Grid
Channel
Number Campers
Sh £
■2 a
1 £
Zo
Toward Ideal
(wt. gain) gj
rf
5'
iq
O
3"
Toward Ideal
(Wt. loss) 3
5T
Away from Ideal
(wt. gain)
A4
5
A3
1
1
A2
5
i
A1
12
1
2
M
11
1*
3
B1
12
B2
10
4**
B3
1
1
B4
1
Total
58
6
2
6
* Shift of 2 growth channels
** Two children shifted 2 channels
All other shifts were one channel only.
weights continued to gain at camp. The boy who
was convalescing from trichinosis remained in
channel B4.
CAMP ADJUSTMENT
The majority of campers made an excellent
camp adjustment, although for many it was
their first experience away from home. Diabetic
routine was often accepted with less resent-
ment at camp than at home. The adolescent
children were more apt to break their diets
and to reject the diabetic routine than were the
younger children. Psychometric studies were
made at camp when indicated, and were an
aid in establishing better rapport with those
campers. One child showed bizarre psychopathic
behavior with complete rejection of diabetic
control.
SUMMARY
A short description is given of a summer camp
for diabetic children in Ohio, outlining its facil-
ities and the methods of management used during
the 1949 season.
Clinical experience is considered briefly, in-
cluding remarks about the blood sugar tests,
the type of insulin therapy used, and the readjust-
ment of insulin doses and diets.
The complications of diabetes which were en-
countered included insulin reactions, ketosis,
hepatomegaly, and in one child early diabetic
retinopathy.
Follow-up studies indicate that insulin re-
adjustments made at camp are valuable for many
subsequent months.
It is evident that summer camping experience
is of psychologic and therapeutic benefit to the
diabetic child.
454
The Ohio State Medical Journal
The Control and Treatment of Brucellosis
JOHN A. PRIOR, M. D.
A WIDESPREAD infection involving both
man and animals, brucellosis is one of the
major public health problems in the United
States. It is of growing importance, more cases
being reported in 1948 than ever before.* 1
Morbidity and mortality statistics in man rep-
resent only the reported cases of this disease and
for each known case there are undoubtedly others
that fail to reach the attention of health of-
ficials. Also, brucellosis represents a major
health problem in livestock, and is estimated to
cost the cattle industry alone almost $100,000,000
each year.2
An understanding of the bacteriology and
epidemiology of brucellosis is essential to a full
appreciation of the problem of diagnosis, treat-
ment and control. The causative agent is the
Brucella bacillus of which there are three prin-
cipal strains : B. abortus, B. suis and B. meli-
tensis. 3 * *’ 5 None of the strains is confined to
a single species; thus, differentiation of strains
on basis of host involved is not possible.
SOURCE AND MODE OF SPREAD
B. abortus has its principal reservoir in cattle
and has replaced tuberculosis as the most serious
problem with which the cattle industry has to
contend. Most frequently involving the cow, it
causes no particular clinical symptoms, but may
result in abortion, sterility and diminished milk
supply without evident mastitis. Large numbers
of organisms may be found in the uterus, em-
bryonic membranes and milk. Occasionally, bulls
may be infected, resulting in sterility or a source
of infection for the cows served. From contact
with the fetus, placenta and membranes or by
consumption of infected raw milk, the disease
spreads to man. Since it is not highly invasive
for man, B. abortus usually causes only sporadic
cases. However, the first epidemic due to this
organism has been reported recently.6 Although
B. abortus tends to cause the most benign form
of the disease, it is the most common, and at
times, may cause serious illness with some
fatalities.
The natural reservoir of B. suis is in swine
and is found most frequently in the middle west.
Although abortion in sows may result, usually
B. suis infection causes persistent localized
lesions, e. g., in skeletal system and in testes.
B. suis is more invasive for man than B. abortus
and in this country results in a relatively severe
form of the disease. It spreads to man by hand-
ling infected tissues or fluids of pigs or by in-
fection of cattle from whom man contracts the
disease.
Presented before the Section on Public Health at the
Annual Meeting of the Ohio State Medical Association,
April 20, 1949, Columbus, Ohio.
The Author
O Dr. Prior, Columbus, Ohio, is a graduate
of Ohio State University College of Medicine
1938; diplomate, American Board of Internal
Medicine; consultant to Tuberculosis Control
Division, United States Public Health Service
and to Communicable Disease Section, Ohio
Department of Health; member, American
Trudeau Society, American Federation for
Clinical Research and American College of
Physicians; director, Contagious Disease Sec-
tion, University Hospital; and Associate Pro-
fessor of Medicine, Ohio State University.
B. melitensis has its natural reservoir in goats
and sheep. Because the disease localizes in the
udder, the animal otherwise remaining healthy,
the principal mode of spread is by consumption
of infected milk or milk products. Occasionally
the disease may spread to cattle and swine.
B. melitensis is very highly invasive for man and
tends to cause a particularly severe illness.
Thus, man contracts brucellosis in three ways:
(1) By consumption of infected raw milk or milk
products; (2) by contact of skin with tissues,
secretions and excretions of animals with brucel-
losis; and (3) occasionally laboratory workers
may contract the disease in the course of their
work. There is no known transmission from
man to man.
AN OCCUPATIONAL DISEASE
Brucellosis is definitely a rural disease. It is
estimated that more than 80 per cent of all pa-
tients develop the disease incident to their oc-
cupation as farmer, dairy worker, veterinarian
and packing house worker. In a study of 1,564
cases in Iowa conducted7 over a seven-year period,
Jordan demonstrated that contact with infected
animals is certainly the most important source
of the disease. His figures show the incidence
to be as follows : Farmers with animal contact, 17
per 100,000 population; packing house workers,
131.1; farmers’ wives, 0.7; and city residents, 0.8.
Because of the lack of definitive or pathog-
nomonic signs or symptoms, the possibility of
brucellosis must be considered in all acute or
chronic febrile illnesses. Weakness, sweating,
chilliness, fever, anorexia and loss of weight
are commonly present.8 Generalized aching,
headache, joint and back aches, insomnia and
nervousness are less frequent manifestations.
Cough, abdominal pain, constipation, rash and
splenomegaly occasionally may be present. Thus,
it will be seen that brucellosis is characterized by
for May, 1950
455
a multiplicity of non-specific subjective com-
plaints and by the absence of diagnostic physical
findings.
The classic picture of bouts of undulating fever
seldom is seen in this country. Usually, the
onset is acute lasting several weeks to even
several months. There may be gradual subsidence
into complete recovery in some instances. More
often the acute phase is followed by low grade
chronic disease in which the patient will have
recurrent bouts of fever every few weeks or
months, although eventually the disease will burn
itself out. A number of patients with chronic
brucellosis never have had an acute phase.
Even though there may be history of exposure
and signs and symptoms that suggest brucellosis,
it is usually necessary to fall back on the labor-
atory for more conclusive evidence of its
presence.
DIAGNOSTIC AIDS
Of all the laboratory procedures used in the
study of brucellosis, blood cultures are the most
valuable. It is only by culture of the causative
Brucella organisms that the diagnosis can be
-established indisputably. It is well known that
In some cases the Brucellae cannot be recovered
even on repeated cultures. However, at least
several attempts always should be made. Be-
cause growth on primary culture is difficult to
obtain, every precaution should be taken to assure
success. Generally, an enriched tryptose media
works well and a portion of each blood specimen
must be incubated at 10 per cent C02 tension
since B. abortus will not grow on primary culture
at* normal atmospheric tensions. The three
species of Brucellae can be differentiated only
by: (1) dye tolerance, (2) sulfide production,
(3) carbon dioxide requirements, and (4) ele-
mentary chemical analysis. Cultures should never
be discarded as negative until observed for at
least six weeks as these organisms are slow to
grow. Our inability to readily isolate Brucellae
in chronic brucellosis remains our greatest handi-
cap in the study of this phase of the disease.
By the end of the second week of disease, ag-
glutinins will appear in significant titer in the
blood of more than 90 per cent of the patients.3
The agglutination test is usually reliable if
proper antigen and careful technique are used.
A titer of 1:100 or above generally is con-
sidered of diagnostic significance. A significant
titer often will be present if the patient has any
fever and will be present in almost every patient
in whom blood cultures are positive. Although
frequent statements are made that agglutinins
are commonly absent in chronic brucellosis, they
are more apt to be present in significant titer
if the patient has any elevation of temperature
above normal. It is not possible to differentiate
the three strains of Brucellae by means of ag-
glutination tests.
In addition the presence of serum agglutinins
may not be necessarily specific for Brucellae since
significant titers may develop as result of infec-
tion with B. tularense 9 and following cholera vac-
cine.10
The opsonocytophagic index which is designed
to measure the ability of the polymorphonuclear
leukocytes to phagocytize Brucellae has been sub-
jected to extensive clinical evaluation. However,
opinions are still divided as to its usefulness.
Active phagocytosis in 60 per cent or more of the
white blood cells is considered by Huddleson4 to
indicate immunity while in the non-immune or
the active case, little or no phagocytosis is
present. Huddleson believes that it is a valuable
diagnostic procedure and has worked out a
rather extensive correlation of this test with the
skin test. However, Spink,11 Simpson,12 Car-
penter13 and Dowling14 feel that it is not reliable.
Since skin sensitivity develops soon after in-
fection, the skin test has been widely used
and misused as a diagnostic procedure. Brucel-
lergen, which is a nucleo-protein derivation from
Brucella organisms, has been used rather ex-
tensively as a skin test antigen. One tenth cc.
of 1:2000 dilution is injected intradermally and
is interpreted after forty-eight hours in the
same manner as the tuberculin test. Definitely
more specific are the heat killed vaccines.15
One-tenth cc. of full strength vaccine is injected
intradermally and interpreted after ninety-six
hours. However, all skin test antigens may cause
considerable local reaction and not infrequently
after injection of such material, the patient’s
symptoms may be accentuated. In addition, skin
tests may cause the presence of, or an increase
in, agglutinin titers. It cannot be emphasized
too strongly that positive brucellergen or vaccine
skin tests mean nothing more than does a posi-
tive tuberculin test. A positive skin reaction
means only that at some time the patient has
been infected with Brucella organisms and tells
absolutely nothing about the presence or absence
of active or latent disease. In addition, a
violently positive reaction means nothing more
than does a weakly positive reaction except that
in one the patient is much more sensitive than
in the other. Far too many people with a few
vague symptoms and a positive skin test are
diagnosed and treated as having chronic brucel-
losis. Spink11 states that “the skin test is the
most abused procedure in the diagnosis of brucel-
losis.”
Recent work suggests that the bactericidin
test may develop into a valuable diagnostic tool.
However, its full significance has not yet been
determined.
Usually the blood count will reveal a normal
or reduced number of leukocytes with a relative
lymphocytosis.
TREATMENT
The treatment of brucellosis has presented a
serious challenge to medical science for many
456
The Ohio State Medical Journal
years. In 1936 Carpenter and Boak16 reviewed
the treatment of this disease and concluded that
a successful method of treatment remained to
be developed. Then, it was found that some
patients with acute brucellosis responded favor-
ably to sulfonamide compounds.
Combined streptomycin and sulfadiazine ther-
apy later was found to be superior to the sul-
fonamides alone. In recent months the use of
aureomycin in the treatment of acute brucel-
losis has been reported. The results have been
very encouraging1, in some instances truly
dramatic, bringing the high fever of acute
brucellosis within normal limits in two to three
days,17 including that due to the more malignant
B. melitensis 18 that had responded only occasion-
ally to combined streptomycin and sulfadiazine
treatment. Spink19 now suggests the use of 0.5
gram four times a day for 10 to 14 days. Toxic
reactions are mild and seldom necessitate dis-
continuing administration of this dosage. Aure-
omycin appears to be definitely superior to any
previous therapy and available evidence would
indicate that this splendid new antibiotic is
the current treatment of choice in acute brucel-
losis. In the event of relapse, a repeat course
of aureomycin is usually effective. However,
further study is needed to fully evaluate aure-
omycin. Heilman20 has reported recently that
the spleens of mice infected with Brucella, after
treatment with aureomycin, still contained great
numbers of organisms. Woodward21 reported
that Chloromycetin appeared to be equally as
effective as aureomycin in the treatment of acute
brucellosis.
TREATMENT IN CHRONIC BRUCELLOSIS
UNSATISFACTORY
The problem of treatment in chronic brucel-
losis still remains. Brucellin, a filtrate of pooled
cultures of the three strains of Brucella, has been
widely used in its therapy. Heat-killed or oxidized
vaccines have their advocates. All are designed
to stimulate antibody formation and as a result
overcome the chronic disease as well as to de-
crease the hypersensitivity. There is consider-
able doubt that such measures achieve these de-
sired results. A more rational approach to the
problem instead would seem to be the use of
some chemotherapeutic agent that would eradicate
the disease from the body. Conclusive reports
are not yet available on the use of aureomycin
in chronic brucellosis. However, it is the hope
of all students of brucellosis that if aureomycin
does not prove effective, some other chemo-
therapeutic agent will soon solve this trouble-
some problem.
CONTROL MEASURES
Since brucellosis does not spread from man
to man, the ultimate elimination of the disease in
man is dependent upon the eradication of the
reservoir of brucellosis in domestic animals.
Every effort should be made to support the
brucellosis control campaign of the Ohio De-
partment of Health and the various veterinary
organizations. Infected cattle should be de-
stroyed where the percentage of reactors in a
herd is small. Immunization of young stock
with strain 19 of B. abortus should be encour-
aged at every opportunity. When considering the
possibility of a patient’s exposure to infected
cattle, the physician should remember that simply
because a farmer, dairy worker or livestock
producer says that his cattle have been “Bang’s
tested” does not mean that his herd is free of
brucellosis. Instead, he may have numerous in-
fected animals and is participating in a pro-
gram of vaccination of the young stock with the
gradual elimination of the older infected animals
over a period of several years. Brucellosis in
goats, quite uncommon in Ohio, is proof of the
effectiveness of a unified control campaign. How-
ever, where goats are infected, the problem is
readily solved by slaughter. In swine the prob-
lem is much more difficult and so far, little ef-
fort has been expended in the elimination of the
disease from this species. It is obvious that
any program for the elimination of the animal
reservoir of brucellosis will necessitate the
combined support of the farmers, livestock
producers, dairymen, veterinarians, meat packers
and public health officials.
Pasteurization of all milk or milk products
for human consumption will prevent effectively
the spread of brucellosis by this means. The
medical profession will do well to understand
that there are no state laws in Ohio requiring
pasteurization and that compulsory pasteuriza-
tion is accomplished on a municipal or county
basis. Stringent legislative measures and strict
enforcement are essential to the success of wide-
spread pasteurization. On the farm or small
community where pasteurized milk is not avail-
able, raw milk may now be economically pas-
teurized at home or it can be boiled.
The prevention of brucellosis in those whose
occupation necessitates frequent close contact
with domestic animals remains very difficult and
can be accomplished only by eternal vigilance
in personal hygiene. There is no safe and de-
pendable means of immunization in man. Cer-
tainly, the greatest possible protection for these
workers would be the eradication of the animal
reservoir of this disease.
CONCLUSIONS
1. The establishment of a diagnosis of brucel-
losis remains difficult and usually requires labor-
atory confirmation, the data from which must be
carefully interpreted.
2. Aureomycin is the drug of choice in the
treatment of acute brucellosis. Its value in the
for May, 1950
457
treatment of chronic brucellosis remains to be
determined.
3. Absolutely fundamental to the control of
brucellosis in man is the eradication of the res-
ervoir in domestic animals.
BIBLIOGRAPHY
1. Incidence of Disease, Public Health Reports, 63 :59,
1948.
2. Mingle, C. K. : Quoted in Spink, W. W. : Ann. Int.
Med., 29:238-258, 1948.
3. Elberg, S. : In Dubos, R. J. : Bacterial and Mycotic
Infections of Man. Lippincott, Philadelphia, 1948.
4. Huddleson, I. F. : In Hull, T. G. : Diseases Trans-
mitted From Animals to Man. C. C. Thomas, Springfield,
111., 1947.
5. Boyd, W. L. : Progress in the Control of Brucellosis
(Bang’s Disease) in Domestic Animals. Minnesota Medi-
cine, 29:681-683, 1946.
6. Steele, J. H., and Hastings, J. W., Sr.: Report of
Brucellosis Outbreak at Federalsburg, Md. Pub. Health
Rep., 63:145-146, 1948.
7. Jordan, C. F. : Proc. 46th Annual Meeting, U. S.
Livestock Sanitary Association, 137-143, 1942.
8. Hardy, A. V., Jordan, C. F. Borts, I. H., and
Hardy, G. C. : Undulant Fever with Special Reference to a
Study of Brucella Infection in Iowa. Nat. Inst. Health
Bull. 158, 1931.
9. Spink, W. W. : Pathogenesis of Human Brucellosis
With Respect to Prevention and Treatment. Ann. Int. Med.,
29:238-258, 1948.
10. Eisele, C. W., McCullough, N. B., Beal, G. A., and
Rottschefer, W. : Brucella Agglutination Tests and Vac-
cination Against Cholera. J. A. M. A., 135:983-984, 1947.
11. Spink, W. W. : Brucellosis. J. A. M. A., 139:554,
Feb. 19, 1949.
12. Simpson, W. M. : The Diagnosis and Management
of Brucellosis. Ann. Int. Med., 15 :408-430 1941
13. Carpenter, C. M. : Brucellosis. Med. Clin. North
Amer., 27:698, 1943.
14. D'owling, H. F. : The Acute Bacterial Diseases.
Saunders, Philadelphia, 293-308, 1948.
15. Harris, H. J. : Brucellosis : Advances in Diagnosis
and Treatment. J. A. M. A., 131 :1485-1493, 1946.
16. Carpenter, C. M., and Boak, R. A. : Treatment of
Human Brucellosis ; Review of Current Therapeutic Methods.
Medicine, 15:103-127, 1936.
17. Bryer, M. S., Schoenbach, E. B., Wood, R. M., and
Long, P. H. : The Treatment of Acute Brucellosis With
Aureomycin. Bull. Johns Hopkins Hospital 84:444-460,
1949.
18. Spink, W. W., Braude, A. I., Castaneda, M. R., and
Goytia, R. S. : Aureomycin Therapy in Human Brucellosis
Due to Brucella Melitensis. J. A. M. A., 138 :1145-1148, 1948.
19. Spink, W. W. : Personal Communication.
20. Heilman F. R. : The Effect of Combined Treatment
of Aureomycin and Dihydrostreptomycin on Brucella In-
fections in Mice. Proc. Staff Meet., Mayo Clinic, 24 :133-
137, 1949.
21. Woodward, T. E. : Chloromycetin and Aureomycin:
Therapeutic Results. Ann. Int. Med., 31 :53-82, 1949.
Modern Trends in Radiology
Omissions in Medical Practice: (1) Failure to
realize the importance of, and to carry out, a
thorough clinical examination before any radi-
ology— radiology being regarded as an easily
obtained substitute requiring little personal
effort. On the serious errors in diagnosis and
treatment which this has occasioned, a great deal
could be written. Careful attention to the clin-
ical condition of the patients in these cases
would have spared them much mental and physi-
cal pain, and the clinicians the blame the fruits
of which they escape perhaps too often. There
would be fewer errors in the interpretation of
radiographs if radiology was always preceded
by a sound clinical examination: if one of these
must be omitted the least harm will come from
omission of the radiography and most from
omission of the clinical examination.
(2) There has been a failure to learn the
bounds and appearances of the normal, and even
the character of the artifacts produced by faulty
material and techniques. Radiographic methods
have been applied to the examination of struc-
tures made visible by contrast media, and opera-
tions have been conducted to remedy “defects”
long before the appearance of the normal have
been learnt (Ed. learned) : when sound knowl-
edge of the normal has with time and experience
been acquired the operative measures for the cor-
rection of some of the “defects” have been abol-
ished. This was very noticeable in the gastroin-
testinal radiology. I am confident that in the
realms of other specialties, notably thoracic sur-
gary and neurosurgery, the same sequence will
occur, for in these our knowledge of radiology,
with and without contrast media, is still inade-
quate and incomplete; yet surgical explorations
based upon the radiology are many.
(3) It is often not realized that the initial
changes in many conditions are indistinguishable
from one another, and that serial radiographs
with continuous clinical examinations over a
short or long period may be necessary for elu-
cidating a problem.
(4) Many have failed to appreciate that the
onset of disease is not associated with immedi-
ate changes in the radiographic appearances, and
that it requires time — what I have called “the
latent negative radiographic period,” sometimes
only a few days, but sometimes a year or more —
before the changes are sufficient to produce
enough contrast density or irregularity of con-
tour to alter the radiographic appearances from
the normal; by the time these changes are recog-
nizable they are extensive — in some conditions
more extensive than the radiographs suggest —
in some cases healing may have commenced.
Even fractures and other more serious conditions
of bones and joints may be masked, if displace-
ment has not resulted, until secondary changes
have developed.
(5) There has been a failure to realize that,
though the disease has ceased its activity, the
radiograph may show spectacular appearances
even to the end of an apparent normal life —
the positive radiographic symptomless period.
It is questionable whether surgical methods with
their attendant risks would be so often under-
taken if the full importance of this were under-
stood. In some cases failure to appreciate omis-
sions 4 and 5 have, on the other hand, led to
the disregard of active clinical signs or recent
injury when radiographs have shown no sign of
change or only typical evidence of old healed
lesions. You may ask what evidence I have of
these omissions. I believe you could obtain such
evidence from the activities in many hospitals,
but the strongest evidence is in the boosting of
mass radiography. — James F. Brailsford, M.D.,
British Medical Journal, No. 4630, October 1,
1949.
458
The Ohio State Medical Journal
Early Recognition of Danger Signals During
Anesthesia and Their Correction*
HOLLAND J. WHITACRE, M. D.
PROBABLY the most important factor in
combating cardiorespiratory failure is rec-
ognizing the signs early and instituting the
proper therapy promptly. This will greatly
reduce the number of patients requiring heroic
resuscitative measures. When acute emergen-
cies occur, we often hear it said that the patient
suddenly “went bad” — his circulation suddenly
failed or he suddenly stopped breathing. As a
matter of actual fact, what usually occurs is
that it is suddenly discovered that the patient is
in extremis. In the vast majority of cases, these
sudden catastrophies are preceded by definite
signs which give warning of the impending
failure. The prompt institution of effective
therapy at this time can often prevent serious
cardiorespiratory depression.
Before discussing the early danger signals,
I should like to mention a few precautionary or
prophylactic measures which experience has
shown to be of value.
The prophylactic use of intravenous fluids is
now a common practice in preventing circulatory
depression. We no longer wait for even the early
signs of shock to appear before instituting sup-
portive therapy. In most major operations, in-
travenous glucose is started routinely. In selected
cases, such as intestinal resections or thoracic
surgery, blood transfusions are started at the
beginning of the operation.
Generally speaking, the experience and skill
of the anesthesiologist are more important than
the agent and technic used. Nevertheless, cer-
tain physical states in themselves make it unwise
to use certain agents. Spinal anesthesia, for
example, is a poor choice in the presence of
shock or hemorrhage; cyclopropane is less likely
to cause further depression. Pentothal should
not be used in a patient with respiratory embar-
rassment.
The individual susceptibility of patients to
predetermined doses of nonvolatile drugs must
constantly be anticipated. Rapid induction with
pentothal and curare, or a large dose of spinal
anesthesia will, in some cases, lead to profound
depression, Fatal cardiorespiratory depression
has occurred from ordinary doses of all the
commonly used agents.
OXYGENATION AND HYPOXIA
Having the proper resuscitative equipment
readily available for the administration of oxygen
* Part VII of a Symposium on “Acute Cardiorespiratory
Failure: Requirements for Successful Resuscitation,” pre-
sented at the Annual Meeting- of the Ohio State Medical
Association, Columbus, April 19-22, 1949.
The Author
• Dr. Whitacre, East Cleveland, Ohio, is a
graduate of Hahnemann Medical College,
Philadelphia, 1933; member, American Society
of Anesthetists, Inc.; diplomate, American
Board of Anesthesiology; director, Department
of Anesthesia, Huron Road Hospital.
is of the utmost importance. This applies to
local and intravenous as well as to general
anesthesia. It is amazing how often this elemen-
tary precaution is neglected, even in the best-
equipped operating rooms. It is not sufficient
to have the equipment in the next room or
down the hall. Furthermore, it must be in good
working order and ready for use.
Position on the operating table is another
significant factor. Certain positions are more
likely to precipitate circulatory and respiratory
failure. In the sitting position the patient
should be protected against the pooling of blood
in the lower extremities. Peripheral vascular sup-
port by the use of elastic bandages or a G.
suit is an effective measure in preventing de-
pendent stagnation. The use of the prone posi-
tion, particularly in obese individuals, or of the
steep Trendelenburg position may cause marked
respiratory depression. The real solution of
these and many similar problems depends on the
careful observation of the patient at all times.
This is facilitated by keeping accurate records
during the anesthesia.
Evidence of obstruction is one of the first in-
dications of what is perhaps the most common
cause of respiratory failure. In the past, when
ether was the principal agent, obstruction was
usually accompanied by noisy respiration and
was therefore easily detected. Today the wide-
spread use of depressing drugs such as pento-
thal or cyclopropane has complicated the problem
of recognizing obstruction because the patient
may not make sufficient respiratory effort to
cause a noise. Quiet respiration should not
be relied upon as an indication of an unobstructed
airway.
Usually our problem is with upper respiratory
tract obstruction, but interference with gas ex-
change in the lower bronchial tree is occasion-
ally encountered. The latter is usually due to
the presence of foreign material or to broncho-
spasm. Foreign material must be promptly re-
for May , 1950
459
moved. Bronchospasm is sometimes encountered
during the administration of pentothal, curare,
or cyclopropane and may be relieved by changing
to sympathomimetic agents such as nitrous
oxide or ether and oxygen. Isuprel hydrochloride,
administered intravenously, has also been used
with some success to alleviate this condition.
The insertion of an endotracheal tube during
too light anesthesia frequently causes severe
bronchospasm. This can be avoided by making
sure that an adequate depth of anesthesia has
been reached before intubation.
Any alteration in the rate or depth of respira-
tion should be carefully noted. A sharp increase
in the rate of respiration or a decrease in the
depth may interfere with adequate pulmonary
ventilation and lead , to hypoxia. A decrease in the
minute volume exchange requires lightening of the
anesthesia, administration of a higher concentra-
tion of oxygen, or inflation of the lungs. The im-
portant thing is to be aware that respiratory
depression is occurring and to institute these
measures promptly.
A progressive paralysis of the intercostal
muscles is indicative of increasing depth of gen-
eral anesthesia or a high level of spinal anes-
thesia. Unopposed action of the diaphragm
may cause a tracheal tug to develop or a gasp-
ing type of respiration may occur. It is impor-
tant to recognize that this denotes impending
respiratory failure. At this point the exag-
gerated diaphragmatic activity may be pushing
the intestines into the abdominal incision and
hampering the work of the surgical team. This
is often erroneously considered as evidence that
deeper anesthesia is required. The proper treat-
ment is, of course, to lighten the anesthesia,
give oxygen, and allow a few minutes for the pa-
tient to eliminate the excess carbon dioxide that
has accumulated during the period of inadequate
ventilation.
The appearance of cyanosis should be con-
sidered a sign of inadequate oxygenation of
the blood. It is equally important to recognize
that a patient may be hypoxic without being
cyanotic. An inadequate supply of circulating
hemoglobin or a pallor due to peripheral vaso-
constriction, which often accompanies circulatory
depression, may completely eliminate cyanosis
as a dependable clinical guide. It has been
demonstrated that, even in normal patients,
trained observers cannot always detect cyanosis
until the arterial oxygen saturation is danger-
ously low.1
prevention of respiratory or circulatory depres-
sion during anesthesia.
CARDIOCIRCULATORY FAILURE
Perhaps the most reliable signs of circulatory
failure are a decrease in blood pressure and an
increase in the pulse rate. Both of these should
be checked and recorded by the anesthesiologist
at least every five minutes.
The use of cardiac and circulatory stimulants
has a limited but nevertheless a very definite
place in combating some of the early signs of
cardiac failure. A fall in blood pressure with a
marked decrease in pulse pressure that does
not respond to reasonable replacement therapy,
or the onset of auricular fibrillation or decom-
pensation during anesthesia merit the considera-
tion of administering ouabain, a drug that could
be used to advantage much more frequently than
it is at the present time.
Acute hypotension of reflex origin, which re-
sults from the use of gallbladder or kidney rests,
may be benefited by small intravenous doses
of ephedrine. Likewise, the sudden hypotension
due to spinal anesthesia indicates the use of a
vasoconstricting drug. In this connection, it
should also be remembered that the elevation
of the legs to right angles to the body is a
prompt and effective method of decreasing the
amount of blood pooled in the lower extremities.
It is usually recognized that an increase in
pulse rate to 120 or more is indicative of the
onset of surgical shock. But a slowing of the
pulse to 60 or less may indicate a decrease in
cardiac output and be equally significant. It
may occur during spinal anesthesia, in which
case it indicates that the level of anesthesia is
ascending into the upper thoracic region and
is paralyzing the cardiac accelerator fibers.
This should warn the anesthesiologist of the
possibility of further circulatory depression.
During general anesthesia, an intravenous
dose of atropine may be given to correct
a bradycardia of vagal origin. In many long
operations, particularly those in the thorax, un-
due vagal stimulation should be blocked by
repeated doses of atropine if the heart rate is
60 or less.
Irregularities in the pulse rate should make
one cautious against deepening the .level ©f
anesthesia.
A decrease in skin temperature accompanied
by sweating has long been recognized as a
sign of circulatory depression and may indicate
the need for intravenous fluids or blood trans-
fusions.
The cerebral effects of cardiorespiratory de-
pression are, for the most part, related to oxygen
deficiency. Disorientation, excitement, loss of
consciousness, muscular twitchings, particularly
those originating in the region of the head and
neck, and generalized convulsions are very likely
It is much easier to prevent hypoxia than
it is to detect it, and preventing it can best be
accomplished by administration of an excess of
oxygen at all times. Maintenance of adequate
oxygenation to the tissues, especially those of
the heart and brain, is fundamental in the
460
The Ohio State Medical Journal
to be followed by depression of respiration and
circulation. Likewise, loss of the corneal reflex
and dilation of the pupil should command care-
ful evaluation.
REFLEX ACTIVITY
Reflex disturbances due to surgical manipula-
tion may produce serious depression. Complica-
tions from this source can be guarded against
by (1) adequate depth of general anesthesia to
prevent reflex activity; (2) blocking the reflexes
with some form of regional or local anesthesia;
and (3) preventing hypoxia from occurring dur-
ing these reflex manifestations — because in the
presence of oxygen lack, fatal damage is much
more likely to occur.
CONCLUSION
We have reason to be hopeful that, in the
future, recognition of the early signs of cardio-
respiratory depression will be facilitated by the
application of better diagnostic instruments. The
use of the oximeter will enable us to know the
oxygen saturation of the blood at all times. The
electrocardiograph and electroencephalograph,
as weH as equipment for continuous recording of
the blood pressure and pulse, will provide much
more reliable information as to what is happen-
ing to the patient during anesthesia. The re-
cent development of an electronic spirometer
for the constant measurement of breathing gives
promise of being another step toward provid-
ing patients with better, safer, and more exact
care during anesthesia.
At the present time, however, it is evident
that the early signs of acute cardiorespiratory
failure, though numerous, are not sharply
defined. Their recognition requires meticulous
observation of the patient at all times. No one
sign can be relied upon to the exclusion of the
others. Often the earliest indications are nothing
more than subtle hints or isolated signposts
which, in themselves, may have no clear-cut mean-
ing. However, if each one is carefully noted
and correlated with past experience, it may
indicate a trend which will alert the anesthe-
siologist and surgeon to institute remedial
measures and thus preclude more serious com-
plications.
BIBLIOGRAPHY
1. Comroe, Julius H., Jr., and Botelho, Stella : The Un-
reliability of Cyanosis in the Recognition of Arterial
Anoxemia. Am. J. Med. Sc., 214:1-6, July, 1947.
Duodenum — Because this first portion of the
small intestine in man is about twelve inches in
length, it was given the name duodenum which
is derived from the Latin word duodeni mean-
ing “twelve each.”
* * *
Rectum — This last portion of the large intestine
is so named because it is comparatively straight.
The word rectum is derived from the Latin
“rectus” or straight.
KEEPING UP WITH MEDICINE
• Diabetics are especially prone to develop
symptoms resulting from a deficiency of several
fractions of the vitamin B-complex.
* * *
• When we become sick it is because the un-
favorable factors in our environment have caused
our resistance to such factors to break down
under the stress and strain of living with them.
When we are ill with even relatively minor ail-
ments, the ordinary worries of earning a living,
taking care of our families and meeting our social
and financial obligations all become more com-
plicated and difficult to bear. They then ag-
gravate our disease, and hinder our recovery
by depressing our bodily functions.
❖ ❖ ❖
• With the present low level of tuberculosis
in this country, it does not seem likely that
vaccination of the generally tuberculin-negative
population with B. C. G. is a practical procedure.
* * *
• The progressive development of the inhibitory
process in the child represents an immunization
and desensitization of his neuro-psychic con-
stitution. It renders him refractory to his
“neuro-psychic allergens.”
'k v 'I*
• One of our greatest shortcomings is the in-
completeness and haphazardness of our examina-
tions of our patients’ mouths.
* * *
• Approximately 15 per cent of patients seen
for vascular impairment due to arteriosclerosis
give a history indicative of thrombosis of a
major limb sometime during their illness.
% %
• The cytologic diagnosis of malignancy is
moving forward at a very rapid rate.
^ ^
• The formation and growth of kidney stones
lead all other pathological processes in the de-
struction of kidney tissue.
* * *
• As yet, we do not have proof of any relation-
ship between vitamin or protein deficiency and
peptic ulcer in the human being. As a result
of the ulcer, however, many patients are deficient
in vitamins C, B, and proteins.
* * *
• Numerous studies in many parts of the coun-
try made in the last few years have shown that
all but a very few pregnant women have seri-
ously inadequate diets.
* * *
• Children do not just grow up. Actually,
growth is a far more complicated business. The
shape and form of the body changes — and in
several ways. The head, the arms and legs,
and the other parts of the body grow at dif-
ferent rates. — J. F.
for May, 1950
46 1
Ground Rules for Doctors of Morgan County in 1848
A CENTURY ago Morgan County had at
least 18 practicing physicians, probably
more, compared with the five who are now
actively engaged in general practice and the two
resident members of the staff of Rocky Glen
Sanatorium. A copy of the “Constitution of the
Morgan County Medical Society, together with
Code of Ethics and Fee Bill” lists these 18 early
doctors as well as much interesting data about
medical practice 100 years ago. The time-worn
pamphlet is in possession of Dr. C. E. Northrup
and was found a number of years ago by his
son, Dr. Edgar Northrup, now of Marietta. Five
dollars was set as# a fair fee for delivering a
baby in 1848 and it was considered unethical by
the society to “make gloomy and unfavorable
prognostications, savoring of empiricism.”
EIGHTEEN PHYSICIANS
The 18 members of the society are listed in
the booklet as follows: P. B. Johnson, Charles
Robertson, E. Dawes, John Hull, H. H. Little,
W. F. Grubb, McConnelsville; H. C. Grimmell, J.
G. Shoch, Malta; N. M. Nichols, Pennsville; U. K.
Hurd, W. H. Reeves, Deavertown; James Bell,
John S. Abbot, Windsor; J. C. Clark, Anderson’s
Store; A. Plumley, Meigs Creek; James Rusk,
Triadelphia; and Daniel Rusk and H. Dover, Ros-
seau.
Dr. Charles R. Robertson was the author
of the History of Morgan County bearing his
name, the Robertson family home being the large
frame structure on Fourth street which Andrew
Wilson razed a number of years ago to make way
for the building and lot now used by Bill Janes’
Motor Sales. According to his autobiography,
Dr. Robertson practiced in McConnelsville nearly
60 years and was born near Leesburg, Loudon
County, Virginia. Poor, losing his mother at an
early age, he took his first job as an apprentice
printer in a time when wages for the craft
were notoriously low, made the best of the
meagre library of the editor of the St. Clairs-
This historical feature article appeared in the January 26,
1950, issue of The Morgan County Herald, and is based
on information obtained from C. E. Northrup, M. D., Mc-
Connelsville, and the document he possesses.
ville “Repository” and at the age of 21 became
postmaster at St. Clairsville. With the aid of
the salary and the spare time his job afforded
him, he read medicine under Dr. W. Wood and
in three years was licensed to practice. He
first practiced in Barnesville, later in Woodsfield
and came to McConnelsville in 1826, still keeping
his hand in the printing trade by setting type
and performing kindred jobs as a hobby in his
spare time in the old Morgan Sentinel. Mrs.
Bessie Robertson Barrows of San Jacinto, Calif.,
is his last surviving daughter.
From Dr. Robertson’s history, we quote the
following biographical data about the other
physicians on the membership roster:
Dr. Perley Brown Johnson was among the
first physicians who permanently located in the
county and for many years was an influential and
honored citizen. Dr. Johnson has more namesakes
in Morgan County than any other man and per-
haps more than all others who have lived here
(Dr. Robertson notes). He was born in the
block house at Marietta and read medicine under
Dr. John Cotton, before locating in McConnels-
ville in 1823,
Edward Dawes — We have been unable to find
any data on Dr. Dawes, other than that he was
deceased when Dr. Robertson’s history was com-
piled in 1886.
John Hull, H. H. Little, and William F.
Grubb, M. D.’s, no data in Robertson, other than
that Drs. Hull and Grubb were deceased at time
of publication.
H. C. Grimmell and J. G. Shoch of Malta, like-
wise, no data, but are listed as deceased members
of the Morgan County Medical Society, having
been admitted in 1840 and 1842, respectively.
REEVES BROTHERS
N. M. Nichols, M. D., Pennsville, admitted to
the society in ’44; U. K. Hurd, M. D., Deavertown,
admitted to society in ’44, practiced at Deaver-
town for 19 years, leaving in ’64. W. H. Reeves,
M. D., Deavertown, admitted to the society in
1846. With his brother, Dr. James Reeves, Dr.
46 2
The Ohio State Medical Journal
Reeves practiced for many years at Deavertown
and was an ardent abolitionist while his brother,
James, took the other side of the question. The
story made famous by the late A. H. Humphries
in his “The Underground Railroad” of the hiding
of an escaped slave in the tyler’s room of Doric
lodge at Deavertown, gives an intimate glimpse
into the life of the Drs. Reeves. Mr. Humphries
relates how T. L. Gray met W. H. Reeves one
evening and was told that if he ever needed a
horse to assist some unfortunate “on his way
to Can-a-day” that “you know where mine al-
ways is in the stable.” On the particular oc-
casion referred to, the underground conductors
needed a horse, but got the wrong animal, tak-
ing the one of Dr. James Reeves instead of
that of his brother. Dr. James Reeves was
called out early the next morning on a confine-
ment case and went hurriedly to the stable where
he was enraged to find his horse sweat-stained,
and tired. He openly charged that it had been
stolen by the abolitionists and gave his opinion
of the whole anti-slavery outfit as being very
low, stooping to steal horses in addition to
Negroes.
James Bell, M. D., admitted to the society in
1846. Dr. Bell practiced for several years in
Windsor township, then moved to McConnelsville,
where he remained a few years, then sold out to
Dr. Brown. He was a graduate of the Ohio
Medical College and was regarded as a capable
physician. He went to Indiana and died in Terre
Haute.
JOHN S. ABBOT, M. D.
John S. Abbot, M. D., admitted to the so-
ciety in 1846. A native of Washington County,
Dr. Abbot was educated in the common schools
and came to Morgan County in 1840 and began
the study of medicine under Dr. James H. Berry
and finished under Dr. James Bell. He estab-
lished himself in the practice of his profession
in Stockport in 1846 and at the time of publica-
tion of the Morgan County History was the
oldest living member of the County Medical
Society, having served as president, vice-president
and on the board of censors. A Democrat in
politics, a Universalist in religious belief, he was
a Mason. On April 22, 1847, Dr. Abbot married
Miss Lucretia White and the following children
were issue of their marriage: Henrietta, Henry,
Louisa, Se, John Q., May Bell, Jesse R., Arthur
(Art of Cleveland), and James B., who was
drowned when six years old.
Dr. J. C. Clark, Anderson’s Store, one of the
most romantic figures ever to reside in Morgan
County, was a native of Ireland, enjoyed a
tremendous practice, enviable reputation and has
been the subject of more ghost and buried treas-
ure stories than most any other citizen of this
part of Ohio. The late V. B. Walters of Reiners-
ville, in his “Manchester Men, Events and Re-
flections,” devotes considerable space to Dr. Clark
and quotes the following as a sample of his
poetry:
Yet not all the wealth that surrounds us so
tempting,
Can wean my fond heart from the scenes of
my_ youth,
For Erin looms up in my soul’s warm af-
fection
And thrills every chord to love, friendship
and truth.
Dr. Clark built the magnificent brick home
atop the knoll in Manchester which was for many
years the J. F. Elliott home and of late years
has been the property of G. F. Grassel of Cin-
cinnati. One of the early Knights Templar in
this section, Dr. Clark left numerous signs of the
fraternity in his house which can be seen to
this day. The late Dr. W. E. Radcliff of Cald-
well, who once practiced in Reinersville, came
into possession of the dagger and baldric which
were part of Dr. Clark’s Templar uniform and
had planned, before his death, to present them
to Cambridge Commandery, where he, himself,
was a past eminent commander. Gold coins still
turn up occasionally in the hog lots and under
the sod at the Clark farm, supposedly tokens
of the wealth accumulated by this early practi-
tioner who had a deep-seated mistrust of banks
and was purported to have buried untold wealth
somewhere about his home.
Dr. Aaron Plumley, Meigs Creek, admitted to
the society in 1846.
DANIEL RUSK, M. D.
Jas. Rusk, M. D., Triadelphia, admitted to
society in ’42 and Daniel Rusk, Rosseau, ad-
mitted to the society in 1847. Dr. Robertson
lists Dr. James Rusk as a deceased member of
the society and gives no biography, but devotes
considerable space to Dr. Daniel Rusk, the father
of James M. Rusk, former editor of the Herald,
and the grandfather of Dr. Rogers D. Rusk of
Mt. Holyoke, Mass. Dr. Rusk farmed and
taught school for a number of years until turning
to the medical profession. As a student in medi-
cine, he gained fame for his success in treat-
ing typhoid fever when other physicians failed
in many cases during an epidemic and saved the
life of his brother, Jeremiah, who was later
to become Governor of Wisconsin and second
Secretary of Agriculture. Dr. Rusk read medi-
cine three years with his brother, Jaanes, then
spent two years with Dr. James Reeves of
Deavertown. In the fall of 1847, he moved to
Rosseau, living there until the death of his
wife in 1858. He then with his two boys, James
M. Rusk and W. A. Rusk, moved to Malta. He
was appointed U. S. examining surgeon for Mor-
gan County in 1875, continuing in office until 1885.
Hiram Dover, Rosseau, admitted to the society
in 1846.
FEE BILL
The Fee Bill of the society is interesting as
will be noted from just a few of the items
for May, 1950
46 3
quoted. For a visit in town (not more than two
to be charged in the same day), 75c. For a pre-
scription to a drug store, 20c to $1. Amputa-
tions of the arm, tibia and fibula were from
$15 to $25 and of the femur (hip bone), $25 to
$50. If it were only a finger or a toe, the phy-
sician could let you off with $2.00 to $5.00. If
unfortunate enough to be born with a hair lip,
you could have same fixed for $10 to $25 and
ordinary obstetrical cases were $5, except that
if prolonged the doctor could charge the parents
$1 for every 12 hours extra he had to wait on
your arrival.
Finally, the society strictly charges its mem-
bers that: ‘‘The use of nostrums and quack medi-
cines should be discouraged as degrading to the
profession, injurious to health, and often de-
structive to life. Patients, however, under linger-
ing disorders, are often determined on having
recourse to such as they see advertised, or hear
recommended with a boldness and confidence
which no intelligent physician dares to adopt,
with respect to the means that he prescribes. In
these cases some indulgence may be accorded
to a credulity that is insurmountable and the
patient should neither incur the displeasure of
the physician or be entirely deserted by him; but
it is the duty of the attending physician to warn
them of the fallacy of their expectations, of the
danger of the experiment, and the necessity of
strict attention to the effects produced by them
in order that their bad effects, if any, should
be timely obviated.”
Dr. Lester E. Siemon, of Cleveland,
1867-1943
Dr. Thomas A. McCann, of Dayton
1858-1943
Two pioneers passed away in 1943 that may
well be considered together and whose counter-
parts, a century might not produce in Home-
opathy or in any other school of medicine. They
were contemporaries and intimate friends, Drs.
Tom McCann of Dayton and Lester Siemon
of Cleveland. Each served on the Ohio State
Examining Board with great credit to our
school of medicine. Dr. Siemon from the year
1911 served several terms and was even presi-
dent of the Board for a time, and Dr. McCann
served sixteen years and as I remember it, they
were on the Board together for ten years.
Both of these men had unusual, outstanding
gifts which they used unstintedly in the interest
of Homeopathy and of all medicine and in any
position of trust wherever it might be. They
never jockeyed for position and power. Both
had large practices, and held the deep regard
and confidence of their communities.
Among other things which they held so
strangely in common, both men were ardent
hunters and fishermen, lovers of nature, who
yearly sought the wilds of Canada for mental
and physical solace. Both were intensely human,
Democrats and of Irish descent. Both were
deeply religious; one a Baptist, the other of
Quaker ancestry, and were high in Masonry.
Both were outstanding after-dinner speakers, or
at any other time and place without previous
preparation. Both were adept at unstuffing the
stuffed shirt, and both fought valiantly for a
righteous cause. No one ever had to wonder
how they stood, they told you. Above all
things they had courage, “that lovely virtue, the
rib of Himself, which God sent down to his
children.”
Because they so richly deserved them and
had earned the honors thrust upon them, each
had held practically every position in the gift
of the homeopathic school, state, national, inter-
national and local, with honor and distinction. —
Lucy S. Hertzog, M. D., Chardon, Ohio.
Dr. Hamilton Fiske Biggar,
1839-1926
Dr. Hamilton Fiske Biggar was born in
Toronto in 1839, and died at the age of 89 in
1926. He was the son of a Methodist circuit
rider. At the age of twelve he found and
read a copy of the Cleveland Plain Dealer and
decided at once upon Cleveland as his objective
along with the profession of medicine. He made
both objectives. He graduated from Victoria
University, came to Cleveland and graduated a
good homeopath from the Cleveland University
of Medicine and Surgery in 1866.
By 1880 he had become prominent as one of
the most successful surgeons and gynecologists
in Cleveland, and a splendid leader and teacher
who became nationally known. His many great
gifts and characteristics inclined him to be an
autocrat and a storm center. His Thursday
afternoon clinics were the high point of the
week’s work to students, because of his clear
teaching and gracious handling of patients. He
held an audience by sheer charm and humorous
narrative of fact and experience. He was a man
of education and culture, extraordinarily re-
sourceful in the care of his patients, and never
gave up until the grim reaper took over. He
was well known as J. D. Rockefeller’s personal
physician.
Dr. Biggar had the grand manner — an air of
distinction which easily made him the most im-
pressive figure in any audience. Consciously or
unconsciously he dominated any gathering of the
medical profession and he was equally acclaimed
for his ability by all schools of medicine. “Age
did not wither nor custom stale his infinite
variety.” — Lucy S. Hertzog, M. D., Chardon,
Ohio.
464
The Ohio State Medical journal
^,4At (fail fan /4dv<zttce
Hotel Reservations
for the
1950 Annual Meeting
Ohio State Medical Association
Cleveland, Ohio .
. . May 16,
17, 18
NAME AND LOCATION
SINGLE
DOUBLE
DOUBLE
TWIN BED
ALLERTON HOTEL, 1802 E. 13th St.
$3.50-6.50
$5.50-10.00
$6.00-10.00
AUDITORIUM HOTEL, 1315 E. Sixth St.
$3.50-3.75
$4.50-5.00
$5.50-6.00
$7.00
$7.50 and Up
CARTER HOTEL, PUBLIC SQUARE
$4.75-7.00
$7.00-10.00
$8.00-12.00
CLEVELAND HOTEL (Headquarters Hotel)
$4.50
$6.50-9-00
$9.00-14.00
HOLLENDEN HOTEL, 610 Superior Ave.
$3.50-8.00
$5.50-10.00
$7.00-14.00
OLMSTEAD HOTEL, Superior & E. Ninth
$3.00-6.00
$5.00-8.00
$7.00-9.50
$7.00-9.50
STATLER HOTEL, Euclid at E. 12th St.
$4.00-6.00
$7.00-10.00
$8.00-12.00
HOTEL RESERVATION BLANK
Mail the coupon to hotel selected
Manager Hotel, Cleveland, Ohio
You are requested to reserve the following accommodations during the period of the Annual Meeting
of the Ohio State Medical Association, May 16, 17, 18, 1950, or for such other period as may be
indicated herein.
□ Single Room with Bath □ Double Room with Bath Price
□ Twin Bed Room with Bath □ Suite
Arriving May at A. M P. M.
PLEASE VERIFY MY RESERVATION
Name
Address
for May, 1950
465
*7&e&e “R,cet ^etten "D<Uf4
On tyotvi “TfCecUcaC (falendwi
May 16, 17 and 18
Ohio State Medical Association
Annual Meeting
CLEVELAND, OHIO
Here Is Ohio’s Most Comprehensive Medical Program of the
Year, Condensed Into Three Days of Conveniently
Arranged Schedules
Scientific Program Begins 1:00 P.M. Tuesday — Ends 3:45 P.M. Thursday
All Schedules, Daylight Savings Time
Fourteen Instructional Courses . . . Scientific Programs
by Specialty Sections for Doctors in All Branches of
Medicine . . . Scientific, Educational and Technical Ex-
hibits . . . Banquet With Entertainment and Dancing . . .
Addresses on National Affairs by The Honorable Robert A.
Taft and Dr, George F. Lull . . . Fraternal and Class Re-
unions . . . Medical Topics of the Day . . . Program and
Entertainment for Ladies by the Woman’s Auxiliary . , .
Sessions of the House of Delegates.
For Summary See Facing Page
For Complete Details See April Issue of The Journal
466
The Ohio State Medical Journal
liu.mma.tij ofi 1950 Annual Alee tints Ptoqtam
Time Shown Is Daylight Savings Time
TUESDAY, MAY 16
10:00-12:00 Noon — House of Delegates Business Session and Luncheon
1:00- 2:30 P.M. — Medical Topics of the Day:
“Risk Factors in Anesthesia,” R. J. Whit-acre, M.D., Cleveland, Moderator
“Nephritis and Nephrosis,” J. M. Hayman, Jr., M.D., Cleveland, Moderator
“Neuroses and Early Psychoses in General Practice,”
Calvin L. Baker, M.D., Columbus, Moderator
2:30- 3:00 P.M. — Recess for Visiting the Exhibits
3:00- 5:25 P.M. — General Session:
“Psychiatry in General Practice,” Maurice Levine, M.D., Cincinnati
“Present-Day Practice in Obstetric Analgesia,”
George J. Andros, M.D., Ann Arbor, Mich.
“Modern Concepts of Anesthetic Management for Gynecological and
Obstetrical Patients,” Ralph M. Tovell, M.D., Hartford, Conn.
“Resuscitation of the Newborn,” J. J. Jacoby, M.D., Columbus
7:30 P.M. — Annual Meeting of the Ohio Academy of General Practice
WEDNESDAY, MAY 17
9:00-10:30 A.M. — Instructional Courses Nos. 1, 2, 3, 4, 5
f
9:00-12:00 Noon — Annual Meeting of the Ohio State Radiological Society
10:30-12:00 Noon — General Session:
“Progress in Medical Care,”
The Honorable Robert A. Taft, of Ohio, Member of U.S. Senate
“Your A.M. A. and Its Activities,” George F. Lull, M.D., Chicago, 111.
12:00 Noon — Luncheon Meeting of Ohio Chapter of the American College of Chest Physicians
1:00- 2:30 P.M. — Medical Topics of the Day:
“Convulsive Disorders: Recognition and Treatment,”
Max T. Schnitker, M.D., Toledo
“Peripheral Vascular Disorders,” William D. Holden, M.D., Cleveland
“Retroperitoneal Tumors,” William J. Engel, M.D., Cleveland
2:30- 3:00 P.M. — Recess for Visiting the Exhibits
3:00- 5:30 P.M. — General Session:
“Diabetic Ketosis,” Cecil Striker, M.D., Cincinnati
“Urinary Bladder Emergencies,” Eugene A. Ockuly, M.D., Toledo
“Immediate Management of Head Injuries,” Joseph P. Evans, M.D., Cincinnati
“Full-Scale X-Ray Chest Examinations,” Fred J. Hodges, M.D., Ann Arbor, Mich.
“Metabolic Effects in Man of ACTH and Cortisone (Compound E),”
Jerome W. Conn, M.D., Ann Arbor, Mich.
7:30 P.M. — Annual Banquet — Entertainment — Dancing
THURSDAY, MAY 18
9:00-10:30 A.M. — Instructional Courses Nos. 6, 7, 8, 9, 10
10:30-12:00 Noon — Instructional Courses Nos. 11, 12, 13, 14
12:00 Noon — Luncheon and Business Session of House of Delegates:
1:30- 3:45 P.M. — General Session:
“Prevention and Treatment of Deafness in Children,”
Harry C. Rosenberger, M.D., Cleveland
“Early Recognition of Visual Defects in Children,”
Lorand V. Johnson, M.D., Cleveland
“The Primary Tuberculous Complex: Some Clinical and
Roentgenographic Features,” John Caffey, M.D., New York, N.Y.
“Review of Acute Upper Respiratory Diseases,” John H. Dingle, M.D., Cleveland
for May, 1950
467
Commission on Children . . .
State and Local Organizations Are Paving Way for Participation in
1950 White House Conference; Doctors Are Taking Prominent Parts
THE Ohio Commission on Children and
Youth, assisted by committees in most of
the counties, is paving the way for the
Midcentury White House Conference on Chil-
dren and Youth to be held in Washington dur-
ing December.
The Commission, appointed by Governor Frank
J. Lausche in May of 1949, is conducting fact-
finding studies of children and youths in their
different environments — at home, at church, at
school, at work, etc.
County committees are representative of par-
ents, clubs, churches, unions, fraternities, pro-
fessions, and public and private organizations
that have concern for children. They are gather-
ing data, promoting discussions of child and
youth needs in their own areas and will serve
as spearheads for local activity following the
White House Conference.
MEDICAL PROFESSION’S PART
The Council of the Ohio State Medical Asso-
ciation at a recent meeting recommended that
County Medical Societies have representation on
these county committees in order that members
of the medical profession might properly advise
and guide on matters pertaining especially to
medical care and health.
Dr. Carl A. Lincke, Carrollton, President of
the Association, is its official representative
on the Commission by invitation of the Governor.
Dr. Lincke has pointed out that participation of
doctors in these local projects provides another
means through which the medical profession
can make a positive contribution to community
betterment. Physicians who have not already
done so are invited to contact their local com-
mittees and offer their services.
J. Gordon Crowe, executive secretary of the
Commission, said that to the best of his knowl-
edge the medical profession is represented on
every county committee thus far organized. All
but about six of the counties had been or-
ganized early in April, Mr. Crowe revealed, adding
that he believed all 88 would be organized
before June.
Serving on the Executive Committee of the
Commission are three Ohio physicians: Dr. James
D. Kramer, Akron, chairman of the Ohio State
Medical Association’s Committee on Public Re-
lations and Economics; Dr. Thomas E. Shaffer,
Columbus, chairman of the Association’s Com-
mittee on School Health; and Dr. John D.
Porterfield, director of the Ohio Department of
Public Health. Herschel W. Nisonger, Ph. D.,
recently succeeded the late Judge Raymond P.
Smith as chairman of the Commission. Dr.
Nisonger is director of the Bureau of Special
and Adult Education at Ohio State University.
Offices are maintained at 303 State Office Build-
ing, Columbus.
HISTORY OF COMMISSION
The history of the White House Conferences
goes back four decades. Since 1909, a confer-
ence has been called every ten years by the
President of the United States to consider the
needs of children and youth throughout the Na-
tion. In January, 1948, the National Commission
urged that special attention be given the 1950
White House Conference through intensive ad-
vance study by the individual states. This spe-
cial attention was urged because of the tremen-
dous impact of World War II upon the lives of
young people, and because of new knowledge
about their heeds and how to meet them.
In response to this proposal, the United States
Children’s Bureau called a conference of states’
representatives who met in Washington early
in 1948. Later in that same year, upon invita-
tion of the incumbent Governor, Thomas J.
Herbert, a group met to hear reports of Ohioans
who attended the Washington Conference. The
group voted to recommend to the Governor
creation of the Ohio Commission.
OHIO GROUP ORGANIZED
In May, 1949, 80 representative citizens, in-
vited by Governor Lausche, met and organized.
It was decided that the commission should
consist of all original invitees to the meeting
(125) who cared to serve. The commission also
voted to have an executive committee, to include
a chairman, appointed by the Governor, 17 mem-
bers elected by the commission, and the directors
of the Education, Health, Industrial Relations
and Welfare Departments.
COMMITTEES HIGHLIGHT OBJECTIVES
In order to carry out its objectives and
program the commission has set up major
committees.
The Committee on Children and Youth at Home
is concerned with all aspects of home life and
the factors which affect them. Subcommittees
deal with physical and mental health, economic
security, housing, welfare services and spiritual
needs. Parent education is a major consideration.
Committee on Children and Youth Away From
Their Homes is studying programs and facil-
468
The Ohio State Medical Journal
ities for children who reside in other than their
natural homes.
Committee on Children and Youth at School
compares findings on education in Ohio with
generally accepted standards.
Committee on Children and Youth Out-of-
School is studying civic, vocational guidance, job
placement, employment, education and recrea-
tional opportunities and needs of youth from
16 to 25.
Committee on Children and Youth at Work is
attempting to determine adequacy of present child
labor laws and their enforcement; make special
studies of agricultural and hazardous occupations
and study general work experience in its rela-
tionship to education.
Committee on Children and Youth in the Com-
munity is concerned with recreation, intercultural
relations, law enforcement, community services,
and community planning and coordination.
Committee on Children and Youth and the
Church is studying the role that the church
is playing in the lives of youth especially in
strengthening family life.
In addition there are three committees which
have to do with administration and organization.
They are the Committee on Research and Fact-
Finding, the Committee on Community Organiza-
tion and the Committee on Publicity and Public
delations.
Two physicians head important subcommittees.
Dr. Benjamin Hoyer, Cincinnati, is chairman of
the Committee on Health Services for Children,
a subcommittee of the Committee on Children
and Youth in the Community. Dr. Margot
Deckert, Columbus, is chairman of the Com-
mittee on Physical Health, a subcommittee of
the Committee on Children and Youth at Home.
County Committees do not necessarily follow
the organization pattern of the state Commis-
sion. Each county committee sets up its own
organization according to local needs.
An important phase of the work is that
youths from 15 to 25 are being invited to take
part in all conferences from the county level to
the White House Conference.
Physicians Needed in Pacific
On July 1, 1950, the administrative respon-
sibility for Guam and American Samoa, which
are U. S. possessions, and for the Trust Ter-
ritory of the Pacific Islands, which comprises the
former Japanese mandated Marshall, Caroline,
and Marianas Islands, will be transferred from
the Navy Department to the Department of the
Interior. Plans are under way to replace Naval
personnel, including physicians, with civilian per-
sonnel. Doctors interested should write the
Divisions of Territories and Island Possessions,
Department of the Interior, Washington 25, D. C.
New Specimen Container Used
By State Laboratory
The Division of Laboratories of the Ohio De-
partment of Health announced a new and im-
proved type of feces container which is avail-
able to local health departments for use by
private physicians as well as by public health or
hospital physicians and nurses, according to an
article in Ohio's Healthl
The new container is for sending stool speci-
mens to the Laboratory for culture on typhoid
and Salmonella infections and bacillary dysen-
tery. The outfit contains buffered glycerol as
a preservative, replacing the sterile cotton swab
used heretofore. According to Leo Ey, director
of the Laboratory, stocks of old type mailing
containers for feces may be returned to the
Laboratory by health departments in exchange
for the new.
It is anticipated that some of the more fas-
tidious Salmonella and Shigella organisms will
remain viable in the preservative, leading to
greater chances for positive findings.
The Division of Laboratories desires also to
function as a reference center within the state
to which enteric cultures may be referred by
other public health, hospital, or private labora-
tories for confirmation or identification.
Physicians and health department personnel
are urged to make use of these culture facilities
in detecting the causative agent of enteric in-
fections. However, the routine culturing of stools
of all food handlers in a community is not recom-
mended. Such studies should be confined to
those at whom the finger of suspicion points
through epidemiologic investigation of existing
cases of enteric infection.
In the use of the new specimen container,
it is requested that a feces sample the size of a
marble be added to the liquid in the specimen jar
for culture. The same jar may be used for ova
and parasite examinations, but the liquid should
be poured out before adding the feces and a
notation “For Parasites” should be added on the
case history blank.
It is quite probable that a greater incidence
of Salmonellosis and Shigellosis exists than is
suspected on the basis of past laboratory find-
ings. It is realized that, because of the time-
consuming procedures, it may require several
days before a suspicious organism may be
properly identified by the Laboratory. Thus the
report may be delayed for use by the physician
in treating the patient. However, the epidemi-
ologic and public health significance of positive
findings should be obvious. More widespread
infection may thus be prevented, the report
states.
ARE YOU AND MEMBERS OF YOUR
FAMILY REGISTERED TO VOTE?
for May, 1950
469
New Program for Feeble-Minded . . .
Welfare Department in May Will Put Into Effect Revised Procedure
For Reception, Classification and Custody of Mentally Deficient
AN executive order issued recently by Judge
John H. Lamneck, director of the Ohio De-
partment of Public Welfare, revises the
procedure for care of feeble-minded persons ac-
cepted by the Department.
The executive order, scheduled to be put into
effect early in May, was issued upon recommenda-
tion of Dr. Calvin L. Baker, commissioner of
mental hygiene, with the approval of the Ad-
visory Council to the Division of Mental Hygiene.
It also has the approval of the Probate Judges
Executive Committtee and the Executive Com-
mittee of the Ohio Mental Hygiene Association.
The order states that all feeble-minded per-
sons committed to and accepted for care and
custody by the Department of Public Welfare
shall be maintained, treated and trained until
discharged, released or placed as provided by
law under a procedure which is outlined in the
following paragraphs.
The institutions now designated as the “Co-
lumbus State School,” the “Apple Creek State
Hospital,” and the “Gallipolis State Institute”
will continue to be known by those names. The
institution now designated the “Orient State
School” will be known as the “Orient State In-
stitute.”
CARE OF EPILEPTICS
The executive order states that medical science
has developed new methods of treatment of con-
vulsive disorders which obviates the necessity
for maintaining a separate institution in this
state for the treatment and custodial care of pa-
tients with convulsive disorders who are not
psychotic or feeble-minded. Hereafter psychotic
patients with convulsive disorders who require
institutional care and treatment will be committed
and received at state hospitals other than re-
ceiving hospitals as mentally ill patients.
Feeble-minded persons with convulsive dis-
orders who require institutional care and treat-
ment will be committed and received as feeble-
minded patients.
Patients with convulsive disorders who are not
psychotic or feeble-minded and who require in-
stitutional care and treatment will be committed
to and received at such institutions as the com-
missioner of mental hygiene may designate in
each case.
Dr. Baker explained that patients with con-
vulsive disorders after being classified as feeble-
minded and needing custodial care will be trans-
ferred to Gallipolis. Under the former procedure
virtually all patients classified as “epileptics”
were committed directly to Gallipolis.
COLUMBUS STATE SCHOOL
The Columbus State School will be used for:
(1) The reception of all feeble-minded persons
committed to the care and custody of the State
Department of Public Welfare;
(2) The examination, observation and classi-
fication of all feeble-minded persons committed
to the custody of the Department;
(3) The retention, maintenance, training and
education of such feeble-minded persons com-
mitted to and received by the school as are cap-
able of being trained and educated so as to
render them more comfortable, happy and less
burdensome to society, until released or dis-
charged as provided by law.
ORIENT
The Orient State Institute will be used for
the care and maintenance of such feeble-minded
persons committed as may be ordered transferred
to the institution from the Columbus State School
on the order of the commissioner, or from other
state institutions under the jurisdiction of other
Divisions of the Department on order of the di-
rector of the Department.
APPLE CREEK
The Apple Creek State Hospital will continue to
be used for feeble-minded persons who primarily
need custodial care.
GALLIPOLIS
The Gallipolis State Institute will be used
for the care and maintenance of such feeble-
minded persons as may be ordered transferred
there from the Columbus State School on order
of the commissioner of mental hygiene, or from
other state institutions under jurisdiction of
other divisions of the Departments on order
of the director. Patients will consist primarily
of the feeble-minded with convulsive disorders.
STAFFS
There will be maintained at the Columbus
State School, four principal staffs — medical, psy-
chological, teaching and social service, with such
auxiliary services as the commissioner of mental
hygiene may deem necessary.
Medical Staff — The medical staff, under the
superintendent, will be headed by a clinical
director. To the extent that the Ohio State
University College of Medicine is willing to par-
470
The Ohio State Medical Journal
ticipate, the medical staff will be correlated with
the staff of the College and with the staffs of
other medical schools and hospitals of the State
as desire to participate.
There also wnll be maintained at the Columbus
State School a consultation staff, expert in the
field of psychiatry and associated fields, drawn
from the teaching staff of the Ohio State Univer-
sity College of Medicine, if the medical college
is willing to participate, and other medical
schools willing to participate. It also will for-
mulate and establish research projects pertinent
to mentally deficient persons.
Psychological Staff — The psychological staff
will be headed by a chief psychologist and will
plan, supervise, teach and evaluate results of
psychological testing of feeble-minded persons.
It also will formulate and establish proper re-
search projects.
Teaching Staff — The teaching staff at the
school will be headed by a superintendent of
schools who will cooperate with the other staffs
in the school in establishing proper courses for
teachable wards and will supervise teachers and
teacher-training programs. The superintendent
of schools will cooperate with the director of
the Bureau of Special and Adult Education of
Ohio State University.
The Social Service Staff — The social service
staff will be organized in conjunction with the
school of any accredited college or university
that may desire to participate. It will perform
four major services as follows: (1) Pre-
admission social service work; (2) hospitalization
social service work; (3) home and community
placement work; and (4) such work in the field
of research as may be desirable.
ADMISSIONS TO COLUMBUS STATE SCHOOL
Admissions to the Columbus State School will
be limited to commitments made by probate
courts and to transfers from other state institu-
tions. A classification staff is composed of the
clinical director, all medical personnel on duty,
the chief psychologist, the chief social worker,
the superintendent of schools and certain other
persons from the staffs. The classification staff
will meet at stated occasions to determine
whether each ward is a long-time custodial case
and if so whether he requires maximum or
minimum security; whether treatment or school-
ing or both will benefit a ward and if so what
plan of education or treatment would be best
suited; what disposition should be made of
each ward.
There are also provisions for the superintend-
ent, upon recommendation of the classification
staff, to reevaluate those under training; pass
upon the fitness of each ward to be allowed to
work outside the school or be granted trial
visit, or be placed in a facility or home outside
the school; recommend trial visits and discharges
from the rolls of the school of all those who may
be released with safety and who have received
maximum training provided.
Upon the recommendation of the superintend-
ent of the Columbus State School, the commis-
sioner of mental hygiene is authorized to dis-
charge such wards as he may deem advisable.
QUOTAS FOR ADMISSION
All feeble-minded persons requiring institu-
tional care will be committed to the Columbus
State School. Until further orders are issued,
plans are to receive at least 75 feeble-minded
persons per month committed by the various
probate courts of the State if requests for ad-
mission should equal or exceed that number.
A quota system has been worked out whereby
each county will be entitled to convey its pro-
portion of persons received.
Ohio Tuberculosis-Health Assn,
To Meet June 1-2 in Columbus
The Ohio Tuberculosis and Health Association
will hold its 32nd annual meeting at the Neil
House, Columbus, June 1 and 2. Dr. Azel
Ames, Jr., Hamilton, president of the Associa-
tion, will preside.
The two-day program will center around the
voluntary health agency and ways and means
by which it can stimulate the provision of
better public health service in the county and
state.
Dr. Thomas D. Dublin, executive director of
the National Health Council, will speak on June 1
and will lead a session on the formation and
use of community health councils.
At the annual meeting of the Board of Di-
rectors, Dr. Robert Bloch, Professor of Medicine,
University of Chicago, will speak on “Tubercu-
losis in General Hospitals.”
The featured speaker at the noon luncheon on
June 2 will be Gerald G. Gross, editor of the
“Washington Report on the Medical Sciences.”
Mr. Gross is well known in medical circles and
is thoroughly familiar with the legislative aspects
of public health.
Dr. Joseph B. Stocklen, Cleveland, is first vice-
president of the Association, and Dr. Charles A.
Doan, Columbus, is secretary. The Executive
Committee includes Drs. Lynne E. Baker, Day-
ton; David W. Heusinkveld, Cincinnati; and
Raymond C. McKay, Cleveland. Dr. John D.
Porterfield, Columbus, is a member ex officio, and
Dr. John H. Skavlem, Cincinnati, is a director-
at-large on the board of the National Tubercu-
losis Association.
ARE YOU REGISTERED TO VOTE?
IF NOT, ACT PROMPTLY
for May, 1950
471
Auxiliary Conference . . .
Officers and Committee Members of State and Local Units Guests at
Columbus Meeting Where National and State Problems Were Discussed
(< T IfOW Can Members of the Woman’s
I j| Auxiliaries Help on Legislative Affairs
and Public Relations?” was the theme
of a conference held in Columbus on March 14
at which key officers and committee chairmen
of County and State Auxiliaries were guests
of the Ohio State Medical Association.
More than a hundred women attended the meet-
ing and heard discussions on problems and goals
common to Medical Societies and Auxiliaries.
As the theme indicates, those present were
given up-to-date information on what is taking
place in Washington and other legislative fronts
and on the educational program of the medical
profession. The meeting was held in the Fort
Hayes Hotel where luncheon was served in the
Gold Room.
Dr. Carl A. Lincke, Carrollton, President of
the Ohio State Medical Association, was chair-
man of the conference and welcomed visiting
Auxiliary members. In an address entitled “We
Want Your Help,” Dr. Lincke outlined the three-
fold purpose of the meeting: (1) To offer some
suggestions as to how the local auxiliaries and
local medical societies can work together; (2)
to get suggestions from Auxiliary members; and
(3) to give key persons of the Auxiliary some
up-to-date information on current state and na-
tional problems.
GOALS FOR 1950
Mrs. C. W. Kirkland of Bellaire, President
of the Woman’s Auxiliary to the Ohio State
Medical Association, spoke on the subject, “Our
Goals for 1950.” The principal goal, she said,
might be summarized as that of training women
in the responsibilities of citizenship. She com-
pared the indifference of Americans toward ag-
gressive citizenship to that which prevailed in
other countries which are now dominated by
totalitarian governments.
“Where Do We Go From Here on Public
Relations?” was the topic of a talk by Mr.
George H. Saville, Director of the Department
of Public Relations of the Ohio State Medical
Association. Mr. Saville gave a comprehensive
review of the public relations program of the
A. M. A. and the Ohio State Medical Associa-
tion— what has been done, and what is being
planned for the future. He stressed the point
that the heart of any public relations program
ARE YOU AND MEMBERS OF YOUR
FAMILY REGISTERED TO VOTE?
for the. medical profession must eventually go
back to the individual doctor.
P. R. PROPOSALS
The public relations chairman for the State
organization of the Woman’s Auxiliary, Mrs.
Farrell T. Gallagher, of Cleveland, spoke on the
subject, “Practical Public Relations Proposals.”
Mrs. Gallagher reminded her hearers that the
Auxiliary has been called “organized medicine’s
great untapped resource.” She gave a compre-
hensive summary of what has been done among
the Auxiliaries in public relations, especially in
contacts with other organizations, establish-
ment of speakers’ bureaus, and the like. A re-
view of successful public relations projects of
Auxiliaries and suggestions for the future formed
a prominent part of her talk.
See Pictures on Facing Page
Mr. Charles S. Nelson, Executive Secretary
of the Ohio State Medical Association, addressed
the group on the subject, “What’s New in
Washington?” After a review of highlight
medical and health bills in Congress, Mr. Nel-
son reminded the audience that regardless of what
takes place in Congress, medical and health
issues will be discussed more in the coming con-
gressional campaigns than ever before. He
then explained the workings of the Association’s
Legislative Committee and County Legislative
Committees, whose members evaluate candidates
for public office as to their qualifications, espe-
cially in regard to their stand on health and
medical matters regardless of party affiliation,
and attempt to interest doctors in the campaigns.
Mr. Nelson concluded his remarks by saying
that “no valid reason can be advanced against
the legal participation by individual physicians
and medical societies anywhere in political
activities, providing the medical profession every-
where, collectively and individually, at the same
time (1) offers a positive, constructive, workable
health program; (2) cooperates with other de-
pendable groups in efforts to solve existing health
problems; (3) makes every possible effort to
supply the people of all communities with medi-
cal services which are adequate in quality and in
quantity; and (4) actively supports those medi-
cal and health proposals which are sound and
desirable.”
‘LET’S DO IT’
Dr. E. O. Swartz, Cincinnati, President-Elect of
the Ohio State Medical Association, gave a stimu-
lating talk on the subject, “We’ve Got a Job To
472
The Ohio State Medical Journal
Ladies Hear and Discuss Public Relations
O. S. M. A. Staff Photos
1. More than 100 key officers and committee chairmen of Woman’s Auxiliaries are shown as they enjoyed luncheon
and discussed problems common to Medical Societies and Auxiliaries, as guests of the Ohio State Medical Association.
2. Three of those at the speakers’ table are shown. They are Dr. E. O. Swartz (left). Mrs. C. W. Kirkland and
Dr. Carl A. Lincke.
3. Educational material for distribution was available at the meeting and is always available through the Columbus
Headquarters Office.
4. Mrs. Kirkland, president of the Auxiliary, is shown as she addressed the group.
5. Mrs. Farrell Gallagher, chairman of the Auxiliary Committee on Public Relations, was one of the principal
speakers.
For details, see facing page
for May, 1950
Alb
Do; Let’s Do It.” Characterizing this as the most
critical year for medicine in our generation,
Dr. Swartz declared that “we must be partisan
to the extent that we support those who take
our part in the struggle.” He reminded his
hearers, however, that the only way to get pub-
lic support is through public service.
Dr. Lincke introduced the following other per-
sons seated at the speakers’ table: Mrs. George
Cooperrider, Columbus, president-elect of the
Auxiliary; Mrs. E. Benjamin Gillette, Toledo,
past-president; and members of the advisory com-
mittee of the Ohio State Medical Association
to the Auxiliary — Dr. Harve M. Clodfelter, Co-
lumbus, chairman; Dr. Paul A. Davis, Akron;
and Dr. Chester P. Swett, Lancaster.
The program was concluded with a general dis-
cussion. A wire recording of the conference was
made. A brochure will be prepared later for
general distribution.
Ohio Trudeau Society Is Formed;
To Meet June 1 in Columbus
A group of interested physicians have formed
an Ohio Section of the American Trudeau So-
ciety. The decision to form this section grew
out of a desire on the part of lay workers in
the tuberculosis field and physicians interested
in tuberculosis and allied chest diseases to work
together in greater harmony through a better
understanding of the problems of each.
The first meeting of the group was held
May 19, 1949, at the Neil House in Columbus.
It was decided that the Ohio Section should be
formed and that the American Trudeau Society
should be petitioned for permission to so form.
Dr. John A. Prior, Ohio State University,
Columbus, was elected temporary chairman. A
petition was drawn up, signed, and forwarded
to the American Trudeau Society. Charter
members signing the petition include Drs. Joseph
B. Stocklen, Cleveland; Harold G. Curtis, War-
rensville; Elsa Klein, Chillicothe; Karl P. Klas-
sen, Columbus; D. E. Wetterauer, Columbus;
Max L. Durfee, Oxford; Frederic M. Howard,
Toledo; Maurice G. Buckles, Columbus; Casper
H. Benson, Columbus; David W. Heusinkveld,
Cincinnati; Edward Arnold, Canton; Raymond
C. McKay, Cleveland; Harrry F. Rapp, Ports-
mouth; William L. Potts, Columbus; John C.
Woodland, Mt. Vernon; Oren A. Beatty, Mans-
field; Arnold B. Kurlander, Columbus; Herman
J. Nimitz, Cincinnati; and John A. Prior.
Approval of the petition was given by the
American Trudeau Society on December 9, 1949.
In the meantime a Committee on Constitution
was appointed to draft a Constitution and By-
Laws. The Committee included Drs. Potts,
Nimitz and Stocklen.
The full support of the finances and staff
of the Ohio Tuberculosis and Health Associa-
tion was offered the new group. It was decided
that the Ohio Trudeau Society should act as
the medical section of the Ohio Tuberculosis
and Health Association in much the same rela-
tion the American Trudeau Society is to the
National Tuberculosis Association.
Meetings are to be held at the time and place
of the meeting of the Ohio Tuberculosis and
Health Association except that additional meet-
ings will be at the discretion of the membership.
The first regular meeting since the applica-
tion for charter was approved will be held at
the Neil House in Columbus on June 1 at the
same time as the annual meeting of the Ohio
Tuberculosis and Health Association.
Dr. Prior has asked Drs. Klassen, Wetterauer
and Kurlander to serve as a Program Committee.
Interested physicians are invited to submit short
papers on tuberculosis and allied diseases of the
chest. The Committee has secured Dr. Robert
Bloch, Professor of Medicine and Chief of the
Division of Pulmonary Diseases, University of
Chicago Clinics, Chicago, as speaker and discus-
sion leader.
All physicians are invited to attend. Com-
munications relative to the meeting may be
directed to the Ohio Tuberculosis and Health
Association, 1575 Neil Avenue, Columbus 1, Ohio.
Brookings Workers Visit A. M. A.
Three staff members of the Brookings Institu-
tion in Washington spent several days at A. M. A.
headquarters recently, discussing the institution’s
study of “Availability of Medical Service in the
United States.” This study, the most compre-
hensive ever conducted in the health service
field, will require several years to complete.
The three staff members are: Mr. Benjamin
B, Kendrick, research associate, who will de-
vote most of his time to the broader aspects
of the study relating to voluntary and compulsory
health insurance; Miss Stella Lackey, assistant
to Dr. George W. Bachman, senior staff member,
who is to devote her time to an over-all study of
private practice, hospitals and clinics, and to
coordinate information which will be gathered
concerning union activities, industry and philan-
thropy; and Dr. Emma Ward, who is making a
specific study of medical services in industry
and medical care programs provided by industry.
While the three workers “headquartered”
with the A. M. A. Council on Medical Service
during their visit, they contacted many of the
other staff and bureau heads for the purpose of
ascertaining the type and quantity of data
available to them in the A. M. A. building.
It is likely that the Brookings people will
be contacting state medical associations soon
for assistance in securing certain information
from the various states.
474
The Ohio State Medical Journal
1. Barach, A. L.: Edema of the Lungs, Am. Pract. 3: 27
(Sept.) 1948.
ORAL... PARENTERAL... RECTAL DOSAGE FORMS
PULMONARY EDEMA
AND PAROXYSMAL
CARDIAC DYSPNEA
The development of pulmonary
edema at night may in certain cases
be prevented and in addition effec-
tively treated by intramuscular . . .
administration of aminophyllin in
dosages of 0.5 Gm."1
The diuretic action of Searle Amino-
phyllin frees the tissues of excessive
fluid; its myocardial stimulating ac-
tion improves the efficiency of heart
contractions.
G. D. Searle & Co., Chicago 80, 111.
searle AMINOPHYLLIN
*Contains at least 80% of anhydrous theophylline.
SEARLE RESEARCH IN THE SERVICE OF MEDICINE
for May, 1950
475
Animal Disease Reporting . . .
More Adequate Control of Diseases Common to Live Stock and Humans Is
Object of Program Sponsored by Departments of Health and Agriculture
BECAUSE of the close relationship between
many diseases of human beings and animals,
physicians will be interested in a new pro-
gram intended to educate the public toward more
adequate control. The report is quoted from a re-
cent issue of Ohio’s Health, a publication of the
Ohio Department of Health.
* * *
The Ohio Departments of Agriculture and
Health have recently inaugurated a jointly spon-
sored program to make an animal disease re-
porting service available to the veterinary pro-
fession.
This new program grew out of a need for reli-
able data on animal diseases. Its objectives
are education of the public to the need for ade-
quate veterinary service to control both animal
and human diseases; keeping the veterinary
profession informed of disease incidence, distri-
bution, and trends; provision of a basis for
intelligent planning of public health and live-
stock regulatory programs by correlating animal
and human disease information; and the evalua-
tion of disease control programs.
BEGAN ON SMALL SCALE
Last year the program was tried on a small
scale. The Committee on Public Health of the
Ohio State Veterinary Medical Association then
recommended that the Association support the
establishment on a state-wide basis of a prac-
tical system for the collection of such informa-
tion. This reporting service went into effect
late in January.
There are three state agencies interested in
the diseases of animals. The Department of
Agriculture is responsible for protecting the
livestock industry against the ravages of disease.
The Department of Natural Resources finds it
necessary to consider disease problems as they
relate to the preservation of wildlife. The de-
partment of Health is concerned with the rela-
tionship between the diseases of man and animals.
COMMON INTERESTS
The interests of these three departments, of
necessity, overlap considerably. Rabies, in ad-
dition to being a public health problem and
the cause of considerable livestock loss, also is
of interest to the Department of Natural Re-
sources because of the apparent reservoir among
foxes and other wildlife in some sections of the
state.
Bovine tuberculosis, while primarily a prob-
lem of the Department of Agriculture, cannot
be ignored by public health people because of
its possible transmission to man through the
use of meat and milk of affected animals. Con-
servation officials, too, must consider the problem
of tuberculosis because of the close relationship
between domestic and wild animals.
The satisfactory handling of the public health
problem of brucellosis must depend upon the
ultimate elimination of the disease from the live-
stock of the state.
While swine erysipelas is not a serious public
health problem, it must be given serious consider-
ation by the Department of Agriculture as well
as by the Department of Natural Resources be-
cause of its possible effect on wildlife.
COOPERATION NECESSARY
In view of these common interests in animal
diseases, adequate control programs make neces-
sary close cooperation between the various de-
partments. Satisfactory coordination will not be
possible, however, until reliable information on
the occurrence and distribution of these diseases
is available. The veterinarian is the logical
source of this data since he must, in his prac-
tice, be acquainted with disease problems in his
area. For this reason, the Ohio State Veterinary
Medical Association is assisting in carrying out
the program.
Report cards and franked envelopes are avail-
able to private and public health veterinarians
through their local health departments. When
an outbreak of an infectious disease is diagnosed,
the veterinarian need only check or fill in the
appropriate blank and mail the card to the
Ohio Department of Health. These cards will
be processed by the Division of Communicable
Diseases and the results made available to the
profession at regular intervals, along with other
information pertaining to animal diseases.
Veterans Must File for Ohio
Bonus by June 30
Eligible Ohio World War II veterans and
eligible next of kin of deceased Ohio World
War II veterans have until June 30, 1950, to
file for the Ohio Bonus, if they have not already
done so. The deadline is set by the Constitu-
tion. Casualty lists of the Army and Navy reveal
that many deceased veterans’ next of kin have
not filed application for the bonus. Headquarters
for the World War II Compensation Fund is at
293 E. Long St., Columbus 15.
476
The Ohio State Medical Journal
In conquering infection, medicine has
built a firm and lasting foundation on
products derived from the earth.
When it comes to control of infections,
be they of bacterial, viral or rickettsial
origin — our “terra firma” has provided a
widening group of effective antibiotics.
In the screening, isolation, and production
of these vital agents, a notable role
has been played by the world’s largest
producer of antibiotics
Pfizer
CHAS. PFIZER & CO., INC., Brooklyn 6. New York
for May, 1950
477
Insurance Examination Fees . . .
West Virginia Medical Society Makes Study of Compensation in That
State and Comes Up With Some Interesting Facts Regarding Increases
AT a recent meeting of The Council of the
West Virginia State Medical Society, the
■^■executive secretary submitted the following
report regarding fees for examinations made by
insurance companies, which will be of interest to
Ohio physicians:
* * *
A form letter was prepared and mailed Sep-
tember 1, 1949, to each of the 100 life insurance
companies and the 108 casualty, health and in-
demnity insurance companies licensed to do
business in this state. A copy of this form
letter has heretofore been furnished to each
member of the Council.
INDEMNITY INSURANCE COMPANIES
Casualty, health and indemnity insurance com-
panies do not require medical examinations ex-
cept in special cases. When the need for such
examination arises then the fee is agreed upon
by the examining doctor and the insurance com-
pany. This policy holds for practically all of
the casualty, health and indemnity insurance
companies which have replied to our form letter.
LIFE INSURANCE COMPANIES
From the replies received from life insurance
companies, it is found that the volume of business
of several such companies doing business in
West Virginia is not sufficient to require fixed
fees for examinations. When examinations are
required, then the fee is agreed to in advance
by the doctor and the life insurance company.
The overwhelming majority of life insurance
companies have heretofore maintained a fixed
fee of $5.00 for medical examinations. A few
have been paying fees slightly under that amount.
No increases in prevailing fees in excess of 50
per cent have been reported by any life insurance
company.
FEES INCREASED
As of this date (January 1, 1950), replies
have been received from 33 life insurance com-
panies, and from 21 casualty, health and in-
demnity insurance companies.
The following eight life insurance companies
have reported that during the past year fees
for medical examinations have been increased
from $5.00 to $7.50:
Connecticut General Life Insurance Com-
pany
Connecticut Mutual Life Insurance Com-
pany
Equitable Life Assurance Society
E'hlslity Mutual Life Insurance Company
New York Life Insurance Company
Travelers Insurance Company
Pacific Mutual Life Insurance Company
Bankers Life Insurance Company
This represents a 50 per cent increase in
fees over the schedules of these insurance com-
panies previously in effect.
The following four life insurance companies
report that during the past year substantial in-
creases have been made in their fee schedules for
certain types of medical examinations:
Business Assurance Company
Commonwealth Life Insurance Company
Guardian Life Insurance Company of
America
Massachusetts Mutual Life Insurance
Company
STUDY BEING MADE
It is interesting to note that six life insurance
companies report that the matter of an increase
in fees for medical examinations is now being
given special study.
Another company, the Acacia Mutual Life
Insurance Company, reports that the fee for
a medical examination remains at $5.00, but that
special fees are allowed where additional informa-
tion is required.
NO INCREASE CONTEMPLATED
Several life insurance companies report that
no increase in fees is contemplated at the present
time. Various reasons are assigned for this
stand, the principal one being that it is thought
inadvisable to increase fees for medical examina-
tions unless premimum rates are increased, and
such increase seems improbable at any time in
the near future.
Some of the companies feel that a fee of
$5.00 is adequate for the services rendered,
and others report that there is very little com-
plaint from doctors concerning the amount of
the fee paid for this type of service.
No increase in fees for life insurance examina-
tions is being considered at the present time
by the following life insurance companies which
have replied to our form letter:
American United Life Insurance Com-
pany
Equitable Life Insurance Company of
Iowa
Farmers and Traders Life Insurance
Company
478
The Ohio State Medical Journal
General American Life Insurance Com-
pany
Kentucky Central Life and Accident In-
surance Company
Liberty Life Insurance Company
Life Insurance Company of Virginia
Metropolitan Life Insurance Company
Minnesota Mutual Life Insurance Com-
pany
Mutual Benefit Life Insurance Company
New England Mutual Life Insurance
Company
Northwestern Mutual Life Insurance
Company
Pan-American Life Insurance Company
Penn Mutual Life Insurance Company
Pilot Life Insurance Company
Provident Mutual Life Insurance Com-
pany
Shenadoah Life Insurance Company, Inc.
10,000 Physicians Expected
At A. M. A. Meeting
Approximately 10,000 physicians are expected
to attend the 99th annual meeting of the Ameri-
can Medical Association in San Francisco, June
26-30. The A. M. A. is the largest medical or-
ganization in the world, with a membership of
about 144,500.
Attracting the doctors will be the scientific
sessions and scientific and technical exhibits.
More than 300 papers devoted to medical and
surgical progress will be presented by outstand-
ing physicians from all over the world.
“These features provide doctors with informa-
tion on the latest developments in medicine,”
said Dr. George F. Lull, Chicago, secretary and
general manager of the A. M. A. “It is such
meetings as these that enable the nation’s medi-
cal profession to keep abreast of progress in
diagnosis and treatment. The outstanding health
record of the United States is the result.”
HOUSE OF DELEGATES
The House of Delegates, the policy-making
body of the A. M. A. made up of 198 elected rep-
resentatives of constituent societies and medical
departments of the Federal services, will consider
matters relating to the health welfare of the
country. It also will choose a president-elect,
to be installed at the annual meeting in 1951.
Meetings of the House of Delegates will be
held in the Palace Hotel. They will be presided
over by Dr. F. F. Borzell of Philadelphia,
speaker of the House.
The installation of Dr. Elmer L. Henderson of
Louisville, Ky., as president will take place on
the evening of June 27. Dr. Henderson will
succeed Dr. Ernest E. Irons of Chicago. The
annual award for distinguished service to the
medical profession will be made on that occasion.
The winner will be selected by vote of the
House of Delegates the day before. The presi-
dential ball will be held June 29. Both events
will be in the Palace Hotel.
San Francisco’s Civic Center, a group of
buildings which has housed some of the largest
national conventions, will be used for the scientific
portion of the meeting. Scientific sessions, which
will cover all phases of medicine and surgery,
will be held in several buildings, including the
High School of Commerce and Masonic Hall. A
technical display by more than 280 exhibitors
will be staged in the Civic Auditorium.
SCIENTIFIC MEETINGS
General scientific meetings will be held on the
first two days of the convention. Sectional groups
will meet on the next three days.
The section programs will deal with anesthe-
siology, dermatology and syphilology, diseases of
the chest, experimental medicine and thera-
peutics, gastroenterology and proctology, general
practice, internal medicine, laryngology, otology,
rhinology, physical medicine and rehabilitation,
military medicine and surgery, allergy, nervous
and mental diseases, obstetrics and gynecology,
ophthalmology, orthopedic surgery, pathology and
physiology, pediatrics, preventive and industrial
medicine, public health, radiology, general and
abdominal surgery and urology.
Of educational interest also will be the presen-
tation of surgical procedures over a closed tele-
vision circuit. The operations will be performed
in one of the local hospitals and transmitted in
color to 20 receivers in Masonic Hall.
The 27th annual meeting of the Woman’s
Auxiliary to the American Medical Association
will be held in San Francisco, June 27-30, concur-
rently with the annual session of the A. M. A.,
with headquarters at the Fairmont Hotel. Pre-
convention schedule includes Board and committee
meetings on Sunday and Monday, June 25 and 26.
Assistant Surgeon General Talks
On Nursing in Cincinnati
The Cincinnati Academy of Medicine was one
of the sponsoring organizations of a meeting
at which Lucile Petry, Assistant Surgeon Gen-
eral of the U. S. Public Health Service, spoke on
the subject, “Nursing Research — How It Affects
and Improves Patient Care.”
Other sponsoring organizations were the Coun-
cil on Community Nursing of the Public Health
Federation and the Woman’s Auxiliary of the
Academy of Medicine. The meeting was held at
the auditorium of the University of Cincinnati
College of Medicine on March 14.
The audience consisted of representatives of
those interested in community health and the role
in it taken by professional nurses.
for May, 1950
479
Resolutions . . .
Some of the Policy Matters Which House of Delegates Will Be Asked
To Consider At 1950 Annual Meeting, Cleveland, May 16, 17, 18
IT is the custom of The Journal to publish
in advance of the Annual Meeting re-
solutions which are to be presented for
action by the House of Delegates, for the
purpose of giving delegates and County Medi-
cal Societies an opportunity to study the
proposals prior to the meeting.
The following resolution will be presented
by delegates from the Toledo Academy of
Medicine to the House of Delegates at the
1950 Annual Meeting in Cleveland, May 16,
17 and 18:
“American medicine is being charged by
certain factions as offering insufficient medi-
cal care. The Profession recognizes that there
is basis in part for some of these charges, due
to a dearth of General Practitioners and a
concentration of doctors in the urban centers.
This deficiency of General Practitioners is
directly associated with overemphasis on spe-
cialization in the university centers resulting
in a lack of interns in the Non-University
Hospitals, the hospitals which are, and should
continue to be, the best training centers for
the General Practitioners of Medicine.
“Whereas there are 807 approved hospitals1
in the United States offering a total of 9,124
internships, and
“Whereas these hospitals reported only
7,068 first and second year interns on active
duty, leaving 2,056 vacancies on 1 Septem-
ber 1948, and
“Whereas the University Hospitals compris-
ing only 25 per cent of the approved hospitals,
with only 29 per cent of the total beds2 and
only 23 per cent of the total patient ad-
missions, have 47.4 per cent of the available
internships with only 17 per cent vacancies —
or one intern to each 21 1/3 beds — leaving the
Non-University Hospitals with 70 per cent of
the total vacancies — or one intern to every 60
beds, and
“Whereas this critical shortage of interns
is working a hardship on the Non-University
affiliated hospitals which are taking care of
77 per cent of the patients in our country,
making it more difficult for them to render
adequate service, resulting in poor public rela-
tions for the profession, therefore,
“Be it resolved that the approved hospitals
of the City of Toledo, through the Academy
of Medicine of Toledo and Lucas County,
hereby petition the Ohio State Medical Asso-
ciation to urge the American Medical Asso-
ciation to request that the teaching Univer-
sity Hospitals directly connected with their
medical schools cease to offer first year rotat-
ing internships, thus making available ap-
proximately 1500 graduates each year to fill
the large number of vacancies in the Non-
University affiliated hospitals. The first year
men thus released under this plan would re-
ceive an intimate association with the general
practice of medicine in these Non-University
affiliated hospitals and be stimulated to enter
this field, thus helping to relieve the critical
shortage of General Practitioners which is so
acute today.”
REFERENCES
1. J. A. M. A., Vol. 140, No. 2, May 14, 1949, pp. 157, 158.
2. J. A. M. A., Vol. 140, No. 2, May 14, 1949, pp. 161
through 170.
^ ^
At a recent meeting the Board of Directors
of the Cleveland Academy of Medicine adopted
the following resolution which will be presented
by Cleveland delegates to the House of Dele-
gates of the State Association at the Cleveland
meeting:
Whereas:
Chapter III, Article VI, Section 6, of the re-
cently adopted revised Principles of Ethics of
the American Medical Association reads:
“PURVEYAL OF MEDICAL SERVICE”
Sectiton 6. — A Physician should not dispose of
his professional attainments or services to any
hospital, lay body, organization, group or in-
dividual, by whatever name called, or however
organized, under terms or conditions which
permit exploitation of the services of the phy-
sician for the financial profit of the agency
concerned. Such a procedure is beneath the
dignity of professional practice and is harmful
alike to the profession of medicine and the wel-
fare of the people.
Whereas:
The committee known as the “Hess” Com-
mittee reported to the American Medical Asso-
ciation House of Delegates in Atlantic City in
June 1949, in detail, regarding the Practice of
Medicine by Hospitals.
Whereas :
The “Hess” report in one paragraph stated in
explanation as follows: “Therefore, hospitals
and medical schools cannot charge patients fees
for medical services rendered by physicians even
though the physicians are full time employees
of an individual or institution.
Whereas:
The “Hess” report was adopted by the Ameri-
can Medical Association House of Delegates and
the Trustees of the American Medical Associa-
tion were instructed to enforce the principles and
obligations involved.
Whereas:
The House of Delegates of the American Medi-
cal Association in Washington in December,
1949, reaffirmed its belief in and confirmed the
principles stated in the “Hess” report and
directed that action by the Trustees be deferred
only until all legal requirements were met in
order to insure that all actions taken shall
comply with the law.
Whereas:
The Trustees of the American Medical Asso-
ciation are to report to the House of Delegates
480
The Ohio State Medical Journal
point off departure
for special
feeding cases... =a_B_£®z*
Dryco is not only the point of departure for
almost every type of infant formula— it is also
injtself a valuable food for special cases.
Dryco assures ample protein intake while its
low fat ratio and moderate carbohydrate
content minimize digestive disturbances.
The applicability of the Dryco formula is
strikingly seen in an observation by Pitt: “The
majority of cases of infant diarrhea, seen
in private practice, are of such nature that
changing the formula to one of low fat and
low carbohydrate is all that is necessary to
correct the condition...” Dryco is specifically
recommended for use in these cases.*
In addition to formula flexibility, Dryco
offers other advantages.
Dryco’s special drying process makes it more
easily digested by certain infants than the
fresh milk from which it is made. It supplies
more minerals, particularly more calcium,
than a corresponding formula of whole milk,
plus 2500 U.S.P. units of vitamin A and
400 U.S.P. units of vitamin D per reconstituted
quart. Only vitamin C need be added. Each
tablespoonful supplies 31V2 calories. Readily
reconstituted in cold or warm water.
Available at pharmacies in 1 and 2^ lb. cans.
*Pitt, C.K.: The Art and Science of Artificial Infant
Feeding , J.M. Asso. Ala. 19:101 ( Oct.) 1949.
3
Dryco®
a versatile
base
for
“Custom”
formulation
for May, 1950
The Prescription Products Division, The Borden Company
350 Madison Avenue, New York 17, New York
481
in June, 1950, regarding this matter and the
“Hess” Committee is to report its further study.
Therefore, be it resolved:
The House of Delegates of the Ohio Medical
Association confirms the action of the American
Medical Association House of Delegates regard-
ing the reaffirmation of the Principles of the
so-called “Hess” report.
Be it further resolved:
The House of Delegates of the Ohio State
Medical Association requests the American Medi-
cal Association House of Delegates to expedite
action and Implement methods that WILL en-
force the Section 6, Article VI, Chapter III of
the Principles of Medical Ethics without delay.
Be it further resolved:
Our delegates to the American Medical Asso-
ciation are hereby instructed regarding these
desires and requested to work for their
fulfillment.
* * *
A resolution similar to the one above was
adopted by the Columbus Academy of Medicine,
with instructions to have it introduced at the
Cleveland meeting.
Association Assigned Health Aspects
Of Institute on Education by Radio
The health education aspects of the program
of the annual Institute for Education by Radio,
a nation-wide affair sponsored by the Ohio State
University, has been taken over this year by
the Ohio State Medical Association.
The Association has asked for and received
the cooperation of the Illinois State Medical So-
ciety in the presentation of the main feature
of this year’s program, which will be a special
session devoted to the televising of the dramatic
program, “Guardians of Your Sleep,” a simulated
surgical operation emphasizing anesthesia.
This program is one of the “Health Talk”
series, televised weekly by the Educational Com-
mittee of the Illinois State Medical Society in
cooperation with WGN-TV, Chicago. At the
Institute meeting, the program will be televised
as a public service feature over WBNS-TV, Co-
lumbus, Saturday evening, May 6, marking the
first time that television has been made a formal
part of the meeting.
This particular program was selected for
presentation in Ohio by the Educational Com-
mittee and by the Council of the Illinois State
Medical Society. The program and Chicago ar-
rangements are under the direction of Miss Ann
Fox, Secretary to the Educational Committee.
Members of the health education study group
of the Institute will view the telecast in the
studios of WBNS-TV. Others may see the pro-
gram from television receiving sets which will
be set up in the meeting room at the Deshler-
Wallick Hotel. The health education group will
again meet Sunday morning, May 7, at the
Luncheon, May 17, For Women
Physicians Is Planned
A luncheon to which all women physicians
are cordially invited will be held on Wed-
nesday, May 17, 12:30 P. M., at Hotel Hol-
lenden, Cleveland, during the 1950 An-
nual Meeting of the Ohio State Medical
Association.
The luncheon is being sponsored by the
Cleveland Branch, American Medical Wom-
en’s Association.
Reservations for the luncheon may be
made at the Annual Meeting Registration
Headquarters, Cleveland Public Auditorium,
by those registering on Tuesday, May 16,
and Wednesday morning, May 17.
Deshler-Wallick Hotel to discuss the special pro-
gram and other aspects of television and radio.
The Ohio Chemical Company through its
dealers, the Columbus Hospital Supply and the
Wendt-Bristol Companies, are providing part of
the equipment. Other equipment will be furnished
by the Ohio State University Hospital. A com-
plete complement of hospital equipment will
be available in the studios of WBNS-TV to lend
authenticity to the telecast. Abbott Laboratories
is making possible the transportation of the cast
from Chicago.
Chicago participants, who will make the one
day trip by plane for the telecast, are Dr.
Max S. Sadove, associate professor and head of
the division of anesthesia, University of Illinois
College of Medicine; Dr. James H. Cross, clinical
assistant in surgery at Illinois; Dr. Allan Tal-
bott, resident in anesthesia, Veterans Admin-
istration, Hines, Illinois; Dr. Theodore R. Van
Dellen, assistant dean at Northwestern Univer-
sity Medical School; and Mr. Edward Pelikan,
senior pharmacology student at Illinois, who
portrays the “patient” in the telecast. Miss Sarah
Timms, R. N., supervising nurse, Surgical Pavil-
ion, Ohio State University Hospital, also will
participate.
Dr. Jonathan Forman, Editor of The Ohio
State Medical Journal, is chairman of the health
education work study group of the Institute and
local arrangements for the special program are
being handled by the Public Relations staff of
the Ohio State Medical Association.
Dr. Alvarez To Edit GP
Dr. Walter Alvarez, senior consultant in the
Division of Medicine in the Mayo Clinic, has been
appointed medical editor of GP, published by
the American Academy of General Practice.
Dr. Alvarez succeeds Dr. F. Kenneth Albrecht,
who died following an automobile accident. Man-
aging publisher is Mr. Mac F. Cahal, executive
secretary of the Academy.
482
The Ohio State Medical Journal
* rr was good to J
HAVE THE DOCTORS WORD
ON IT ; BUT I KNEW CAMEL
MILDNESS AGREED WITH ^
MY THROAT FROM THE
START THEYRE A
GREAT SMOKE!
<s«e of
ihiozt irritation due.
to smoking fotnels!"
Yes, these were the find-
ings of throat specialists
after a total of 2,470
weekly examinations of
the throats of hundreds
of men and women who
smoked Camels — and
only Camels — for 30
consecutive days.
ROBERT LAMKfE
Personnel Director
One of hundreds of
people from coast
fo coast who made
the 30-Day Camel
mildness test un-
der the observation
of throat specialists-
msm
R.J. Reynolds Tobacco Co., Winston-Salem. N. C
ACCORDING TO A NATIONWIDE SURVEY:
MORE DOCTORS SMOKE CMOS
THAN ANY OTHER CIGARETTE
Yes, doctors smoke for pleasure, too! In a nationwide survey, three independent research organi-
zations asked 113,597 doctors what cigarette they smoked. The brand named most was Camel.
THROAT SPECIALISTS REPORT
ON 30-DAY TEST OF CAMEL SMOKERS:
for May, 1950
483
ANNUAL AUDIT OF BOOKS OF THE OHIO STATE MEDICAL ASSOCIATION AND THE
OHIO STATE MEDICAL JOURNAL FOR YEAR ENDING DECEMBER 31, 1949, BY
KELLER, KIRSCHNER, MARTIN & CLINGER, CERTIFIED PUBLIC
ACCOUNTANTS, COLUMBUS, OHIO
OHIO STATE MEDICAL ASSOCIATION
Cash and Bonds on Hand at January 1, 1949:
Cash in Huntington National Bank $ 24,934.76
Cash in Ohio National Bank 60,195.00
U. S. Treasury and Savings Bonds 70,000.00
Total cash and bonds on hand, January 1, 1949... $155,129.76
RECEIPTS
Interest on U. S. Treasury and
Savings Bonds $ 1,750.00
1949 Membership dues collected
in 1949 51,125.00
1950 Membership dues collected
in 1949 41,175.00
1949 Exhibit space collected in
1949 6,041.50
1950 Exhibit space collected in
1949 . 4,682.00
Banquet Tickets sold. Annual Meet-
ing — 2,557.50
Membership directories 180.00
Osmagram cash fund, transferred 26.00
Ohio State Medical Journal re-
imbursement for equipment and
repairs 1,823.84
Total receipts.. $109,360.84
U. S. Savings Bonds purchased in 1949 10,000.00
Total To Be Accounted For (Includes 1950
Dues and 1950 Exhibit Payments, Collected
in Advance). $274,490.60
DISBURSEMENTS
Ohio State Medical Journal.. $ 20,000.00
Executive Secretary, salary 10,000.00
Executive Secretary, expense 1,310.41
Stenographic and Clerical Person-
nel, salaries 11,692.68
President, expense..— 441.62
Council, expense — 1,562.09
A. M. A. Delegates, expense 2,556.75
Conference of County Society Presi-
dents and Secretaries 931.28
Department of Public Relations :
Director, salary.. — — 8,500.00
Director, expense 1,464.22
Assistant Director, salary 4,800.00
Assistant Director, expense... 458.91
Exhibits and newspaper pub-
licity 588.52
Literature 10,054.51
Postage and supplies 2,559.09
Miscellaneous expense :
Part - time clerical,
salaries .....$2,404.00
Other 583.95 2,987.95
Standing Committees :
Education 142.25
Public Relations and Economics.... 308.31
Scientific Work 677.32
Special Committees :
Auditing and Appropriations 180.00
Cancer 52.31
Industrial Health 506.27
Medical Care of Veterans 872.41
Postgraduate Programs 15.00
Rural Health 561.32
School Health 402.69
Annual Meeting 13,451.84
Retirement fund 2,366.62
Postage, telephone, and telegraph— 2,333.89
Professional Relations Activity:
(Osmagram and miscellaneous) — 5,307.91
Stationery and supplies 2,285.41
Rent — — 6,017.88
Employees’ position bond, insur-
ance, Social Security 625.46
Collection of A. M. A. assessment
(supplies and postage) 1,173.75
Fifty-Year membership certificates 161.80
Miscellaneous 376.39
Office equipment 1,669.34
Office repairs 243.38
Rural Medical Scholarship 500.00
Woman’s Auxiliary to Ohio State
Medical Association 300.00
World Medical Association 500.00
Employees’ bonus 3,071.67
Purchase of U. S. Savings Bond,
Series G 10,000.00
Total disbursements $134,011.25
Cash on Deposit and Bonds on Hand, December 31, 1949 :
Huntington National Bank— $ 19,304.35
Ohio National Bank .... 41,175.00
U. S. Treasury and Savings Bonds 80,000.00
Total cash and bonds on hand,
December 31, 1949 140,479.35
Total Accounted For (Includes 1950 Dues and
1950 Exhibit Payments, Collected in Advance) $274,490.60
THE OHIO STATE MEDICAL JOURNAL
ASSETS
Current Assets :
Cash in Ohio National Bank. $ 1,080.82
Petty cash 10.00
Total cash.. $ 1,090.82
Accounts receivable: Advertisers.. 1,698.39
Postage deposit 65.00
Total current assets $ 2,854.21
Property Assets :
Furniture and equipment (depre-
ciated value) 9,615.39
Total Assets $ 12,469.60
LIABILITIES
Deferred Credits : Advertising, 1950 $ 9.50
Surplus, December 31, 1948 $ 13,780.13
Less overexpended income for
year ended December 31, 1949 1,320.03
Surplus, December 31, 1949 $ 12,460.10
Total Liabilities $ 12,469.60
STATEMENT OF PROFIT AND LOSS
Income :
Advertising, gross $ 30,728.05
Less :
Commission on advertising $ 1,949.32
Discount on advertising — 950.99 2,900.31
Advertising income, net ~ $ 27,827.74
Ohio State Medical Association appropriation 20,000.00
Subscriptions and sales.. 677.81
Total income, net $ 48,505.55
Expenses :
Journal printing $ 35,006.31
Printing, other 12.72
Salaries 9,420.00
Traveling expense 47.49
Postage for Journal 829.49
Postage, miscellaneous 269.75
Illustrations and engravings 236.96
Journal envelopes — 1,036.27
Auditing 50.00
Clipping service 225.00
Dues and subscriptions 19.20
Office supplies and expense 1,006.11
Employees’ bonus 690.00
Depreciation 956.28
Bad debts 20.00
Total expenditures 49,825.58
Deficit for the year - - $ 1,320.03
484
The Ohio State Medical Journal
Hospital Subject To Taxation . . .
In Recent Majority Decision, Ohio Supreme Court Holds Institution
Can Be Taxed When It Profits From Services of Its Staff Physicians
A RECENT majority decision rendered by
the Ohio Supreme Court has an im-
portant bearing on the tax status of a
hospital that profits from the conduct of its
affairs, which may include (as in the case
decided) a profit from services rendered by
members of its medical staff. In the case at
issue the court held the hospital subject to
taxation.
The case decided by the Supreme Court
was that of Cleveland Osteopathic Hospital,
Appellant, v. Zangerle, Aud., et al., Appellees.
(No. 31960.)
Following is a report of the majority and
minority decisions of the court, as reported
in the March 20 issue of the Ohio Bar, pages
222-234, inclusive:
STATEMENT OF THE CASE
1. Whether the real property of a pri-
vately owned and operated hospital is
property belonging to an institution used
exclusively for charitable purposes and ex-
empt from taxation as such under the pro-
visions of Section 5353, General Code, is a
question of fact in each individual case.
2. Based on the theory that all property
should bear its proportionate share of the
costs of government and that it should be
absolved from such obligation only for good
cause, taxation is the rule and exemption
the exception.
3. One seeking to have property relieved
from taxes has the burden of showing that
such property comes squarely within ex-
emption provisions of the organic law or
a valid statute.
4. Where on a hearing of an application
by a privately owned and operated hospital
for the exemption of its real property from
taxation under the last part of Section
5353, General Code, referring to “chari-
table purposes,’’ it appears from the evi-
dence before the Board of Tax Appeals that
most of the patients admitted to and cared
for in such hospital pay for their accom-
modations at the established rates, that
physicians and surgeons are employed by
such hospital on salaries and that the
hospital collects and appropriates the
charges made for the professional services
they render, which amounts greatly exceed
the salaries paid, and that from the manner
of its over-all operation the hospital de-
signedly makes a substantial annual profit,
a decision by the Board of Tax Appeals
that the property of such hospital by reason
of its use should not be exempted from
taxation will not be reversed by the Supreme
Court as unreasonable or unlawful on a
statutory appeal from the board’s decision.
Appeal from the Board of Tax Appeals.
The Cleveland Osteopathic Hospital, an Ohio
corporation not for profit, made application to
the Board of Tax Appeals to have certain of
its real estate situated in the village of Bay
taxing district, Cuyahoga county, Ohio, exempted
from taxation for the tax year 1949 on the
basis that it is property belonging to an institu-
tion used exclusively for charitable purposes. The
specific property involved is designated as the
west side branch, is called Bay View Hospital
and has accommodations for about fifty patients.
After a hearing, the board denied exemption
and an appeal was then taken to this court
under favor of Section 5611-2, General Code.
The evidence offered and received on the hear-
ing of the application for exemption shows an
unusual situation. It discloses that several —
six or seven — osteopathic physicians and surgeons
voluntarily withdrew from private practice and
became employees of the hospital at salaries
of about $1,000 per month each. They con-
tinued to see and treat patients at the hospital
and elsewhere much in the same manner as they
had formerly done as private practitioners, mak-
ing the usual charges for services rendered.
However, the hospital became the recipient and
beneficiary of the amounts so charged and col-
lected. It also sent out statements covering
the services performed and received and ap-
propriated the sums paid thereon. Apparently,
this plan is to be a continuing one.
STATEMENT AS EVIDENCE
Introduced in evidence as an exhibit is a
statement of the receipts and expenditures of
the Cleveland Osteopathic Hospital for the Calen-
dar year 1948. It shows total receipts of
$485,532.15 and total expenditures of $374,525.09,
leaving a net operating profit of $111,007.06.
For the professional services rendered by the
several physicians and surgeons referred to above,
the hospital collected $182,242.07, while paying
them as compensation or salaries the sum of
$81,433.49.
The sum of $134,355.51 was received from
“regular patients” and the sum of $102,003.64
from the “Cleveland Hospital Service Associa-
tion.”
Under “Expenditures,” the sum of $8,172.78
is listed for “free service” and the sum of
$1,405.71 for “courtesy service.”
The witness for the applicant hospital testified
that profits made from the operation of the
hospital had been and would be applied in paying
for May, 1950
485
off indebtedness and in improving and enlarging
hospital facilities.
OPINION, PER ZIMMERMAN, J.
Zimmerman, J . On the present appeal, it
becomes the duty of this court to decide the
ultimate question whether under the evidence
adduced in this particular case, the decision
of the board is unreasonable or unlawful.
In the hearing before the board and on the
presentation of this appeal, the hospital relies
wholly on that part of Section 5353, General
Code, which reads:
“Real and tangible personal property belong-
ing to institutions used exclusively for charitable
purposes, shall be exempt from taxation.”
Based on the theory that all property should bear
its proportionate share of the costs of govern-
ment and property should be absolved from such
obligation only for good cause, taxation is the
rule and exemption the exception. Hence, one
seeking to have property relieved from taxes
has the burden of showing that such property
comes squarely within the intent and meaning of
exemption provisions. See Crown Hill Cemetery
Assn. v. Evatt, Tax Commr., 143 Ohio St., 399,
55 N. E. (2d), 660; Welfare Federation of
Cleveland v. Glander, Tax Commr., 146 Ohio St.,
146, 174, 64 N. E. (2nd), 813, 825; Battelle
Memorial Institute v. Dunn, Aud., 148 Ohio St.,
53, 59, 60, 73 N. E. (2d), 88, 91.
It seems obvious that no single test is dis-
positive of whether a hospital, for example, is
being conducted exclusively as a charitable proj-
ect. All the facts in each individual case must
be assembled and examined in their entirety and
the substance of the scheme or plan of opera-
tion exhibited thereby will determine whether
the institution involved is entitled to have its
property freed from taxes.
ILLUSTRATION
An illustration of the above statement is to
be found in the cases of American Issue Publish-
ing Co. v. Evatt, Tax Commr., 137 Ohio St.,
264, 28 N. E. (2d), 613, where under the
peculiar facts of that case the property of a
printing plant was held entitled to tax exemption
and Zindorf v. Otterbein Press, 138 Ohio St.,
287 34 N. E. (2d), 748, where under the peculiar
facts of that case the property of another print-
ing establishment was held subject to taxation,
principally because it was in competition with
other concerns engaged in commercial printing
and because a profit motive was plainly dis-
cernible from the manner in which it ran its
business. Compare, Incorporated Trustees of the
Gospel Workers Society v. Evatt, Tax Commr.,
140 Ohio St., 185, 42 N. E. (2d), 900.
To the writer, at least, the adjective “chari-
table” attached to “hospital” conveys the idea of
a place where service and assistance are given
the sick, injured and ailing, with open doors and
benevolent concern for afflicted souls who lack the
ability to pay for the attentions they receive.
Predicated upon language used in the opinion
in the case of O'Brien, Treas., v. Physicians
Hospital Assn., 96 Ohio St., 1, 116 N. E., 975,
L. R. A. 1917F, 741, and in accordance with the
concept of an organization devoted exclusively to
charitable purposes, a hospital to qualify as a
charitable institution, the property of which is
exempt from taxation, should have as an im-
portant objective the care of the poor, needy and
distressed who are unable to pay, although the
fact that it admits and ministers to a number of
pay patients will not necessarily destroy its chari-
table character. See Trust Company of Georgia
v. Williams, 184 Ga., 706, 192 S. E., 913.
But where a hospital extends its facilities and
services very largely to those who are able
to and do pay the established rates for their ac-
commodation and designedly makes a very sub-
stantial profit in so doing, it places itself in the
classification of a business enterprise amenable
to taxation, notwithstanding that some unfor-
tunate persons without means are cared for free
of charge. See 51 American Jurisprudence, 607,
Section 635.
PECUNIARY GAIN
In the instant case it is plain from the figures
presented that services and accommodations of
all kinds for which charges were made and col-
lected greatly exceeded the services performed
and the accommodations furnished without
charge and that by the procedure adopted and
followed the pecuniary gain to the hospital was
considerable.
The bare fact that a hospital devotes the
profits it makes from the conduct of its affairs
to paying off indebtedness and to improving and
enlarging its plant does not of itself place it in
the category of a tax exempt charitable institu-
tion. It is the use of the property and not the
use of the proceeds derived therefrom which is
determinative of the question of tax exemption.
See Benjamin Rose Institute v. Myers, Treas.,
92 Ohio St., 252, 110 N. E., 924, L. R. A. 1916D,
1170, Incorporated Trustees of Gospel Workers
Society v. Evatt, Tax Commr., supra; Burns v.
Glander, Tax Commr., 146 Ohio St., 198, 64
N. E. (2d), 678; Battelle Memorial Institute v.
Dunn, Aud., supra (148 Ohio St., 53, 61, 73
N. E. [2d], 88, 92) ; New Orphans' Asylum of
Colored Children of Cincinnati v. Board of Tax
Appeals, 150 Ohio St., 219, 223, 80 N. E. (2d),
761, 763.
One recognized test for ascertaining whether
a hospital is charitable or otherwise is whether
it is maintained and conducted for gain, profit
or advantage. 14 Corpus Juris Secundum,
“Charities,” 422, Section 2. And this is a ques-
tion of fact in each individual case. Hamilton v.
486
The Ohio State Medical Jour rial
Corvallis General Hospital Assn., 146 Ore., 168,
30 P. (2d), 9.
It has been held that if the books of a hos-
pital show a substantial profit, that is a circum-
stance tending to negative the idea that it is
a benevolent institution. Prairie du Chien Sani-
torium Co. v. City of Prairie du Chien, 242
Wis., 262, 7 N. W. (2d), 832, 144 A. L. R., 1480.
SALARY FIXING
In 2 Restatement of Trusts, 1167, Section 376,
under Comment b., is the following language:
“The mere fact that persons who are not
objects of charity incidentally benefit from the
maintenance of a charitable institution does not
prevent the institution from being charitable.
Thus, an institution for the promotion of chari-
table purposes is charitable although salaries
are paid to its managers, officers and employees.
//, however, the fixing of a salary is merely
a device for securing the profits of the institu-
tion and not merely compensation for services
rendered, the institution is not a charitable in-
stitution.” (Emphasis ours.)
Here, the compensation paid the physicians
and surgeons working as employees of the hos-
pital was a good deal less than the returns which
the hospital enjoyed by reason of the services
performed for its benefit by such physicians and
surgeons. As a matter of fact, the amounts col-
lected by the hospital for these services contri-
buted in an appreciable degree to the tidy profit
it garnered in 1948.
As concerns the problem of tax exemption in
Ohio, cases from other jurisdictions are ordi-
narily not very helpful, because, more often
than not, the tax-exemption provisions under
which they were decided differ materially from
the provisions on the same general subject ob-
taining in this state.
In the pending controversy, the Board of Tax
Appeals found as a fact that the use made of the
property for which tax exemption is sought did
not bring it within the applicable exemption pro-
visions of Section 5353, General Code, and ren-
dered its decision accordingly. A majority of
this court is of the opinion that such decision
is not unreasonable or unlawful, under all the
facts and circumstances developed, and it is
therefore affirmed.
Decision affirmed.
Weygandt, C. J ., Mathias and Turner, JJ.,
concur.
Hart, Steivart and Taft, JJ., dissent.
DISSENTING OPINION, PER TAFT, J.
Taft, J., dissenting. The facts in this case
as supported by the record and the findings
of the Board of Tax Appeals thereon, were
stated by the board as follows:
“The institution is incorporated not for profit.
“In all matters and things save in two respects
the property of this institution and its manner
of use and operation is comparable to other ex-
empted hospital property and would be entitled
to the same privilege of exemption.
“Instead of reciting all of the facts we deem
it wise to fully set forth wherein the properties’
use differs from other hospitals. This institution
encountered financial obstacles in attempting to
secure funds to purchase its present site, re-
model the building thereon and for its equipment.
The osteopathic fraternity of Cleveland and
vicinity sponsoring its aims, when banks and
other financial institutions refused to advance
funds, by donations and personal loans to it,
provided the funds to make the institution pos-
sible. In order that these loans might be repaid
and supply house credits extended be liquidated,
this fraternity devised the plan of employing
some of its doctor members upon a monthly
salary averaging $1,000 a month. All services
rendered by them within and without the hos-
pital were and are paid for directly to the hos-
pital. These doctors make no independent charge
therefor. The hospital receives all the earn-
ings they produce. They have, in fact, retired
from private practice. This plan has worked
to the extent that the hospital’s operation for
the year 1948 shows a net profit of $111,007.06.
It is evidenced that the first six months of 1949
show comparable earnings. These earnings are
being used to liquidate the institution’s construc-
tion and equipment indebtedness.
FUNDS FOR ENLARGEMENT
“The evidence produces another fact that the
applicant intends to pursue this policy after
these debts are paid for the purpose of providing
funds for further enlargement and betterment
of its hospital facilities.
“It is clear, from the statement made of the
facts unhesitatingly disclosed, that although this
property is in part used for the dispensing of
charity, it is being so used as to produce a profit
from its operation and that the income or earn-
ings are being used in freeing the institution of
debt.”
The record further shows without dispute,
that the arrangement made with these doctors
(herein referred to as the doctors) clearly rep-
presented a great financial sacrifice by them.
As the Board of Tax Appeals stated, if this
arrangement had not been made so that appel-
lant’s receipts exceeded its expenditures in
1948, the board would have found appellant
entitled to tax exemption.
As shown by the figures in the statement of
facts prepared by the majority and recognized
by the statements in the majority opinion, the
doctors, instead of receiving $182,000 during
the year for their services, received only $81,000.
This difference of $101,000 obviously represents
far May, 1950
487
the contribution to the hospital of their services
to the extent of that dollar amount.
Heretofore, this court has always recognized
that the mere fact, that a profit is realized from
the operations of an enterprise, does not mean
that such enterprise is not operating exclusively
for charitable purposes if such profit is devoted
to the charitable purposes of the enterprises.
American Issue Publishing Co. v. Evatt, Tax
Commr., 137 Ohio St., 264, 28 N. E. (2d), 613;
Cullen v. Schmit, 139 Ohio St., 194, 39 N. E.
(2d), 146; Am. Jersey Cattle Club v. dander,
Tax Commr., 152 Ohio St., 506, 513. See O’Brien,
Treas., v. Physician’s Hospital, 96 Ohio St., 1,
116 N. E., 975, L. R. A. 1917F, 741 (syllabus
five) ; Taylor, Admr., v. Protestant Hospital
Assn., 85 Ohio St., 90, 99, 96 N. E., 1089, 39
L. R. A. (N. S.), 427.
AUTHORITY FOR CONCLUSION
This conclusion was clearly recognized by the
General Assembly in its enactment of Section
5328-la, General Code, in 1945, at the time
when it amended Section 5353, General Code.
Authorities outside Ohio uniformly sustain this
conclusion. Nuns of Third Order of St. Dominic
v. Younkin, Clerk, 118 Kan., 554, 235 P., 869;
Baylor University v. Boyd (Texas Civil Ap-
peals), 18 S. W. (2d), 700; Butterworth et al.,
Exrs., v. Keeler, 219 N. Y., 446, 114 N. E.,
803; In re Estate of Rust, 168 Wash., 344, 12 P.
(2d), 396; Virginia Masonic Hospital Assn. v.
Larson, 9 Wash. (2d), 284, 114 P. (2d), 976;
Weiss v. Swedish Hospital, 16 Wash. (2d), 446,
133 P. (2d), 978; In re Estate of Bailey, 19
Calif. Appeals (2d), 135, 65 P. (2d) 102;
New England, SanitaHum v. Stoneham, 205
Mass., 335, 91 N. E., 385; Bd. of Commrs. of
Tulsa County v. Sisters of the Sorrowful Mother,
141 Okla., 32, 283 P., 984. See, also, 51 Ameri-
can Jurisprudence, 608, 3 Scott on Trusts, 2033,
Section 376, 14 Corpus Juris Secundum, 423,
424, Section 2.
None of the cases cited in the majority opinion
tends to support a contrary conclusion. In
Incorporated Trustees of the Gospel Workers
Society v. Evatt, Tax Commr., 140 Ohio St., 185,
42 N. E. (2d), 900, it was held that the use
of the premises for living quarters was the factor
which prevented tax exemption. In Zindorf v.
Otterbein Press, 138 Ohio St., 287, 34 N. E. (2d) ,
748; Benj. Rose Inst. v. Myers, Treas., 92
Ohio St., 252, 110 N. E., 924, L. R. A. 1916D,
1170; and Battelle Memorial Institute v. Dunn,
148 Ohio St., 53, 73 N. E. (2d), 88, tax
exemptions were denied because of uses of the
property involved for commercial purposes. The
tax exemption sought in New Orphans’ Asylum
of Colored Children of Cincinnati v. Bd. of
Tax Appeals, 150 Ohio St., 219, 80 N. E. (2d),
761, was allowed. In Trust Co. of Georgia v.
Williams, 184 Ga., 706, 192 S. E., 913, unlike the
instant case, the hospital was to be open only
to those who paid for its services. Hamilton
v. Corvallis Genl. Hospital Assn., 146 Ore., 168,
30 P. (2d), 9; Prairie du Chien Sanitarium Co.
v. City of Prairie du Chien, 242 Wis., 262, 7
N. W. (2d), 832, 144 A. L. R., 1480, and the
underlined portions, quoted in the majority
opinion from Comment b, under 2 Restatement
of Trusts, 1167, Section 376, involved situations
where the hospital or other institution was used
as a device to provide profit for its mem-
bers or promoters. This is the reverse of the
instant case where the promoters (the doctors)
are used by the hospital to provide funds for
its charitable operations.
It is submitted that the more nearly applicable
portion of the Restatement is the subsequent
Comment d following the Comment b quoted in
the majority opinion. Such Comment d reads in
part :
“A charitable trust does not cease to be such
merely because its operation results in a profit,
provided that the profits are to be applied only
to charitable purposes. It is only when the
profits may be applied to private purposes that
the trust ceases to be charitable. The trust is
charitable whether the profits are to be used for
the purposes of the undertaking producing the
profits or for other charitable purposes.”
The majority opinion seems to have overlooked
that there is a sound legislative reason for
granting tax exemption to “property belonging
to institutions used exclusively for charitable
purposes.” The words “charitable purposes” are
usually understood to include those purposes,
the accomplishment of which is beneficial to the
community. Cleveland Bible College v. Board
of Tax Appeals, 151 Ohio St., 258, 264, 85
N. E. (2d), 284; Waddell, a Minor, v. Y. W. C. A.,
133 Ohio St., 601, 604, 15 N. E. (2d), 140; 2 Re-
statement of Trusts, Section 368 and Comment
b thereon. When it provides for their tax ex-
emption, the General Assembly merely recognizes
in a small way the obligation which the state
owes to institutions devoted to charitable pur-
poses. 51 American Jurisprudence, 510, Sec-
tion 504; Cedars of Lebanon Hospital v. Los
Angeles County (Cal. Dist. Ct. of App.), 206
P. (2d), 915; Myers, Treas., v. Benjamin Rose
Institute, 92 Ohio St., 238, 251, 110 N. E., 929.
JUSTIFIABLE BENEFIT
It might well be argued that, as to hospitals
in this state not used as devices to provide
profits for stockholders or other individuals,
they are of sufficient benefit to the community
to justify their treatment as charitable in-
stitutions, even if (as they are not in the
instant case, all patients are required to pay for
the services received from such hospitals. Weiss
v. Swedish Hospital, supra, at 451. This is espe-
cially true in Ohio where most communities are
488
The Ohio State Medical Journal
sorely in need of adequate or even some hos-
pital accommodations.
In the instant case, if, instead of devoting over
$100,000 of their services to the hospital in
1948 and thereby enabling the hospital to have
such an excess of receipts from operations over
disbursements, these doctors had contributed that
sum in money as a gift to the hospital, no ques-
tion of its tax exemption could have been raised
without specifically overruling previous decisions
of this court. O'Brien, Treas., v. Physician's
Hospital, supra; College Preparatory School for
Girls v. Evatt, Tax Commr., 144 Ohio St., 408,
59, N. E. (2d), 142; Taylor, Admr., v. Protest-
ant Hospital Assn., Supra. The interest of the
community in having such a hospital is just as
great where donations in cash are not avail-
able as where they are. That interest is the
interest which justifies classification of the
hospital as a charity and enables it to secure
the tax exemption provided by the General
Assembly.
No institution, even a charitable one, can
operate at a loss indefinitely. Where cash dona-
tions are not available to make up for operating
losses, the need of tax exemption is greater than
where such donations are available. The mere
facts, that a hospital is operated efficiently
within its income and supported in part by
donations of services instead of cash, should
not prevent -it from receiving tax exemption.
Any distinction between donations of money
and donations of services would appear to be a
distinction without a difference.
Hart and Stewart, JJ., concur in the fore-
going dissenting opinion.
Journal of Proctology
Recently the first issue of a new publication,
The American Journal of Proctology, was issued.
The journal is the official publication of the
International Academy of Proctology and is
under editorship of Dr. Alfred J. Cantor. The
journal will publish original articles on proctology
and allied subjects as well as the official pro-
ceedings of the scientific sessions of the Aca-
demy. Dr. Cantor’s address is 43-55 Kissena
Blvd., Flushing, N. Y. The publication office of
the journal is 1819 Broadway, New York 23.
Dr. Daniel Blain, medical director of the
American Psychiatric Association, was guest
speaker at the March 13 annual meeting of the
Montgomery County Mental Hygiene Association
in Dayton.
The Cleveland Health Museum recently gave a
preview of a new film, “Challenge: Science
Against Cancer.” The film has been produced
by the National Film Board of Canada and the
Association of American Medical Colleges.
Patient Waits and Waits Under Medical
Program in England
An Ohio physician has forwarded to the State
Headquarters Office excerpts from two letters
which have been received by an Ohio business
woman. The letters are from a woman in
England who holds a responsible position with
a business firm in a well-known English city.
The excerpts are published here for information
of the reader with regard to current conditions
in England, concerning which he may wish to
advise his patients.
“February 14, 1950
“This reminds me, that I am still without
my glasses. Was speaking to a friend the other
day, and am told that if an appendicitis operation
is necessary, it is a two-year wait to get a
hospital bed. Marvellous, we are paying very
heavily for our medical benefits, and are getting
less and less than before. To have a tooth ex-
traction, you cannot get an appointment under
3 months, that wouldn’t be as bad, if you could
induce the tooth to cease aching for a similar
period.
“No, prevent nationalization where health is
concerned if you can help it. It is an expensive
luxury. The thing that irritates very much, is
the fact that people entering our country are
issued with the return of their passports, a
document assuring them that they are entitled to
free medical benefits, including wigs and artificial
limbs whilst over here, and of course a certain
type make a point of getting it, and have priority
owing to the briefness of their visit. And, of
course, they have never contributed a Id (1/12
of a shilling) towards it. Our Health Minister
to our protests replies that we are building up
a good name for ourselves as a consequence
overseas.
“The majority of us are most annoyed that
it should ever have been necessary to accept aid*
from your country, or that it should have been
mismanaged and spent in crazy ways after
receipt, but there is always a section of the
community who believe every fantastic promise
made to them, and they cannot, or will not look
ahead to the future. So we others are just
waiting and praying for Divine help to bring
us to sanity, and to teach all that existence is
only by personal hard work, and not in existing
on the charity of other nations.
“I suppose we are going through a period of
evolution but I do hope that we can plan ahead
a little more as individuals and not just be-
come automatons under State control. Freedom
has always meant such a lot to the English
speaking peoples.”
jJ: s*c
“March 14, 1950
“By the way, I have not yet got my spectacles,
and the medical profession is so over-worked fill-
ing up Government forms for this and that, they
are left with little time for the attention of the
sick. Unless you have reached the stage where
it is a case of ‘either’ or ‘or’ you might as
well cure yourself. In addition the extra form
filling placed on the doctors has increased the
hours worked to anything up to 80 hours per
week, by which time they are feeling so ill
themselves, that concentration on other peoples
illness is almost a sheer impossibility.”
for May, 1950
489
United Medical Bill Opposed . . .
Executive Committee of A. M. A. Board of Trustees Issues Statement
Against H. R. 5182 Proposing Federal United Medical Administration
A STATEMENT of policy opposing H. R.
5182 which proposes consolidation of cer-
tain hospital, medical and public health
functions of the Federal Government in a
United Medical Administration — one of the rec-
ommendations of the Hoover Commission On
Organization of the Executive Branch of the
Government — has been adopted by the Execu-
tive Committee of the Board of Trustees of the
American Medical Association after consultation
with the Coordinating Committee on Legis-
lation of the A. M. A.
The statement points out that the A. M. A.
favors the purpose of the Hoover Commission’s
recommendation to effect economy in govern-
mental operations but believes that H. R. 5182
falls short of that goal and contains several
objectional provisions.
TEXT OF STATEMENT
Following is the text of the official statement
issued by the Executive Committee of the
A. M. A. Board:
“We are of course in favor of the purpose
of the Hoover Commission’s recommendation
in attempting to effect economy in the opera-
tion of the several medical services under the
Federal Government, provided that economies
can be in reality accomplished without sacrifice
of the quality of service rendered and without
interfering with the special missions of certain
of these services.
“A careful perusal of H. R. 5182 reveals no
evidence of how economies are to be accom-
plished, how the special functions of the sev-
eral services are to be preserved or how the
quality of medical care is to be safeguarded.
AUTHORITY WITHOUT RESTRAINT
“We object also to the administrative pro-
visions of the bill. The administrator, who is
to be directly responsible to the President, is
given blanket authority to issue regulations
having the force of law without any restraint
but that of the President and of a Board made
up of the Surgeons General of the Army,
Navy and Air Force and the Administrator
of the Veterans Administration. The United
States Public Health Service, with its multiple
activities and responsibilities, has no represen-
tation on this Board. The Board can act
only in an advisory capacity and can in no
way control the decisions of the Administrator.
“The American Medical Association has re-
peatedly advocated the consolidation of the
medical activities of the Government other
than those of the Veterans Administration and
the Armed Forces under a single Department
of Health.
“It also believes that an integrated system
of hospitals should be developed for the country
as a whole, such as is now developing under
the Hill-Burton Act. It believes, however, that
the consolidation of the medical services as pro-
posed in H. R. 5182 at this time, or until such
time as careful study has developed convincing
evidence of the wisdom of such a consolidation,
would be a risky procedure and fraught with
great possibility of harm.
CAREFUL STUDY NEEDED
“The Association is of the opinion that the
Congress should proceed slowly in this matter
and that any action by the Congress should be
preceded by a careful study of the entire prob-
lem with particular reference to possible eco-
nomy, the effect on the quality of medical care
and on the execution of the primary missions of
the Armed Forces, the Public Health Service and
the Veterans Administration.
“It believes that the principal economy to be
accomplished is in the coordination of the several
Federal hospital systems that would provide for
joint use of available beds and joint planning
in the field of hospital construction. It believes
a central hospital board, clothed with authority
to adjust the hospital program to the needs of
the services, could gain the ends desired without
consolidation of professional personnel.”
Planned Parenthood League Medical
Board Schedules Luncheon
A luncheon meeting of the Medical Advisory
Board, Planned Parenthood League of Ohio,
will be held on Wednesday, May 17, at 12:15 p. m.,
in the Hotel Hollenden, Cleveland, during the
Annual Meeting of the Ohio State Medical Asso-
ciation.
Dr. William C. Weir, Cleveland, will preside
as chairman of the Medical Advisory Board. He
recently succeeded Dr. Allan C. Barnes, Columbus,
who is continuing to serve on the Executive Com-
mittee. Other members of the committee are Dr.
J. H. J. Upham, Columbus, honorary chairman;
Dr. M. A. Blankenhorn, Cincinnati; Dr. Harrison
Evans, Worthington, and Dr. J. C. Placak, Sr.,
Cleveland.
490
The Ohio State Medical Journal
T ^k11 ^ i # Comments on Current Economic and Social
AH vAlll/ VA A) lxll 0X1 • Questions and Professional Problems;
-- - ■ - Suggestions Regarding Organized Activities
INFLATED COSTS WILL
WRECK PROGRAMS
Voluntary health insurance which is the
strongest, if not the only, alternative to govern-
ment-controlled compulsory health insurance, can
easily become too expensive for people in the
low-income group, Dr. Paul R. Hawley, execu-
tive director of the American College of Sur-
geons and former executive director of the Blue
Cross-Blue Shield plans, stated in an address at
the 10th anniversary dinner of Hospital Care
Corporation (Blue Cross) of Southwestern Ohio,
held recently in Cincinnati.
Amplifying this statement, Dr. Hawley said:
“Too many people, doctors included, labor under
the erroneous impression that health insurance
lowers the cost of medical care. It doesn’t, and
cannot lower it one penny. It only spreads it.”
He then emphasized that the voluntary hospital
and medical plans are at the mercy of hospitals
and doctors. Hawley pointed out that hospitals
must keep hospital costs reasonable through
efficient administration and that physicians must
help to prevent abuses by keeping patient ad-
missions on a “necessity” basis and hospital stays
at a minimum. Voluntary medical insurance can
be “priced” out of business by excessive charg-
ing and other abuses, Hawley added.
Dr. Hawley touched once more on the old, old
story that it takes only a few bad practices
on the part of a few bad actors to kill off
something of benefit to everyone concerned.
SHOW AND TELL THEM
WHAT WE’RE FOR
“Show Them What We’re For” is the head-
line appearing over an editorial in a recent
issue of a medical magazine of national circula-
tion. The point is made in the article that more
constructive action by the medical profession
is needed; that a better job of letting the
people know what the medical profession is doing
and stands for, is required.
In our opinion, the recommendation is sound
and should be heeded.
The day is past when the physician can go
before the public, armed only with arguments
against this bill or that program. He must
be prepared to tell his listeners about the many
things which the medical profession is doing to
improve the health of the people; how it is work-
ing with many other groups and organizations
to make programs in the public’s interest ef-
fective; what pieces of legislation the medical
profession endorses and is actively supporting;
why the measures which are fundamentally
wrong in principle would be harmful to the peo-
ple generally — not just why they would adversely
affect physicians.
There is a wealth of material on the con-
structive side which is available to the physician-
speaker. “The 25-Point Health Program” of
the Ohio State Medical Association and what is
being done by medical societies all over the state
to promote those points offer the basis for a
corking good positive and constructive talk.
The history and progress of Ohio Medical In-
demnity, the Ohio profession’s prepaid medical
care plan, make a fascinating story to tell an
audience. Most of the County Medical Societies
are engaged in important community activities.
The public should be told about these. (Unfor-
tunately, the medical profession is still too
reticent about tooting its own horn.)
These are merely a few examples among many
things which the physician can talk about. If
he does just that, he can easily show his audi-
ences by inference that they don’t need a lot of
the fancy stuff being suggested by the boys
along the Potomac.
Of course, if the local medical society is dead
on its feet and the majority of the doctors in
the county “are too busy” to meet their civic
duties — well, there’s nothing much to talk about
to the folks in that county. That’s just too bad,
isn’t it?
MEDICAL BOARD ON JOB,
REPORT REVEALS
Report for the calendar year 1949 of the State
Medical Board reveals that the Board’s two
inspectors investigated 169 complaints of illegal
practice and made 1,530 calls in making these
investigations. It shows that 65 cases against
illegal practitioners were filed in court; con-
victions secured in 42 cases; two cases dismissed;
21 cases awaiting trial; and five cases from
former years concluded.
The Board held 12 regular and special meet-
ings during the year, including hearings con-
cerning suspension or revocation of licenses and
the examination of applications for a license
in Ohio.
These statistics alone show that the Board
is on its toes and doing a real job despite the
handicap of inadequate finances, especially for
inspection personnel.
One thing is vital when the Board makes a
check-up of illegal practitioners in any county:
It needs the help and cooperation of the medical
profession, especially on the matter of securing
competent evidence and proper witnesses. Be-
for May, 1950
491
fore a ease is taken to court, sound evidence
and reliable witnesses must be obtained. Phy-
sicians can be a big help to the Board’s in-
spectors on such matters. Lack of substantial
evidence is responsible for the failure in most of
the cases which fail to get to court or are dis-
missed. Also, two inspectors for 88 counties
is spreading it pretty thin, but that’s all the
budget will allow.
“GP” WELCOMED
TO THE FOLD
Latest newcomer to the ranks of medical pub-
lications is GP official magazine of the Ameri-
can Academy of General Practice. The first
issue is a beauty. The scientific and clinical
material was written by a battery of high-
class essayists. The news sections are meaty
and well done. GP is a healthy looking baby
— not so small at that with its 128 pages — and
gives promise of quickly becoming an important
member of the medical press. Here’s wishing it
the best of success
THE TEMPTATION WAS
JUST TOO GREAT
An editorial writer in a Northern Ohio news-
paper has chastised a physician who, while ad-
dressing a gathering of citizens on the Truman
health program, put in some plugs for reelection
of Senator Robert A. Taft.
According to the writer of the editorial, the
physician should have stuck to his subject and
should not have brought the political issue into
the talk. He admits that physicians as individ-
uals have a right to be for Taft if they want to,
but he makes the point that some of the listeners
experienced a feeling of having been tricked
because “the meeting had been, billed for a dis-
cussion of socialized medicine — not as a vehicle
for a political rally,” and that it was implied that
those who do not vote for Taft are “not good
Americans.”
Although it may be difficult for anyone who is
opposed to socialized medicine to be anything
but in favor of the reelection of Taft, the
gentleman of the Fourth Estate may have a point
worthy of consideration. We don’t feel the ques-
tion which has been raised is nearly as serious
as the editorial implies. However, it does present
a warning to the physician who takes the public
platform. He should stick to his subject; con-
fine himself to the purposes of the meeting;
and be diplomatic if he decides to touch on
politics.
Doubtless Mr. Taft would agree that he doesn’t
need platform speakers in his behalf nearly as
badly as he needs folks who are willing to go
out, rub elbows with folks hither and yon, and
tell them in a personal way why they ought to
be for the senior Ohio Senator.
WILL OHIO RANK LOW AGAIN IN
BIRTH-DEATH REGISTRATIONS?
With the 1940 decennial census, a test was made
to determine the thoroughness with which births
had been registered in the various states. Ohio,
with only 95.6 per cent of births registered
during the test period, ranked lowest of the Mid-
western States.
A similar test is being made with the 1950
census. This time both birth and death reg-
istrations are being counted. The test includes
only those births and deaths which occurred dur-
ing the three-months period January 1 through
March 31, 1950. Although the period is now
past, leeway will be allowed for certificates which
come in late but which register births or deaths
for the period.
In addition to their value as vital statistics
records, birth and death certificates are bcom-
ing increasingly valuable to individuals, families
and heirs.
Ohio is one of the most progressive states and
should be at the top of the list as far as regis-
trations are concerned. There is still time if
you have a registration for the period not com-
pleted, or if you have a colleague who has not
completed a registration. And why can’t we
make it 100 per cent the year ’round?
GOOD WORK BEING DONE
IN LORAIN COUNTY
Hats off to the doctors in Lorain County!
All but six of the 119 members of Lorain County
Medical Society are registered and eligible to
vote, according to the Public Relations News
Letter of Dr. Theodore Berg, chairman of the
Society’s P. R. committee. Indications are that
the delinquent six will be brought into the fold
before too long. Appears as if some good work
has been done in Lorain County. Other counties
please copy. Getting every doctor in Ohio reg-
istered and then to the polls in November should
be the goal of all county medical societies dur-
ing the ensuing months. It’s a job for the Legis-
lative Committee or a select committee or the
Woman’s Auxiliary — and a big one.
TOUR OF EXHIBITS SHOULD BE
A “MUST” ON YOUR SCHEDULE
Those planning to attend the Annual Meeting,
May 16-18, Cleveland, should make repeated
tours of the Technical and the Scientific and
Educational Exhibits a must. When visiting
the booths, each member should register and
spend time getting acquainted with the exhibit
representatives.
As another state medical society magazine
pointed out recently, “our annual meeting would
be but a poor shadow of its usual self were it
not for the technical or commercial exhibits.”
It then emphasized that the technical exhibits
492
The Ohio State Medical journal
bring the doctor up to date on the practical ap-
plications of advances in medicine and medical
technology and provide a means for getting first
hand information on the value and uses of the
finest pharmaceutical, biological and surgical tools
in existence.
The Scientific Exhibits need no press agent.
As in the past they will be of high standard and
value. They will present a beneficial course in
visual education. Those who have gone to the
time and effort to present these displays deserve
the support of all in attendance. Visit each one
and discuss the subject with the person in charge.
Unless you make a thorough tour of these
exhibits — technical and scientific — a “must” part
of your schedule you will be overlooking a real
bet; you will be letting down the firms, organ-
izations and individuals who are sponsoring the
displays.
TOO LITTLE TAUGHT ABOUT
WHAT IS RIGHT IN U. S. A.
Commenting on the Hiss case, Raymond Moley
in Newsweek points out that Hiss was educated
in an institution provided by the profits of the
very economic system that Communism is deter-
mined to destroy. Then Moley adds this ad-
monition which applies to many schools and
colleges all over the nation:
“It may well be considered by those who
direct higher education in America whether
there is not a need to reexamine their respon-
sibilities and the way they are carried out.
The danger is not that there is too much taught
about what is right in Communism, but that
there is too little taught about what is right
in America.”
MEDICINE LOSES A
REAL FRIEND
Through the recent untimely death of Victor
L. Keys, Columbus, the Ohio State Pharmaceu-
tical Association lost the services of an efficient,
loyal executive secretary and the medical pro-
fession of Ohio, a staunch ally.
One of Mr. Keys’ last acts was to assist on
arrangements for a joint meeting of officials of
the Ohio State Pharmaceutical Association and
the Ohio State Medical Association. This was
held on April 1 for the purpose of discussing
in an informal way some of the mutual prob-
lems of the two professions. As a result of that
meeting, a joint committee has been set up to
continue conferences and to draft a proposed
joint statement of policy on various matters, to
be submitted to each organization for ratification
at a later date.
It would be a real tribute to the fine work
which Mr. Keys did, not only for pharmacy but
also for medicine, if something of lasting value
can come from the series of conferences which
he helped to originate.
THE GOVERNMENT CAN SUPPLY
SOME NEEDS, BUT NOT ALL
A recent survey conducted by the psychiatry
and neurology division of the Veterans Admin-
istration disclosed that about a third of the
mental patients in V. A. hospitals had been visited
by neither family nor friends for a year or more.
The report states that while visitors might be
disturbing in some instances, they would be
highly beneficial in the majority of cases.
The survey uncovered many cases of veterans
whose families refused to accept them back
home when medical discharge was indicated.
Without being facetious on such a pathetic
theme, it does not seem out of place to point
up an underlying moral. Here are cases in
which the Government (and justly so) has
gone all out to provide the best in medical service
to men who highly deserve it. Yet there prob-
ably are not more than a few of the more than
14,000 who would not gladly exchange their
lot for the most humble existence in family
or community life.
Few of these men likely will join in reciting
the psalm of the bureaucrats, “The State is
my shepherd, I shall not want.”
PROFOUND WORDS BY
MR. BRANNAN
According* to the Washington (D.C.) Evening
Star, the following passage from a recent report
of Secretary of Agriculture Brannan (genius
behind the socialistic Brannan farm plan) should
be engraved in marble or other lasting stone and
placed above the main portal of the Department
of Agriculture’s fine building:
“Experience with potatoes and with eggs
shows that it is much easier to buy than to
sell.”
This emotional eloquence and these profound
words (sic) are not too difficult to understand
after a look at the scrambled-egg and mashed-
potato methods of financing now employed by
the group with which Mr. Brannan is associated
and which is guiding the economic destiny of the
country.
IT USUALLY TAKES MORE
THAN IT GIVES
Newsweek says that Paul L. Styles, new
member of the National Labor Relations Board,
has hung a picture of the late Samuel Gompers,
onetime head of the A. F. of L., on his office
wall along with this Gompers’ quotation: “What
the government gives you, the government can
take away, and once it starts taking away, it
can take more than it gave.”
It’s about time this quotation received
nation-wide circulation, not only among the
rank and file of labor organizations, but among
plenty of other citizens who are making it a
habit of extending an itching pahn toward
Washington.
for May, 1950
493
Washington Roundup . . .
News and Developments on Proposed Medical and Health Legislation
Now Before Congress; Other Events of Interest in Nation s Capital
ALTHOUGH Congress is beginning to look
toward adjournment so members can get
^ ^home to build up political fences, some hot
medical and health proposals continue to hold the
spotlight.
The following news on the status of pend-
ing bills and on other events and developments
in Washington is taken from recent bulletins
issued by the Washington Office of the American
Medical Association.
American Medical Association is moving into
the windup months of Congress with its contact
and legislative work up to date. In four days
of conferences and meetings in Washington,
leaders of the association reviewed legislation
introduced in the last two months, talked with
Representatives and Senators and generally
appraised Washington developments.
For their sessions, 20 A. M. A. leaders met
for the first time in the Association’s new
Washington offices, located across L street from
the Statler Hotel.
AID TO MEDICAL EDUCATION
The Easter House recess delayed Committee
work on Federal Aid to Medical Education
(H. R. 5940). The House Interstate and Foreign
Commerce Committee got started in executive
session on the medical education bill, but had to
sidetrack it temporarily. The full Committee is
trying to decide whether to go along with a
subcommittee’s recommendations, one of which
gives the council authority over the Surgeon
General in approving grants. Other recom-
mended changes are:
Schools of sanitary engineering would be-
come eligible.
Scholarship provisions to be dropped from the
bill (except nursing).
The Surgeon General would allocate funds
among the several classes of schools only after
approval of the National Council on Education
for Health Professions. In original bill the
Council merely advised. If the appropriations
are not sufficient, the amount paid for each
student would be uniformly reduced.
A revised provision cuts the total Federal
payment to any school (except schools of nurs-
ing) from 40 per cent to 30 per cent of the
school’s annual cost of instruction.
In certifying eligible schools the Surgeon
General must follow standards prescribed by
the Council. Under the old bill the Council was
merely advisory.
Approval of schools of nursing would be left
to an agency of the state. The original bill gave
the Surgeon General such power.
A new provision authorizes the Surgeon Gen-
eral, in determining whether to make a construc-
tion grant and arriving at the amount, to give
consideration to the ability of the applicant to
defray the cost of the contemplated construction
and equipment without receiving assistance from
the government. Such grants could not be in
excess of 50 per cent or less than 33-1/3 per cent
of the cost of such construction or equipment.
Not more than 25 per cent of such funds for
construction may be allotted to schools and
facilities within any one state.
Schools applying for assistance for construc-
tion and equipment would be approved or ac-
credited by a recognized body or bodies ap-
proved for the purpose by the Surgeon General
in accordance with general standards prescribed
by the Council.
A revised section provides that if a school
within ten years fails to carry out its full con-
struction and equipment commitments, the U. S.
shall be entitled to recover its contribution less
depreciation.
The section safeguarding schools against
Federal control has been rewritten and prohibits
interference in the control of personnel or curri-
culum.
SCIENCE FOUNDATION
Concession by both House and Senate members
of the conference committee has speeded up
progress of the National Science Foundation
Bill (S. 247). First House members backed down
on the strict security requirements. One House
amendment had required that the F. B. I. itself
rule on candidates for Foundation employment
or scholarships, rather than merely report the
facts without recommendations, the usual F. B. I.
responsibility. Instead conferees agreed infor-
mally on the following system for clearance:
1. An F. B. I. report without recommendation on
all persons who would have access to information
on national security. 2. For persons having ac-
cess to “classified” information, clearance would
be the same as for Atomic Energy Commission
or military service. 3. Where the employee
would not have access to “classified” or security
information, the standard government loyalty
oath would suffice. After this — the most con-
troversial point — had been argued out, the Sen-
ators accepted House restrictions on amount of
money to be spent by the Foundation. This
means the Foundation will have half a million
dollars the first year while it is being organized.
Then its spending will work up to an eventual
limit of $15,000,000 annually.
HUNT INSURANCE MEASURE
Senate Labor and Public Welfare Committee
hearings on Senator Hunt’s National Health In-
surance Bill (S. 2940) and Senator Humphrey’s
bill to assist co-op and non-profit health insur-
494
The Ohio State Medical Journal
ance associations (S. 1805) both have been shoved
back. The plan now is to take testimony from
just one witness on S. 2940, Senator Hunt him-
self. The Wyoming- Senator-dentist, who has
done considerable lecturing- on health problems
in the last few months, says he finds the pub-
lic more concerned about the cost of hospital
care than doctors' charges.
Hearings on S. 1805 will be held May 9 and 10,
A representative of A. M. A. will testify in op-
position to this bill.
V. A. SQUABBLE
Veterans Administration personnel reductions
are creating a confusing situation in the medi-
cal department. However, no physicians, den-
tists or nurses have been given notice, and
none will be until V. A. gets a hard and fast
decision from Congress as to how much money
it will have available, both in deficiency appro-
priations and in appropriations for the next
fiscal year. It is reported that V. A. called off the
professional personnel reductions only after get-
ting informal assurance that it would receive
enough money to keep all currently employed
physicians, dentists and nurses on the payroll.
MILITARY HOSPITAL CUTBACK ROW
The House Armed Services Subcommittee
which investigated military hospital cutbacks
has asked Defense Secretary Johnson to again
review the conflicting arguments. After open
hearings in Washington and two inspection trips
the Committee was faced with two sets of testi-
mony, so far apart factually that no recommenda-
tions could be made. Meanwhile, the hospital
reduction program moves ahead as scheduled,
under Dr. Richard Meiling, director of the
Office of Medical Services, formerly of Colum-
bus, Ohio.
Some background on the Defense Department's
hospital cutback program may help to explain
the charges and counter-charges now out in
public. After the cutback program was drawn
up, the three surgeons general were asked their
views, Major Gen. R. W. Bliss (Army), Rear
Adm. C. A. Swanson (Navy) and Major Gen.
Harry G. Armstrong (Air Force). Present at this
meeting of the Military Medical Council, in addi-
tion to these three officers, were Dr. Meiling, Rear
Admiral Joel T. Boone, top military man directly
under Dr. Meiling, and Secretary Johnson.
Gen. Armstrong accepted the program and
supported it from there on. Gen. Bliss, Adm.
Swanson and Gen. Armstrong were asked to
talk it over and come back with any suggestions.
Their first counter-proposal was rejected by
Secretary Johnson because he considered the sav-
ings insufficient. They returned with a second
proposal, under which five, not 12, general
hospitals would be closed, and 13 other hospitals
IF YOU’RE NOT REGISTERED TO VOTE,
VISIT YOUR ELECTION BOARD
0 milk modified
. with
^4' Maltose s dexti
M PHOSPhIS.N 0F A SMALL AMW
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rm
NORMAL DILUTION
Dextrogen®+ Water = Formula
f 1 fl. oz. VA fl. ozs. 2a fl. ozs.
7 (50 Cals.) (20 Cal.
for May, 1950
495
would be reduced in status. This was approved,
and it was this plan which was announced. When
protests started, Chairman Carl Vinson of the
House Armed Services Committee decided to
investigate.
PLANS FOR CHANGES
The flare-up over closing of hospitals is not
the last word on the subject of Defense Depart-
ment economies. Another series of tightening-
up moves is in the making. Some will be aimed
strictly at saving dollars, but others will have
no direct relation to economy but to produce
an orderly, efficient service.
Here is the general shape of reorganization
plans in Defense military services:
Regardless what comes of the House hearings,
hospitals and other facilities will be reduced in
status or closed when they no longer can be
justified under an integrated program — Army,
Navy and Air Force.
When Dr. Meiling took office last October,
the services were staffing 46,281 beds for pa-
tients, which he described as “16,000 beds in
excess of patient requirements.” In addition,
Dr. Meiling reports that the services had
50,000 “bed spaces” in facilities which were not
staffed. Since then there have been a number
of reductions and cutbacks.
Meanwhile, the Department is making a long-
range study of its hospitals, preparatory to re-
placing semi-permanent structures on an orderly
priority schedule. The hope is to arrive at a
single general pattern for the three services
and to decide on the same type facilities. One
proposal is to have each new installation, regard-
less of size, capable of lf)0 per cent expansion.
Recruitment of doctors will continue. But the
total number of doctors on active duty might
even be reduced. Secretary Johnson has been
informed that the essential problem is not how
to obtain more doctors, but how to utilize
properly approximately the present number.
These are Defense Department figures on
medical manpower: Total operational require-
ments of physicians for the three services, 5,639.
Total physicians available for operational use,
3,982, plus 1,590 interns, residents and civilian
doctors in military hospitals. The grand total of
these is just 67 short of operational requirements
— 5,639. Another 1,206 military medical officers
— interns and residents — are serving in civilian
hospitals and therefore not available for treat-
ing military personnel. The total of all phy-
sicians in active military service and serving
in all capacities is 7,216.
A committee now is at work on the whole
question of internships and residencies. It is
seeking some system under which the three serv-
ices could use these officers more efficiently as
well as more economically.
There is some question within the Defense
Department whether the civilian consultant pro-
gram is run as efficiently and economically as
it might be. In the last full year the three
services hired 1,931 physicians on a consultant
fee basis. Another committee is studying this
question, attempting particularly to devise an
appointment system which could be used by all
three services and a practical method for joint
utilization of the consultants.
Defense Department is making an analysis of
the manner in which the three services calculate
their medical personnel requirements — how they
determine the number of doctors each needs and
their distribution. At present three different
systems are used; the hope is that a common
formula can be found.
A report, now under preparation, will at-
tempt to solve the problem of the medical re-
serves. Dr. Meiling’s office believes the present
reserve program is dangerously inadequate, both
as to numbers and as to type of training sched-
ules. He is anxious to get more officers to par-
ticipate in reserve activities and to develop pro-
grams which will keep the men and units in
maximum readiness.
CIVIL DEFENSE PROGRAM
Working with A. M. A., the National Security
Resources Board is getting into outline form
a program that will fully integrate medical and
health services in civil defense plans. Dr. Norvin
Kiefer, the board’s medical director, will an-
nounce details shortly.
Reassuring testimony was scarce when rep-
resentatives of four large American cities testi-
fied before the Joint Atomic Energy Committee,
which is trying to determine the state of the
nation’s preparedness for atomic attack.
On the medical phase, witnesses generally
brought out that any planning would have to be
done regionally and nationally, to insure prompt
movement into a bombed area of medical sup-
plies and personnel. They emphasized that little
reliance can be placed on availability of purely
local supplies and personnel, because of the de-
structive nature of an atomic attack and sub-
sequent confusion and disruption.
Dr. Kiefer was no more reassuring than the
city officials. He said board studies had estab-
lished that in event of heavy civilian casualties,
the health services definitely would be inadequate.
He warned that in such an emergency, health
personnel, supplies and hospital facilities could
not do the job demanded. Dr. Kiefer said the
Federal government was looking toward regional
stockpiling of supplies. He advised communities
to inventory all local personnel and supplies.
Dr. Kiefer also discussed progress toward estab-
lishment of a national organization which could
handle the various problems of blood procurement.
He said, “The only recourse is a highly efficient
organization — including a huge reserve of stand-
ard bottles and other supplies — ready to stage a
mass blood procurement from persons outside
the attacked area.”
MISCELLANEOUS
Public Health Services get 69 million dollars
more than it has this year but 34 million less
than it asked in the lump-sum appropriation bill.
The Appropriations Committee made the changes.
The Committee recommended a total of $269,-
500,000 for P. H. S., which may go up or down de-
pending on action of House and Senate.
A major reduction came in appropriations to
496
The Ohio State Medical Journal
carry on the Hill-Burton Hospital Construction
Act, which was cut in half to 75 million dollars.
% s(c
Over the past 25 months, U. S. has approved
grants of $210,000,000 toward construction of
1,019 hospitals and health centers under the
Hill-Burton Act; total cost of the projects is
more than half a billion dollars, with the dif-
ference financed by state, local and private in-
stitutions. Only 139 of the institutions are in
operation now, the remainder under construction
or in the blueprint stage.
* * *
More delay is in prospect for the school health
services bill (S. 1411), which A. M. A. opposes
because of one provision — the grant of authority
to treat all children regardless of parents’ ability
to pay. The school health bill is awaiting action
by the House Interstate and Foreign Commerce
Committee. Meanwhile, the House Education
Labor Committee is involved in discussing the
general school aid bill (S. 246). Two issues still
are not resolved: 1. Does this bill open the way
to an undesirable amount of Federal control of
schools? 2. Shall private and religious schools
be eligible for assistance along with public
schools? The second point is not an issue in
the health bill, but the question of Federal con-
trols is. It may be found desirable to consider
the bills together in the House. If this is the
plan, action on school health will be held up-
until the most controversial sections of the
general aid bill have been argued out in Com-
mittee. At any event, the close relationship be-
tween the two bills does not make for fast action
on school health.
* * *
Grass-roots appeals, from physicians and the
public, are one explanation of why a House Com-
mittee added two and one-half million dollars to
an appropriation for research into cortisone and
ACTH. The House Appropriations Committee
boosted a requested appropriation for National
Institutes of Health from $1,100,000 to $3,600,000.
However, there is almost no possibility that these
substances will be available for general treat-
ment in the near future because the supply is
scarce and the cost very high.
:Jc * *
Congress is being urged to increase appropria-
tions for mental health from a budgeted 9.9 mil-
lions dollars to 26 million. The request, made
before a Senate subcommittee, came from two
representatives of the National Committee for
Mental Hygiene, who were seconded by two
other witnesses.
TO BE A GOOD CITIZEN, YOU MUST
BE REGISTERED TO VOTE
THE NEW YORK POLYCLINIC
MEDICAL SCHOOL AND HOSPITAL
(Organized 1881)
THE PIONEER POST-GRADUATE MEDICAL INSTITUTION IN AMERICA
For the GENERAL SURGEON
A combined surgical course comprising general surgery,
traumatic surgery, abdominal surgery, gastroenterology,
proctology, gynecological surgery, urological surgery.
Attendance at lectures, witnessing operations, examina-
tion of patients pre-operatively and post-operatively
and follow-up in the wards post-operatively. Pathology,
radiology, physical medicine, anesthesia. Cadaver demon-
strations in surgical anatomy, thoracic surgery, proc-
tology, orthopedics. Operative surgery and operative
gynecology on the cadaver.
OBSTETRICS AND GYNECOLOGY
A full time course. In Obstetrics: Lectures; pre-natal
clinics ; witnessing normal and operative deliveries ; op-
erative obstetrics (manikin). In Gynecology: Lectures;
touch clinics; witnessing operations; examination of pa-
tients pre-operatively; follow-up in wards post-opera-
tively. Obstetrical and gynecological pathology. Anes-
thesia. Attendance at conferences in obstetrics and
gynecology. Operative gynecology on the cadaver.
For the GENERAL PRACTITIONER
Intensive full time instruction covering those subjects
which are of particular interest to the physician in
general practice. Fundamentals of the various medical
and surgical specialties designed as a practical review
of established procedures and recent advances in medi-
cine and surgery. Subjects related to general medicine
are covered and the surgical departments participate in
giving fundamental instruction in their specialties.
Pathology and radiology are included. The class is ex-
pected to attend departmental and general conferences.
PROCTOLOGY AND GASTROENTEROLOGY
A combined course comprising attendance at clinics and
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For Information Address
MEDICAL EXECUTIVE OFFICER
NEW YORK CITY 19
for May, 1950
497
Do You Know? . . .
Dr. Charles L. Hudson, Cleveland, presented
the viewpoint of the medical profession in a
panel discussion of National Health Insurance
sponsored by the Wayne County Community
Forum, April 12, at Wooster.
%
The role of the medical profession in guiding
school health programs was discussed by Charles
S. Nelson, Executive Secretary of the Ohio State
Medical Association, at a combined meeting of
the Highland County Tuberculosis and Health
Association and other groups interested in school
and community health, at Hillsboro, March 29.
Other speakers included Dr. Paul Q. Peterson,
Assistant State Director of Health, and Paul
E. Landis of the State Department of Education.
%i 5{C
Dr. C. W. Waggoner, Toledo, has been reap-
pointed by Governor Frank J. Lausche to mem-
bership on the State Medical Board, for a term
ending March 18, 1957.
* * *
Members of the University of Cincinnati Col-
lege of Medicine Alumni Association presented
Dr. Martin H. Fischer, professor of physiology,
with a gold cigaret case and a check for $600
at the annual University of Cincinnati Founder’s
Day dinner, April 4. Dr. Fischer will retire
this year after 40 years of service to the school.
3*c %
Thomas A. Hendricks, secretary of the Council
on Medical Service of the American Medical As-
sociation, spoke on “Medical Problems of Today,”
at a public meeting sponsored by the Woman’s
Auxiliary to the Belmont County Medical So-
ciety, March 23, in the Bellaire High School
auditorium.
* * *
Dr. J. V. Winans, Madison, aged 85, now in his
63rd year of active medical practice, has been
reelected president of the Lake County Board of
Health, which he has headed since the board
was organized 30 years ago.
>|: s*:
The Ohio County Medical Society, Wheeling,
W. Va., now requires payment of A. M. A. dues
of $25 for 1950 as a prerequisite to membership
in the county society.
* * *
During the recent convention of the American
Protestant Hospital Association in Chicago,
the Southside Baptist Hospital Association re-
pudiated all forms of government financial aid
for hospital construction and operation. The
Baptist group described acceptance and use of
government funds by a religious denomination
or society as “encouragement of the present
trend in America toward a socialized state.”
Dr. Richard W. Vilter, associate professor of
medicine, University of Cincinnati College of
Medicine, is one of 80 physicians recently ap-
pointed as consultants on nutrition to the U. S.
Public Health Service.
* * *
The Council of Pharmacy and Chemistry of
the American Medical Association has formed
a Committee on Pesticides to study the health
problems associated with the use of insecticides,
fungicides, rodenticides, herbicides and other
forms of economic poisons. Dr. Torald Sollmann,
Cleveland, is chairman of the committee.
* * Sj!
Dr. Allan C. Barnes, chairman of the De-
partment of Obstetrics and Gynecology, Ohio
State University College of Medicine, was guest
speaker at a meeting of the Louisville, Ky.,
Obstetrics and Gynecology Society, March 27.
❖ ❖ ❖
Mrs. Erma Drayer Marting, wife of Dr. W.
F. Marting, Ironton, has been named Ohio Mother
of 1950 in a state-wide competition sponsored
by the Woman’s Forum of Cleveland. The
Martings have three daughters who are phy-
sicians— Dr. Esther Fabing, Cincinnati; Dr. Anne
Alstott and Dr. Miriam Marting, Ironton.
❖ ❖ ❖
Dr. Phillip T. Knies, Columbus, associate pro-
fessor of clinical medicine, Ohio State Univer-
sity College of Medicine, will be the delegate of
the Ohio State Medical Association to the decen-
nial meeting of The United States Pharmacopoeial
Convention, May 9-10, at Washington, D. C.
v '!•
The American Physicians Art Association will
hold its twelfth art exhibition in conjunction
with the American Medical Association meeting
at San Francisco, June 26-30. For details and
entry blanks, write the secretary, Dr. F. H.
Redewill, 525 Flood Bldg., San Francisco 2.
^ ^
Dr. Marion A. Blankenhorn, professor of medi-
cine, University of Cincinnati College of Medicine,
was one of the guest speakers at an interstate
medical meeting held at the Greenbrier, White
Sulphur Springs, W. Va., March 29. Dr. Blanken-
horn spoke on “The Specificity of the Vitamins
and Their Proper Clinical Use.”
* * *
Approximately $72,000,000, about $110 per pa-
tient, was spent by the City of New York for pa-
tient care administered through its municipal
hospitals during 1949. Of those treated, 275,000
were in-patients, 377,500 were cared for in clinics
and 2,500 received home care, according to the
annual report of the Bureau of Administration
of the City’s Department of Hospitals.
498
The Ohio State Medical Journal
Health Department Sets Up Five
District Consulting Offices
The Ohio Department of Health is setting
up five district offices in the State in order to
decentralize its consultation services, Dr. John
D. Porterfield, director, announced.
Four of these district offices have been selected
as follows: Southeast district, Athens; northeast
district, Cuyahoga Falls; northwest district,
Bowling Green; central district, Delaware. An
office for the southwest district had not been
announced at the time of this writing.
In announcing the new development, Dr.
Porterfield said: “It was decided to increase the
consultation services available to local health
departments in line with the Ohio Department’s
basic objective of establishing at least minimum
standards of service and to provide all possible
assistance to local health departments in meeting
standards.”
The director further explained that for years
consultation service has consisted of aid in pub-
lic health nursing and sanitary engineering,
but that personnel had to impose upon local health
departments for space and facilities.
Ultimate goal of the Department is to staff
district offices with medical officers, engineering
and sanitation consultants, public health nursing
consultants, health education consultants, rec-
ords and administrative consultants or personnel
for any other special assistance which might be
needed.
No direct services will be rendered through
district offices. Their functions will be purely
that of consulting with local health departments,
Dr. Porterfield stressed.
Unemployment Compensation
Leaving Ohio for reasons of health does not
necessarily disqualify a person from drawing
unemployment compensation if he can prove that
he is actively seeking a job after he recovers
and is able to work.
That was the decision of the Bureau of Un-
employment Compensation’s Board of Review on
the claim of a former Cincinnati worker who
applied for benefits in Arizona where he had
gone on the advice of his physician.
With one member dissenting, the Board’s
decision reversed the B. U. C. administrator’s
initial determination in which the claim was
disallowed on grounds that the claimant was on
sick leave and was not available for work.
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for May, 1950
499
• • •
On the Firing Line
Shots at Truman-Ewing Compulsory Sickness Insurance Scheme;
Ammunition For Doctors in Speeches Against Federalized Medicine
“The British National Health Service, which
provides medical, hospital, and dental care, as
well as medicines and appliances, to all persons
in the country, is financed mainly from general
taxation, but slightly more than one-tenth of
the employer-employee contribution for national
insurance goes to the health services. These
contributions meet at this time about one-ninth
of the cost of the National Health Service.” —
Social Security Bulletin, March, 1950, Page U-
* * *
“Before it is too late, before we have too
many on unemployment insurance, socialized
medicine, too many looking to the govern-
ment for support, we had better step back,
survey our future and start working towards
a return to individual initiative, incentive
for development of local resources, and less
Federal control in local activities.” — Wil-
liamsburg, Ohio, Times.
* * *
“This process through which people slowly
sell their control over their own earnings and
savings is inherent in the welfare state. And it
is fostered, of course, by the Socialist doctrine
that the state is better able to spend the people’s
money than they are themselves.” — Raymond
Moley in the Columbus Dispatch.
* * *
“To put the matter quite bluntly, the Admin-
istration (compulsory health insurance) plan is
a phony. It would not even begin to do what its
political sponsors say.” — The Cincinnati Times-
Star.
* * *
“Too many people in this country are blind
to the pitfalls of government control and
are wont to pattern after European coun-
tries whose standard of living is not as
good nor ever will approach the American
people.” — Freeport, Ohio, Press.
Hs * *
“Now, it is said that the Russians are going
to purge the doctors and medical investigators.
They are accused of accepting the doctrines of
Pasteur and the German pathologist Rudolf
Virchow. They must, says the Kremlin, disavow
such abominable ideas and accept the medical
theories of Marx, Lenin, and presumably, Stalin.”
— Marietta Times.
“Pointing out that in England a movement
already is under way to have the government
provide legal services, Gallagher advised his
audience that ‘preventive law is just as important
as preventive medicine.’ ” — Address of Harold J.
Gallagher, president of the American Bar Asso-
ciation before Cleveland Bar Association, as re-
ported by The Cleveland Press.
% % %
“They — the patients — are beginning to see the
fallacies of the scheme, and they are going to
take it out of someone. That someone is going
to be us, as it has always been intended that it
should be. There will come the final destruction
of our traditional medicine. The doctor-patient
relationship will have gone, and gone for many
generations, if not forever.” — Ronald I. Bence,
of Birmingham, England, in the British Medical
Journal.
* * *
“People must stand up and be counted on
issues of the day or else be counted out in
the final analysis and eventually become
shackled by a socialist government. People
should voice their opinions by voting and
writing letters to their senators and congress-
men, telling them how they feel about
things.” — Robert Wallace, Pittsburgh, dis-
trict manager, Lilly Pharmaceutical Co.,
addressing Steubenville Lions Chib.
* sjc *
“In the absence of violent revolution, socialism
isn’t something that happens to a country over
night. It has small beginnings, a suggestion
here, a regulation there, a slight addition to the
powers of government, all of which combined
eventually to government control over the lives
of everyone. And it is never called socialism.
It is disguised under the name of government
planning.” — Cleveland Plain Dealer.
❖ ❖
“The other day I heard a discussion of socialized
medicine. It was a plea for retention at least
of the personal relationship between doctor and
patient, and in support of that plea the speaker
remarked that the collective conscience had
never equaled the individual conscience in aware-
ness of right and wrong . . . and that is perhaps
the best reason I have heard why Jefferson was
right in holding the best government governs
least.” — Wes Lawrence in the Cleveland Plain
Dealer.
CLIP THIS MATERIAL FOR REFERENCE
500
The Ohio State Medical Journal
An Observation on the Accuracy of Digitalis Doses
Withering made this penetrating observation in
his classic monograph on digitalis: "The more I
saw of the great powers of this plant, the more it
seemed necessary to bring the doses of it to the
greatest possible accuracy.”1
To achieve the greatest accuracy in dosage and at
the same time to preserve the full activity of the
leaf, the total cardioactive principles must be iso-
lated from the plant in pure crystalline form so
that doses can be based on the actual weight of the
active constituents. This is, in fact, the method by
which Digilanid® is made.
Clinical investigation has proved that Digilamd is
"an effective cardioactive preparation, which has
the advantages of purity, stability and accuracy as
to dosage and therapeutic effect.”2
Average dose for initiating treatment: 2 to 4 tab-
lets of Digilanid daily until the desired therapeutic
level is reached.
Average maintenance dose: 1 tablet daily.
Also available: Drops, Ampuls and Suppositories.
1. Withering, W.: An account of the Foxglove, London, 1785
2. Rimmerman, A. B.: Digilanid and the Therapy of Congestive
Heart Disease, Am. J. M. Sc. 209: 33-41 (Jan.) 1945.
Literature giving further details about Digilamd and Physician’s Trial
Supply are available on request.
Digilanid contains all the initial glycosides from
Digitalis lanata in crystalline form. It thus truly
represents "the great powers of the plant” and
brings "the doses of it to the greatest possible
accuracy”.
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501
In Memoriam . . .
Henry Renick Brown, M. D., Chillicothe; Uni-
versity of Michigan Medical School, 1901; aged
71; died April 4; member of the Ohio State
Medical Association; member of the American
Medical Association; vice-president of the Ross
County Medical Society, 1932-33. Dr. Brown had
practiced medicine in Chillicothe for 47 years.
In addition to his professional work, he was
active in many community affairs; was a past-
president of the Rotary Club and vice-president
of the city Board of Health on which he had
served since 1932; was a member of the Epis-
copal Churfch and several Masonic orders. He
was a veteran of World War I. Surviving are
his widow, two sons, one of whom is Dr. Henry
A. Brown of San Mateo, Calif., and two daughters.
Elber Robert Brubaker, M. D., Springfield;
Medical College of Ohio, Cincinnati, 1908; aged
65; died April 4; member of the Ohio State Medi-
cal Association and a Fellow of the American
Medical Association; member of the Radiological
Society of North America, Inc. Dr. Brubaker
had practiced medicine in Springfield for ap-
proximately 40 years where he was active in
other community activities. He was a veteran
of both World Wars, having served as an Army
medical officer during I and as a Navy medical
recruiting officer during II. He was a member
of the Masonic Lodge, the Elks Lodge, the Last
Man’s Club, the American Legion, the Methodist
Church and the Springfield Farmers’ Club. Sur-
viving are his widow and two sisters.
William Dean Collier, M. D., Youngstown;
Johns Hopkins University School of Medicine,
Baltimore, 1924; aged 53; died March 15; mem-
ber of the Ohio State Medical Association and
a Fellow of the American Medical Association;
member of the American Association of Path-
ologists and Bacteriologists and the American
Society of Clinical Pathologists. Dr. Collier
moved his practice from St. Louis in 1939 to
Youngstown where he was pathologist at St.
Elizabeth Hospital. In St. Louis he was on the
faculty of St. Louis University School of Medi-
cine. He was a member of Sigma Xi. A sister
survives.
Preston Wiley Fishbaugh, M. D., Mendon; Col-
lege of Physicians and Surgeons of Baltimore,
1893; aged 86; died March 25; former member
of the Ohio State Medical Association and a
Fellow of the American Medical Association
through 1945; president of the Mercer County
Medical Society, 1932-34; chairman of the Defense
and Legislative Committee of the Society in
1944. Dr. Fishbaugh had been active in prac-
tice in Mendon from 1893 until his retirement in
1940. Recently he was presented the 50-Year
Pin and Certificate of the Ohio State Medical
Association. He was a member of the Methodist
Church. Surviving are his widow, one son and
two daughters.
Desider Foldes, M. D., Cleveland; Royal Hun-
garian University, Budapest, 1905; aged 69; died
March 27; member of the Ohio State Medical
Association and a Fellow of the American Medi-
cal Association; member of the American Col-
lege of Surgeons. Dr. Foldes began his prac-
tice in Cleveland in 1914.
Frederick William Gross, M. D., Madisonville;
University of Cincinnati College of Medicine,
1935; aged 40; died March 21; member of the
Ohio State Medical Association and the American
Medical Association. Dr. Gross had practiced in
Madisonville for about 15 years. Surviving are
his widow, two children and his parents.
Elliott Miley Hendricks, M. D., Fort Lauder-
dale, Fla.; University of Cincinnati College of
Medicine, 1922; aged 53; died March 7; former
member of the Ohio State Medical Association
through 1926 ; listed in the A. M. A. Directory as
a member of the Florida Medical Association
and a Fellow of the American Medical Associa-
tion. Surviving are his widow, a daughter, three
brothers including Dr. Louis J. Hendricks, of
Cincinnati, and Dr. Anthony B. Hendricks, of
Biloxi, Miss., a sister and his step-father.
Henry Demuth Jackson, M. D., Circleville; Ohio
State University College of Medicine, 1911; aged
66; died March 23; member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association; president of the Pick-
away County Medical Society for several terms
including 1950 and vice-president for a number
of terms; treasurer for the year 1930, and
delegate to the Ohio State Medical Associa-
tion for several terms. Dr. Jackson served
his entire professional career in Circleville with
the exception of time he was in military service.
During World War I he served as a major,
and later was advanced to the rank of colonel
as a medical officer in the Ohio National Guard.
He served also as a medical officer during World
War II. Active also in many community affairs,
he served for many years on the city board of
health, was a member of the Presbyterian Church
and held many offices in the Masonic Lodge and
in the Elks Lodge. Surviving are his widow, one
daughter and one son.
John Donovan Kessler, M. D., Coolville; Uni-
versity of Pennsylvania School of Medicine,
Philadelphia, 1912; aged 61; died April 2; former
member of the Ohio State Medical Association
and the American Medical Association through
1937. Dr. Kessler moved his practice to Coolville
12 years ago from Columbus where he also
practiced for many years. Surviving are his
widow, a son, a daughter and a sister.
502
The Ohio State Medical Journal
Harold Levi Lawrence, M. D., Canton; Ohio
State University College of Medicine, 1931; aged
47; died March 12; former member of the Ohio
State Medical Association and the American
Medical Association through 1947. Dr. Lawrence
was chief medical officer for the Veterans Ad-
ministration office in Canton. He previously
spent a number of years in public health work
and several years in Europe as a medical of-
ficer on diplomatic service. Surviving are his
widow and two brothers.
Alfred Lewin, M. D., Piqua; Friedrich-
Wilhelms University Medical School, Berlin, 1913;
aged 63; died March 24. Dr. Lewin came to the
United States 13 years ago and practiced for
10 years in Piqua. Surviving are his widow
and a daughter.
Lora Larason Marriott, M. D., Newark; Physio-
Medical College of Indiana, Indianapolis,
1896; aged 80; died March 25; former mem-
ber of the Ohio State Medical Association and
the American Medical Association through 1939.
Dr. Marriott practiced medicine in Licking
County from 1896 until 1917 when he went into
the Army. After World War I, he served with
the Veterans Administration. Upon his retire-
ment in 1939 he returned to Newark. Surviving
are his widow, a brother and two sisters.
Esther M. Mast, M. D., Mansfield; University
of Rochester School of Medicine, New York, 1931;
aged 46; died March 17; member of the Ohio
State Medical Association and the American
Medical Association; member of the American
Trudeau Society and the American College of
Chest Physicians. Dr. Mast practiced for a
number of years in Mansfield where she was on
the active staff of the Mansfield General Hos-
pital. She was co-author of Fundamentals of
Nutrition published in 1939. Surviving are her
husband, Dr. Earl C. Mast, of Mansfield, a son,
a daughter, two brothers and a sister.
Frederick Roy McVay, M. D., Botkins; Medi-
cal College of Ohio, Cincinnati, 1909; aged 67;
died March 25 wThile on a trip in Florida; member
of the Ohio State Medical Association and a
Fellow of the American Medical Association;
vice-president of the Shelby County Medical
Society in 1926; its secretary in 1943 and presi-
dent in 1944. Dr. McVay had practiced his pro-
fession in Botkins and vicinity for 40 years. He
was a member of the Methodist Church and
several Masonic orders. Surviving are his widow
and a sister.
Lawrence Delano Miller, M. D., Toledo; Eclec-
tic Medical College, Cincinnati, 1915; aged 57;
died March 18; member of the Ohio State Medi-
cal Association and a Fellow of the American
Medical Association; delegate of the Academy
of Medicine of Toledo to the Ohio State Medical
Association, 1942-43. Dr. Miller had practiced
in Toledo for 33 years, where he was director of
the Urological Clinic of the Toledo State Hos-
pital for 23 years and on the staff of other
hospitals. He was a member of the Meth-
odist Church, several Masonic orders, past-
president of the Kiwanis Club, and a veteran
of World War I. Surviving are his widow, two
daughters, a sister and a brother.
George Elliott Peters, M. D., Columbus; Ohio
State University College of Medicine, 1927; aged
55; died March 24; member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association. Dr. Peters had served
his entire professional career in Columbus, where
he was director of surgery at Mercy Hospital. A
veteran of World War I, he was a member of
the American Legion, and held membership in
the Elks Lodge, the Columbus Athletic Club
and the Columbus Maennerchor. Surviving are
his widow, a son, two daughters, his mother
and a sister.
William A. Ray, M. D., Portsmouth; Medical
College of Ohio, Cincinnati, 1897; aged 76;
died March 24; member of the Ohio State Medi-
cal Association and the American Medical Asso-
ciation; president of the Hempstead Academy of
Medicine, 1920, and its vice-president in 1933.
Dr. Ray had practiced in Portsmouth beginning
in 1918. He recently was honored by being
presented the 50-Year Pin and Certificate of the
Ohio State Medical Association. He was active
in several Masonic orders. Surviving are his
widow and a son.
William Thomas Shipe, M. D., Middletown;
Baltimore Medical College, 1894; aged 83; died
March 13 at the Veterans Administration Hos-
pital, Augusta, Ga., where he had been for six
years; former member of the Ohio State Medi-
cal Association and the American Medical Asso-
ciation through 1939. Dr. Shipe had practiced
his profession in Middletown for many years
before retiring several years ago. He served
in the Medical Corps during World War I.
Daniel Webster Shumaker, M. D., Dover; Ohio
Medical University, Columbus, 1898; aged 80;
died March 28; member of the Ohio State
Medical Association and the American Medical
Association; president of the Tuscarawas County
Medical Society in 1938; member of the Ameri-
can College of Surgeons. Dr. Shumaker had
practiced his profession for 52 years — 43 years
in Dover. Recently he was honored by being
presented the 50-Year Pin and Certificate of the
Ohio State Medical Association. In 1940 he
was awarded the degree of doctor of humane
letters by Mount Union College. He wTas a
charter member and past-president of the Dover
Kiwanis Club and a member of the Lutheran
Church. Surviving are three daughters and a
son.
Charles Herbert Spencer, M. D., Bowling Green;
Chicago Homeopathic Medical College, 1898;
for May, 1950
503
aged 74; died March 4. Dr. Spencer practiced
for short periods at Lucas, Carey, Bowling Green
and Cleveland, and for many years was in the
pharmaceutical business. Surviving are his
widow, a son, a daughter, a sister and a brother.
Joseph J. T. Sweeney, M. D., Toledo; Jefferson
Medical College of Philadelphia, 1911; aged 65;
died March 16; member of the Ohio State Medi-
cal Association and the American Medical Asso-
ciation. A native of Toledo, Dr. Sweeney served
his entire professional career there. In addition
to his medical practice, he took an avid interest
in public affairs, especially athletics. For 18
years he served as physician for the Toledo Base-
ball Club; he served also as boxing commissioner
and in other official capacities in sporting events.
He was a member of the Catholic Church and
the Kiwanis Club. Surviving are his widow, two
sons and two daughters.
Let Medico Press fill your printed needs at prices
you will appreciate. Medico Press has earned a rep-
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place to buy quality printed supplies.
Lester Taylor, M. D., Cleveland; Johns Hop-
kins University School of Medicine, 1910; aged
65; died April 11 while vacationing in North
Carolina; member of the Ohio State Medical
Association and a Fellow of the American Medi-
cal Association; president of the Cleveland Aca-
demy of Medicine, 1935; its vice-president, 1934;
secretary-treasurer, 1920-22; delegate, 1936;
served as member and chairman of numerous
Academy committees; member of the Board of
Directors, 1928-37 ; diplomate of the American
Board of Internal Medicine. Dr. Taylor began
his practice in Cleveland upon completion of his
education. He was founder of the Cleveland
Health Museum and its president from the time
of its founding in 1936 until his death. During
World War I he served as a major in the Army
Medical Corps in Europe, and during World War
II served on a local draft board. His widow and a
sister survive.
Anderson L. Troy, M. D., Springfield; Miami
Medical College, Cincinnati, 1904; aged 77; died
March 20. A resident of Springfield for 14
years, Dr. Troy had retired from active practice
several years ago. Survivors include his widow,
a daughter and two sisters.
Gerard Thomas Willke, M. D., Cincinnati; Uni-
versity of Cincinnati College of Medicine, 1921;
aged 53; died April 3; member of the Ohio
State Medical Association and a Fellow of the
American Medical Association. Dr. Willke began
his practice in Maria Stein where he succeeded
his father, the late Dr. A. J. WTillke, and moved
to Cincinnati in 1935, after directing Kneipp
Sanatorium, Rome City, Ind., for five years.
He was a member of College Hill Civic Associa-
tion, College Hill Business Men’s Association,
and the Catholic Church. Surviving are his
widow, four daughters, two sons, one of whom
is Dr. John C. Willke of Cincinnati; five sisters,
and two brothers, Dr. Edgar J. Willke, Maria
Stein, and Dr. Alois H. Willke, Cincinnati.
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504
The Ohio State Medical Journal
Buckeye News Notes . . .
Ashland — Dr. H. M. Gunn discussed “Medical
Aspects of the Atomic Bomb” before the Ash-
land Lions club at a recent meeting.
Bedford — “Socialized Medicine From a Doctor’s
Point of View” was the topic discussed by Dr.
Iredell M. Hinnant, Cleveland, before the Bed-
ford Kiwanis Club.
Chillicothe — “Community Pill Mills” was the
title of a talk by Dr. Edwin H. Artman before
the Kiwanis Club. The title was the speaker’s
characterization of proposed socialized medicine.
He also discussed “Socialized Medicine” before
the Rotary Club.
Chillicothe — Dr. Ralph W. Holmes discussed the
influence of Rotary on legislation affecting crip-
pled children before the Chillicothe Rotary Club.
Cincinnati — Dr. Stanley E. Dorst, dean of the
University of Cincinnati College of Medicine, was
reelected president of the Heart Council of
the Public Health Federation. Other officers are
Dr. Charles Maertz, vice-president, and Dr. Floyd
P. Allen, treasurer and executive secretary.
Cleveland — Dr. Douglas D. Bond, of the West-
ern Reserve University School of Medicine, ap-
peared before a Senate committee in Washing-
ton in behalf of appropriations of Federal funds
to train more people in the field of mental illness.
Columbus — Dr. Roger M. Gove, Piqua, has been
appointed superintendent of the Columbus State
School effective April 1. Dr. F. L. Keiser re-
cently resigned from the position.
Columbus — Dr. W. D. Inglis has been named
an honorary life member on the Board of Direc-
tors of the Friendship House, a community
project with which he has worked since its
organization in 1911.
Elyria — Dr. Robert H. Browning, Oberlin, was
guest speaker at the Elyria Chapter meeting of
the National Council of Catholic Nurses. His
topic was “The Chest.”
Elyria — Dr. Marion G. Fisher, Lorain County
health commissioner, was speaker at the meet-
ing of the Elyria Business and Professional
Women’s Club. He explained the work of the
health department.
Fostoria — Dr. Thomas W. Geoghegan spoke on
“Preventive Medicine” before the Whittier P.-T. A.
Fostoria — Dr. Emmerich von Haam, Ohio State
University College of Medicine, Columbus, con-
ducted the regular monthly clinical and path-
ological conference of the Fostoria Medical So-
ciety. Dr. William F. Yarris, president of the
society, presided.
Fremont — Dr. John J. Gedert of Clyde has
been designated by the Sandusky County Tubercu-
losis and Health Association to assume charge
of monthly chest clinics at Fremont Memorial
Hospital.
Grove City — Dr. Gilman D. Kirk, Columbus,
spoke on “Socialized Medicine” before the Grove
City Lions Club.
Hillsboro — Dr. J. Martin Byers, Greenfield, was
named to the Highland County Board of Health
for a one-year term to fill the unexpired term of
Dr. W. H. Willson, Greenfield, who resigned.
Lisbon — Dr. Chester W. Dewalt, Columbiana,
was reelected to the Columbiana County Board
of Health. Dr. Robert M. Dunlap is county
health commissioner.
Navarre — Dr. C. S. Palmer, Massillon, discussed
“Socialized Medicine” at a dinner meeting of the
King’s Club, Inc., held at the Bolivia Evangelical
and Reformed Church.
Painesville — Dr. J. M. York has been named
medical director of the Diamond Alkali Com-
pany’s plant in Painesville. He is continuing
his private practice also.
Piqua — Dr. George A. Woodhouse, Pleasant
Hill, addressed Piqua and Miami County Le-
gionnaires on the subject, “Federal Health
Insurance.”
St. Marys — Dr. W. V. Barton spoke on the
subject of health before the Parent-Teachers
Association.
Salem — Dr. Paul Q. Peterson, assistant direc-
tor, Ohio Department of Health, Columbus, was
guest speaker at a recent meeting of the Salem
Rotary Club.
Salem — Dr. Lea A. Cobbs was elected president
of the Columbiana County Public Health League
at its annual meeting.
Salem — Dr. Lewis K. Reed, Youngstown, spoke
of the detection and treatment of heart dis-
eases before the local Kiwanis Club. Dr. Richard
McConnor was program chairman.
Toledo — Dr. Foster Myers was a speaker on the
weekly broadcasts entitled “Things You Ought
To Know,” sponsored by the Toledo Public
Health Association, over Station WSPD.
Toledo — Dr. Maurice A. Schnitker was prin-
cipal speaker at the February meeting of the
Northwestern Ohio Branch of the American
Pharmaceutical Association. His topic was “New
Developments in Cardiovascular Disturbances.”
Washington C. H. — Dr. J. H. Persinger is chief
of staff of the new Fayette County Hospital.
Dr. James E. Rose is vice-president and Dr.
Hugh W. Payton, Jeffersonville, secretary-
treasurer.
for May, 1950
505
Payments for Rabies Cases . . .
Recent Investigation in Cuyahoga County Reveals Claims Settled
Unlawfully By Commissioners; Findings Made Against Physicians
THAT there is considerable confusion in
the minds of many physicians — perhaps
among boards of county commissioners, as
well — regarding the existing state law providing
for compensation at public expense to persons
bitten or injured by a dog, cat or other animal
is revealed in a recent investigation made in
Cuyahoga County by examiners of the Bureau
of Inspection and Supervision of Public Of-
fices, Department of Auditor of State.
The history of the present situation is as
follows: Recently the books and records of the
Board of County Commisisoners of Cuyahoga
County were examined by representatives of the
state bureau. They had not been examined since
1946.
FACTS IN CASES
The examiner made certain findings for re-
covery against the board of commissioners, basing
his action on the fact that the provisions of
Section 5851 and 5852 of the Ohio General
Code had been violated and that approximately
285 claims filed by persons bitten or injured by
dogs or other animals had been paid unlawfully.
In practically all of these cases, physicians
had been paid for medical care to the claimants
although in all cases it had been determined that
the animal was not afflicted with rabies. For
that reason, the examiner contended that the
payments had been made in violation of state
law. Subsequently, actions to recover from the
physicians the amount paid to them by the
county commissioners were instituted.
The two sections of the state law which
served as a basis for the recovery action read
as follows:
ANIMAL MUST HAVE RABIES
Section 5851 — A person bitten or injured
by a dog, cat or other animal afflicted with
rabies, if such injury has caused him to
employ medical or surgical treatment or re-
quired the expenditure of money, within
four months after such injury and at a regu-
lar meeting of the county commissioners
of the county where such injury was re-
ceived, may present an itemized account of
the expenses incurred and amount paid by
him for medical and surgical attendance,
verified by his own affidavit and that of
his attending physician; or the administra-
tor or executor of a deceased person may
present such claim and make such affidavit.
If the person so bitten or injured is a
minor such affidavit may be made by his
parent or guardian.
Section 5852 — The county commissioners
not later than the third regular meeting,
after it is so presented, shall examine such
account, and, if found in whole or part cor-
rect and just, shall order the payment
thereof in whole or in part to the patient
and to the physician who rendered such
treatment, in accordance with their respec-
tive claims, but a person shall not receive
for one injury a sum exceeding two hundred
dollars.
It should be noted that the law states spe-
cifically that the person entitled to compensa-
tion must have been bitten or injured by an
animal “afflicted with rabies.”
WARNING TO PHYSICIANS
Obviously, a physician called to see a per-
son bitten by an animal should not delay in
providing the person with necessary and ade-
quate treatment. In other words, he should not
delay treatment until it has been decided that
the animal is afflicted with rabies.
On the other hand, the physician should under-
stand the provisions of the law and should advise
the patient of such provisions. Also, he should
make it clear to the patient that the patient
is in the first instance responsible for and
obligated to pay for the medical services. If
the animal had rabies and the claim is allowed
by the commission, then the patient can use the
compensation received to pay the physician.
There is even some question, due to the word-
ing of Section 5852, whether the commissioners
can pay the physician directly.
Nevertheless, the important thing for physi-
cians to remember is that payments by county
commissioners to physicians in cases wherein
the animal does not have rabies is an unlawful
act and that recovery can be made against the
commissioners, physicians or claimants receiving
such payments.
Eighth District Meeting Scheduled
At Rocky Glen June 15
The customary annual spring meeting of the
Eighth Councilor District of the Ohio State
Medical Association will be held on June 15 at
the Rocky Glen Sanatorium at McConnelsville.
An excellent scientific program and the usual
congenial get-to-gether are in store for doctors
of the area. Dr. Louis Mark and members of
his staff at the Sanatorium will be official hosts
for the occasion.
A program with further details will be
mailed to doctors of the district by the pro-
gram committee.
506
The Ohio State Medical Journal
X-Ray Technicians Schedule National
Meeting in Columbus
The American Society of X-Ray Technicians
will hold its 22nd annual convention at the
Deshler-Wallick Hotel in Columbus, May 28-
June 2. The organization is anticipating an
attendance of approximately a thousand persons,
including technicians from all the States,
Canada and Hawaii.
Refresher courses will include classes con-
ducted by L. G. Idstrom, M. D., Minneapolis, and
Darmon A. Rhinehart, M. D., Little Rock, on
X-Ray physics; George L. Sackett, M. D., Cleve- >
land; and Grant 0. Graves, Columbus, on radio-
graphic anatomy.
Other prominent physicians taking part in the
scientific program will be Joseph L. Morton,
M. D., Columbus, Robert A. Arens, M. D., Chi-
cago; Maurice D. Frazer, M. D., Lincoln, Neb.;
and Robert Reeves, M. D., Durham, N. C. Donald
F. Bowers, M. D., Columbus, will be toastmaster
at the banquet.
Additional information may be obtained from
Genevieve J. Eilert, R. T., executive secretary,
16 Fourteenth St., Fond du Lac, Wise.
Conference of County Medical Society
Officers Scheduled in San Francisco
The Seventh National Conference of County
Medical Society Officers will be held in San
Francisco on Sunday, June 25, the day prior
to the opening of the A. M. A. annual session.
The program is designed as a discussion forum
on subjects of particular interest to county
medical society officers. All persons attending
the conference will be welcomed to participate in
discussions.
Two sessions will be held, both at the Palace
Hotel — one from 9 a. m. to 12 noon, and another
session from 8 p. m. to 9:30 p. m.
The conference is sponsored by the Board of
Trustees of the A. M. A. and is designed to help
individual county societies.
A feature of the program is entitled “What Do
You Know for Sure?” It will be a true and
false questionnaire on socialized medicine to be
given to everyone in the audience. Results
will be announced at the end of the morning
session.
Other features of the morning session will be:
“How To Set Up a County Medical Society
Record System”; How To Organize a Com-
munity Health Council”; and “Providing Spe-
cial Benefits Through County Medical Society
Membership.”
The evening session includes two discussions.
The discussion on the subject, “The Third Party
in the Practice of Medicine,” refers to insurance
companies, hospital and medical care plans, etc.
“Hospitals and the Practice of Medicine” will be
the topic of a second discussion.
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for Alay, 1950
507
Communicable Disease Regulations . . .
At a Recent Meeting of the Ohio Public Health Council
Part of the Sanitary Code Was Revised, Effective July 1
NEW communicable disease regulations,
adopted by the Ohio Public Health
Council at a meeting in Columbus on
April 8, will replace the current communicable
disease regulations in the Ohio Sanitary Code
as of July 1, 1950.
Dr. John D. Porterfield, director of the Ohio
Department of Health, called attention to the
fact that these regulations are a material change
from those currently in effect. It has been the
intent of the Ohio Department of Health and
the Ohio Public Health Council to bring these
regulations as close to modern scientific knowl-
edge as possible, he said.
Conferences with qualified epidemiologists and
communicable disease specialists over the past
six months have contributed heavily to improve-
ment in the regulations. Consideration of the
1950 revised recommendations of the American
Public Health Association and current regulations
in other states played a part in the revision.
In addition to modernization, Dr. Porterfield
pointed out, these regulations have been changed
as much as possible in the direction of the
least amount of complexity for the private phy-
sician, compatible with good communicable dis-
ease control.
It is to be noted that the diseases listed as
reportable must in all instances be reported by
the attending physician to the responsible local
health authority.
“It is our feeling,” Dr. Porterfield continued,
“that the best method by which compliance can
be obtained is cooperation with and assistance
to the practicing physicians. Reporting of com-
municable diseases in Ohio has been nowhere
near complete and it is hoped the new regulations
will simplify the requirements to the point where
better conformance will follow.”
The health director pointed out that com-
municable disease data are important to com-
munities and to local health departments in
enabling them to plan the public health pro-
grams most necessary. Such data are important
to hospitals and medical people in general in
measuring disease incidence and prevalence.
They are important to individual physicians in
their diagnostic work by indicating the prob-
abilities of various conditions in the individual
community.
In regard to cooperation between health of-
ficers and private physicians, Dr. Porterfield re-
marked that it seemed to him a desirable idea
that the local health commissioner be requested
to report at the local medical society meetings
at appropriate intervals on communicable disease
incidence and distribution to permit physicians
to retain an idea of the total health picture of
the community.
“It is finally to be noted that the diseases
listed as reportable were selected with consider-
able attention from the point of requiring re-
ports only in those conditions where collected
data would be of use,” the health director said.
Each disease listed is an actual or potential
problem in Ohio, he assured. He concluded by
saying that the Health Department will be
happy at any time to discuss communicable dis-
ease reporting and the best methods of main-
taining good cooperative relations between prac-
ticing physicians and public health officers.
IF YOU’RE NOT REGISTERED TO VOTE,
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508
The Ohio State Medical Journal
Rural Health Committee Approves
Lecture Course and Makes Plans
for Future Work
Meeting at the State Headquarters Office, Co-
lumbus, Sunday, April 2, the Committee on
Rural Health of the Ohio State Medical Associa-
tion approved detailed outlines for a “Lecture
Series on General Practice in the Small Com-
munity.”
The Committee, which met with members of
the Committee on Education for consideration
of this and similar projects, is selecting lecturers
for the series. In the near future it will see
the approval of the deans of Ohio’s medical
schools, for presentation of the series at the
three Ohio institutions.
DEANS TO BE CONSULTED
Further study was given to a proposal in-
volving rural externships for medical students,
with rural general practitioners. Information
on such a plan in Wisconsin was received by the
Committee. It was decided that the medical
school deans should be consulted about the pos-
sibilities of such a plan, and that definite re-
sponsibilities of both student and preceptor
should be listed, following which the proposal
should again be considered by the joint com-
mittee and further information be considered
regarding the operations of such plans in Okla-
homa and Kansas.
The Committee developed and approved plans
for a meeting to be sponsored by the Ohio State
Medical Association, with interns and residents
of Cincinnati and other Southwest Ohio
areas as guests. This proposal envisions an
afternoon seminar or workship for the interns
and residents on economic, legal, ethical and
organizational matters of importance to young
doctors starting a practice, to be followed by a
dinner for the men and their wives.
A July 1 deadline for the receipt of completed
applications for the 1950 Rural Medical Scholar-
ship was set by the Committee, and copy and
layout for a printed folder describing the scholar-
ship were approved.
JOINT MEETING
The Committee selected Wednesday, May 24,
as the date for a joint meeting of the Committee
and members of the Advisory Committee for
the Rural Medical Scholarship. The session to
be held in Columbus, will begin at 4 p. m., and
conclude with a dinner.
Those present at the April 2 meeting were
Dr. Carl A. Lincke, President of the State Asso-
ciation, Dr. E. 0. Swartz, President-Elect;
Dr. Carll S. Mundy, Chairman of the Rural
Health Committee, and Committeemen Jon-
athan Forman, E. G. Caskey, H. T. Pease, L.
E. Anderson, H. R. Mayberry, J. Martin Byers,
F. M. Hartsook, Carl Goll, and Kenneth Taylor.
Representing the Education Committee were
Dr. Carl Wilzbach, Chairman, and members,
J. L. Webb and Thomas E. Rardin. Also present
were Secretaries Nelson, Saville, Page, and
Moore.
Commission Studies Indoctrination
In Aspects of Atomic Warfare
A commission of Ohio doctors has been named
by Governor Frank J. Lausche to study plans
whereby the medical profession and allied groups
may be indoctrinated in the aspects of atomic
warfare and is scheduled to report its recom-
mendations back to the Governor at a conference
arranged in Columbus for May 3.
Nominees, appointed at the request of the Na-
tional Security Resources Board, are: Dr. Edgar
P. McNamee, Cleveland, representing the Ohio
State Medical Association; Dr. William G. Myers,
Ohio State University College of Medicine, Co-
lumbus; Dr. Frank R. Dutra, University of Cin-
cinnati College of Medicine; Dr. Hymer L.
Friedell, Western Reserve University School of
Medicine, Cleveland; Dr. S. R. Gerber, coroner
of Cuyahoga County and secretary of the Ohio
Coroners Association; Dr. Harold J. Knapp,
Cleveland health commissioner; and Dr. Thomas
F. Mancuso, chief of the Division of Industrial
Hygiene, Ohio Department of Health, Columbus.
The appointed doctors engaged in an exten-
sive short course the week of April 3 at
Western Reserve, one of seven centers designated
for similar courses. The National Security Re-
sources Board named Dr. Friedell, who is head
of the Radiology Department at the Medical
School, to direct the course. Instruction in-
cluded biological effects of radiation, thermal-
burns, methods of detecting radiation, how to
treat casualties, handling the injured, and in-
struction in the types of casualties that would
be expected to occur in case of atomic warfare.
Appointed physicians from Indiana, Kentucky,
Michigan, West Virginia as well as Ohio were
included at the Western Reserve Course.
The commission of doctors is scheduled to
recommend plans for a program whereby the
physicians of the State will receive training in
the aspects of atomic warfare. The plan would
entail indoctrinating the entire medical profes-
sion and allied professional groups in the treat-
ment of injuries as the result of an atomic
attack upon the civilian population.
Welfare Convention
The Central States Regional Meeting of the
American Public Welfare Association will be
held in Columbus at the Neil House, June 12-13.
It will bring together public welfare administra-
tors and workers from Iowa, Minnesota, Mis-
souri, Wisconsin, Illinois, Michigan, Indiana and
Ohio.
for May , 1950
509
U. S. Ranks With Leading Nations in
Preventing Infant Deaths
Rapid strides in improving and applying medi-
cal techniques of caring for babies have made
the United States practically equal to any other
nation in the world in preventing infant deaths,
an American Medical Association study shows.
The study, which was recently completed by
Frank G. Dickinson, Ph. D., and Everett L. Wel-
ker, Ph. D., Chicago, of the A. M. A. Bureau of
Medical Economic Research, and published as
Bulletin 73, is summarized in the April 1
Journal of the A.M.A.
One reason for the marked improvement in this
country’s infant death rate is that in recent years
the two diseases which are the major causes of
deaths of babies over one month and under one
year — pneumonia and infant diarrhea — have
largely been conquered in most sections of the
United States, according to Dr. Dickinson.
This medical advance has brought about a
reduction in deaths of babies from six months
to a year of age, he said. During 1946, the
latest year for which specific information is avail-
able, the United States had the world’s lowest
infant death rate for this age group.
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Drs. Vosburgh and Patek Named
At Western Reserve
Two appointments of physicians to fill key
positions at Western Reserve University School
of Medicine have been announced.
Dr. Gilbert Jay Vosburgh, assistant professor
of obstetrics at Johns Hopkins University, has
been appointed head of the Department of Ob-
stetrics and Gynecology of the School of Medi-
cine and director of obstetrics and gynecology at
University Hospitals.
Dr. Vosburgh will go to Cleveland in July,
where he will be the first incumbent of the
Arthur H. Bill Chair, recently established. Dr.
Bill retired from the University and Hospitals
positions in 1948 and is devoting his time to pri-
vate practice.
Dr. Arthur J. Patek, clinical assistant profes-
sor of medicine at Columbia University, has been
appointed professor of medicine and director of
medicine at Mount Sinai Hospital. He was
scheduled to resume his new duties May 1. Dr.
Patek is not new to Cleveland. After receiving
his degree from Harvard University, he served
an internship in medicine at University Hospitals.
Establishment of the position of director of
medicine on a full-time basis at Mount Sinai
Hospital is in line with affiliation of the hospital
with the School of Medicine, and of placing major
emphasis on the teaching of medical students and
house officers.
Have You an Article in this Issue?
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510
The Ohio State Medical Journal
Activities of County Societies . . .
First District
(COUNCILOR: D. W. HEU SINKVELD', M. D„
CINCINNATI)
HAMILTON
Dr. Carl J. Wiggers, Western Reserve Uni-
versity School of Medicine, Cleveland, delivered
the Roger Morris Memorial Lecture for 1950
before the Cincinnati Academy of Medicine on
March 7. His talk was a discussion of dis-
eases of the heart.
At the March 21 meeting, Dr. Fred Wharton
Rankin, University of Louisville School of Medi-
cine, spoke on the subject, “Lesions of the Lower
Gastrointestinal Tract.”
Second District
(COUNCILOR: M. D. PRUGH, M. D„ DAYTON)
CLARK
Dr. C. W. Hullinger of Springfield spoke before
the March 20 meeting of the Clark County Medi-
cal Society on the subject, “Postural Backache.”
The dinner meeting was held at the Ker-Deen Inn.
DARKE
“Mass X-Ray Surveys and Clinical Tubercu-
losis” was the topic of a talk by Dr. Lynn E.
Baker of Dayton before the March 21 meeting
of the Darke County Medical Society in Green-
ville.
MIAMI
In keeping with the theme of April as “Cancer
Control Month,” the Miami County Medical So-
ciety arranged a program on the subject for
the April 7 meeting. The topic for discussion
was “Carcinoma of the Ovary, Uterine Fundus
and Uterine Cervix,” with a team from the Uni-
versity of Cincinnati College of Medicine as
members of the panel of discussants. They are
Dr. Edward Gall, who discussed pathological
phases; Dr. Charles M. Barrett, who spoke from
the standpoint of the radiologist, and Dr. Lester
J. Bosse, who talked on the surgical aspects. The
program was arranged in cooperation with the
Cancer Committee of the Ohio State Medical
Association.
The secretary announced that 130 copies of the
book, The Road Ahead, had been distributed
through members. It was announced also that
a new series of radio programs had been ar-
ranged over Station WPTW at 10:30 a. m. on
Saturdays, entitled “Doctors Make History.” It
was announced that Dr. E. L. Sutton had opened
practice at Tipp City.
MONTGOMERY
Dr. C. O. McCormick, Indiana University School
of Medicine, was guest speaker at the March 4
meeting of the Montgomery County Medical So-
ciety in Dayton. His talk centered around rec-
ommended methods of teaching sex and phy-
siology and pathology of birth in schools.
Fourth District
(COUNCILOR: CARLL S. MUNDY, M. D., TOLEDO)
PUTNAM
Putnam County Medical Society held its
monthly meeting on March 7 at Columbus Grove.
Dr. Daniel R. Barr, Grand Rapids, Ohio, was
guest speaker and gave an informative talk on
“Problems of General Practice.” Dr. Barr is
secretary for the Fourth District, Ohio Academy
of General Practice.
The speaker placed particular emphasis upon
high standards of qualification for non-specialist
members of hospital staffs. He decried what
he termed the overworked and sometimes pa-
tronizing term “family doctor” and suggested
the term “personal physician” as being more
definite and applicable.
Dr. Barr mentioned pre-clinical medicine as
being a rich and inexhaustible field for the man
practicing general medicine. This, he said,
means real, scientific medicine and not social
welfare. By the use of his knowledge of the
patient’s early life, he said, the personal physician
often is the logical one to make diagnosis and
advise treatment.
WOOD
Dr. Bert Seligman, Toledo, addressed the
Wood County Medical Society at its regular
dinner meeting at the Midway Restaurant,
Perrysburg, March 16. Dr. Ray Whitehead of
Bowling Green presided.
Dr. Seligman spoke on the “Differential Diag-
nosis of Chronic Lymphedema and Venous In-
sufficiency.” Dr. Seligman has had a large ex-
perience in this field and his authoritative state-
ments were very much appreciated by the mem-
bers. Effective treatment in these sectors de-
pends in a great measure on the recognition of
the condition.
A rising vote of thanks was tendered Dr.
Seligman.
Fifth District
(COUNCILOR: FRED W. DIXON, M. D., CLEVELAND)
ASHTABULA
The Ashtabula County Medical Society ob-
served its annual dinner dance in the Hotel
Ashtabula on Feb. 25. Doctors and their wives
took part in the festive occasion.
CUYAHOGA
Ballotting on a slate of 16 nominees for the
Board of Directors of the Cleveland Academy
for May, 1950
511
of Medicine for the three-year term beginning
in May is scheduled to be completed by May 12.
From the slate, eight members will be chosen.
The nominating committee which submitted the
names at the March 17 meeting consists of the
following members: Dr. O. B. Pomeroy, chair-
man, Drs. Milton E. Bobey, John F. Boettner,
Walter L. George, Clarence P. Huston, Edward
F. Kieger and Victor E. Woldman.
The program for April included the following
features and speakers:
Internal Medicine Section, April 2 — “A Sym-
posium on the Present Status of Antibiotic Ther-
apy”; Moderator, Dr. John H. Dingle; discus-
sants, Drs. R. F. Parker, F. M. Barry and C. H.
Rammelkamp, Jr.
Experimental Medicine Section of the Academy
of Medicine and Cleveland Section of the So-
ciety for Experimental Biology and Medicine,
April 14 — (1) “The Role of Adrenal Cortex in
Alanine Metabolism,” Drs. Beecher W. Sitter-
son, Max Miller, and Jack Owens, and Hiram
Woodward, Jr., B. S.; (2) “The Adrenal Cortical
Response to Foreign Therapy in Man,” Drs. A. M.
Potts and L. V. Johnson; (3) “On the Mechanism
of Action on Aminopterin,” Charles A. Nichol,
Ph. D.
Obstetrical and Gynecological Section, April
18 — “The Treatment of Toxemia in Pregnancy,”
Dr. Richard T. F. Schmidt (Co-author, Dr. E. E.
Rhoads).
Industrial Medicine and Orthopedic Section,
April 19 — (1) “Industrial Medicine Today,” Dr.
E. A. Irvin, Cadillac Motor Car Division, De-
troit, Mich.; (2) “Surgical Treatment of Her-
niated Disc,” Dr. Karl S. Alfred.
Dr. John H. Budd has been elected to fill
the unexpired term of Dr. Stanley Gardner on
the Board of Directors, who resigned upon mov-
ing to Florida. The term expires in May, 1952.
GEAUGA
Dr. Fred S. Basquin of Chardon and Dr.
Isa Teed Crampton of Burton were honored
for their 50 years of medical service in Geauga
County at a community banquet at the Chardon
Methodist Church on March 9. The affair was
sponsored jointly by the Geauga County Medical
Society, the Geauga County Kiwanis Club and
the Geauga Women’s Hospital Association.
The address of the evening was given by Dr.
Lucy Stone Hertzog of Chardon. Dr. Hertzog,
in praising the records of the two honored doc-
tors, related experiences from the lives of the
pioneer doctors who made medical history in
Geauga County. She described the local Society
as a close-knit organization of well-informed phy-
sicians, all of whom are general practitioners.
Dr. Fred W. Dixon, Cleveland, Councilor of the
Fifth District of the Ohio State Medical Asso-
ciation, presented the 50- Year Pin and Certificate
of the Association to Dr. Basquin and Dr.
Crampton.
Dr. Dixon reviewed the history of medicine
in the area, pointing out that the first doctor
came to Geauga County in 1800. During the
last 50 years, he asserted, medicine has ad-
vanced more than it did during the previous
5,000 years.
Sixth District
(COUNCILOR: PAUL A. DAVIS, M. D„ AKRON)
MAHONING
Eleven physicians were honored by the Mahon-
ing County Medical Society at the organization’s
78th annual banquet on March 16, when they
were presented the 50- Year Pin and Certificate
of the Ohio State Medical Association.
Those honored are: Dr. Coyt H. Beight, Dr.
C. R. Clark, Dr. C. D. Hauser, Dr. M. E. Hayes,
Dr. W. W. Ryall, Dr. D. R. Williams, Dr. H. E.
Blott, Dr. W. D. Coy, Dr. A. V. Hinman, Dr.
R. E. Whelan and Dr. H. M. Osborne. Drs.
Blott, Coy, Hinman, Whelan and Osborne were
unable to be present.
Dr. Paul A. Davis, Akron, Councilor of the
Sixth District of the Ohio State Medical Asso-
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The Ohio State Medical Journal
ciation, made the presentations. Dr. Gordon G.
Nelson, president of the Society, presided.
SUMMIT
Dr. Walter C. Alvarez, Rochester, Minn., spoke
before the Summit County Medical Society in
Akron on March 7. Dr. Alvarez centered his
talk around the importance of taking a complete
history before making a diagnosis. The talk
before the Medical Society as well as a reporter’s
interview with Dr. Alvarez was given a prominent
play in the Akron Beacon- Journal.
Guest speaker at an open meeting of the
Summit County Medical Society and Auxiliary
on April 4 was Dr. Andrew C. Ivy, head of the
Department of Clinical Sciences at the Uni-
versity of Illinois College of Medicine, Chicago.
Dr. Ivy discussed the subject, ‘‘Problems of
Overweight.” An eight-column feature in the
Akron Beacon- Journal was devoted to a report
of Dr. Ivy’s talk.
TRUMBULL
Four members of the Trumbull County Medi-
cal Society, Dr. Aubrey L. Sparks, Dr. Louis
Razinsky, Dr. Densmore Thomas and Dr. David
L. Beers, discussed the subject of government
health programs before a meeting of the War-
ren Business and Professional Women’s Club
at Trumbull Memorial Hospital.
Dr. Sparks served as moderator and pointed
out the advantages and disadvantages of various
types of hospitalization, costs of surgical in-
surance and types of bills presented to Congress.
Dr. Razinsky described the British health
plan, and spoke of health plans as practiced in
Austria, Germany and France.
Dr. Thomas gave a resume of American medi-
cal advancement under private enterprise and
initiative.
Dr. Beers gave statistics on the effect of com-
pulsory insurance based on reports prepared for
Congress. A prominent part of the program
consisted of questions and answers.
Seventh District
(COUNCILOR: R. J. FOSTER. M. D., NEW
PHILADELPHIA)
BELMONT
Five physicians were honored by the Belmont
County Medical Society by being presented the
50-Year Pin and Certificate of the Ohio State
Medical Association. They are: Dr. E. W. Turner,
Belmont; Dr. R. H. Wilson, Martins Ferry; Dr.
Henry F. Zink, Bellaire; Dr. D. 0. Sheppard,
Barnesville; and Dr. Homer S. West, St. Clairs-
ville.
Eighth District
(COUNCILOR: CHESTER P. SWETT, M. D„ LANCASTER)
GUERNSEY
The Guernsey County Medical Society met in
regular session on March 16 at the Berwick Hotel
in Cambridge with 10 members present. Dr. Reo
M. Swan, president, presided.
Dr. Swan and Dr. Robert A. Ringer reported
on the meeting in Columbus of County Medical
Society Presidents, Secretaries and Committee-
men. They outlined briefly discussions of speak-
ers at the conference.
The scientific program was in charge of
Dr. O. R. Martin who chose as his subject,
“Why Mental Illness?” The speaker stressed
that the newborn infant begins at birth to form
its psychiatric pattern and that even these early
experiences may have a lasting effect as regards
mental health. Dr. Martin furnished each mem-
ber present with a Public Affairs Pamphlet
on “Mental Health Is a Family Affair.”
The president announced that members of the
Society were invited to attend a meeting of local
dentists to hear a discussion on “Oral Cancer.”
Dr. F. Gordon Lawyer, secretary, discussed
items of current interest contained in the Secre-
tary’s Letter from the A. M. A., such as urging
physicians and members of their families to
register and vote, excessive fees by some phy-
sicians, collection of membership dues, etc.
The scientific program at the April 6 meeting
of the Society was in charge of Dr. O. R. Jones,
who presented the speaker of the day, Dr.
Myron A. Freilich of Zanesville. Dr. Freilich
spoke on “Digitalis,” supplementing his talk with
a blackboard resume of the variations and
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brands, data regarding origin, trade names and
dosage. The talk brought out many questions
and comments from members.
As a sequel to a letter sent to Mr. Charles S.
Nelson, Executive Secretary of the Ohio State
Medical Association, Columbus, regarding dis-
satisfaction with the method of handling pay-
ments for medical services rendered in Aid for
the Aged recipient cases, Mr. John Small from
the Columbus office of the Division of Aid for
the Aged, appeared and spoke at length regard-
ing the Aid for the Aged program. He was
accompanied by the head of the local county
office, Mr. Walter Howell. Mr. Small stressed
the following points:
1. That aid for the aged program is not a
true pension, but rather is a public assistance
program under jurisdiction of the Department
of Public Welfare.
2. That receipt of aid under the program is
based upon need.
3. That need is established when it is shown
that the applicant’s resources are not equal to
basic requirements, such as adequate medical
care, food, clothing and shelter.
4. That Ohio law establishes the maximum
amount of aid permitted, namely, $55 per month
to be allowed.
5. That if further need is established, the
law permits an extra $5 per month to be allowed
to cover medical expenses; if the recipient is
already receiving the $55 maximum allowance,
an extra fund of $200 per year is available for
extraordinary health requirements.
6. That if this $200 fund proves inadequate
in any calendar year, the unpaid difference in
excess of the $200 must be sought elsewhere,
such as from local relief agencies.
This condition brought out the observation by
some of the members that they have been un-
able to secure cooperation in these cases from
the local relief director, although the So-
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ciety committee had recently signed a new agree-
ment with the county commissioners in which
the commissioners agreed to take care of medi-
cal fee bills in relief cases. Mr. Howell assured
members that he would make every effort to
cooperate with the Society in Aid for the Aged
cases.
Ninth District
(COUNCILOR: J. PAUL McAFEE, M. D.,
PORTSMOUTH)
LAWRENCE
A suggestion by a member that a county
forum dealing with health problems be started
highlighted the March 29 meeting of the Lawrence
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The Ohio State Medical journal
County Medical Society at which representatives
of local labor organizations were present.
Dr. W. W. Lynd suggested “that a County
Forum be instituted, and that the Granges of
all County Groups take up the idea, so that rep-
resentatives of labor, industry, the professions,
farmers, and all other groups, be instructed in
problems of health and medical care in our
county and country. This new Forum would
meet possibly once a month, and several of the
doctors should be present at each meeting.”
The group also discussed the questions of the
Lawrence County General Hospital deficit, the
hospital budget and means to meet it. It was
suggested that a county forum might be the
solution to this problem also.
Dr. J. N. Rose, city-county health commis-
sioner, was accepted into the Society.
Tenth District
(COUNCILOR: H. M. CLODFELTER, M.D., COLUMBUS)
FRANKLIN
Dr. Robert M. Salassa, Consultant in the Di-
vision of Medicine, Section on Metabolism, at
the Mayo Clinic, was guest speaker at the April
17 meeting of the Columbus Academy of Medicine.
His subject was “Use of Combined Insulin
Mixtures in the Treatment of Diabetes.”
Eleventh District
(COUNCILOR: JOHN S. HATTERY, M. D., MANSFIELD j
LORAIN
Dr. A. C. Siddall, Oberlin, spoke before the
Lorain County Medical Society on the subject,
“Cancer Detection in Rural Private Practice,” at
the March 7 meeting at the Spring Valley Coun-
try Club.
“The Anemias” was the subject discussed by
Dr. Robert W. Heinle of Cleveland at the
April 11 meeting of the Lorain County Medical
Society. The meeting was held at the Pueblo
in Lorain beginning with a dinner.
RICHLAND
Topic of the program for the March 16 meet-
ing of the Richland County Medical Society was
“Translumbar Aortography.” It was presented
by Dr. Arthur Evans and Dr. Parke G. Smith,
both of Cincinnati. A buffet dinner was served
at the Mansfield General Hospital. After the
scientific program, a business session was held.
A combined meeting of the Medical Society
and the active staff of Mansfield General Hos-
pital was held at the hospital on Feb. 23. Din-
ner was served followed by a business meeting
presided over by Dr. R. D. Campbell, president.
The program subject was “Local Review of
Sterility in Women From a Clinical and Radi-
ological Viewpoint.” The clinical aspects were
presented by Dr. L. D. Bonar of Mansfield and
the radiological aspects by Dr. R. L. Garber,
also of Mansfield.
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Woman’s Auxiliary . . .
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
President — Mrs. C. W. Kirkland, 4805 Guernsey Street,
Bellaire
Recording Secretary — Mrs. C. H. Bell, 754 Dickson Parkway,
Mansfield
Treasurer — Mrs. A. Paul Hancuff, 3551 Maxwell Road,
Toledo 13
INCOMING PRESIDENTS
It has been requested by Mrs. George W.
Cooperrider, State President-Elect, that county
presidents for the 1950-51 term please bring to
the Cleveland Convention a list of their full
slate of officers and chairmen (both names and
addresses) for the ensuing year, or at least as
complete a list as is possible.
There will be a specially designated table
close to the registration desk where this in-
formation may be deposited. Mrs. Cooperrider
points out that such cooperation on the part of
each new county president will do much toward
facilitating the work of all State officers and
chairmen in getting activities and materials
started promptly for the new Auxiliary year.
ALLEN
A discussion of local health conditions, their
deficiencies and the facilities for improving them
featured the Feb. 28 meeting of the Allen County
Auxiliary held at the home of Mrs. John A.
Glorioso. Mrs. Gwen Horre, physiotherapist at
St. Rita’s Hospital, was the guest speaker. She
spoke on “What About Polio?”
The March meeting of the Auxiliary was a
panel discussion on “School Health Program”
held at the home of Mrs. Carl Zinsmeister.
Guest speakers included: Ralph Turner, execu-
tive secretary of the Allen County Tuberculosis
Association; Mrs. Alfred Schwerin, consulting
psychologist of the Mental Hygiene Association;
and Mrs. Waldo May, public health nurse.
4SHTABULA
The Student Nurse Recruiting Fund sponsored
by the Woman’s Auxiliary to the Ashtabula
County Medical Society benefited from the
style show held by that organization on March
14. One hundred attended the event which was
held at the Nurses’ Home. Preceding the fashion
show, a Conneaut octet was heard in three num-
bers under the direction of Mrs. R. C. Irving
and accompanied by Mrs. Deweese Davis. The
octet presented another three selections at the
close of the show.
Mrs. Frank Veroni and Mrs. Paul Longaker
presided at the refreshment table. Mrs. Donald
Forward, fashion show chairman, introduced
Mrs. Viola Bilka, the style representative. Others
serving on Mrs. Forward’s committee included:
Mrs. E. N. Wright as co-chairman; Mrs. A. A.
DeCato, Mrs. James Macaulay, Mrs. J. R. Higerd
and Mrs. C. C. Campbell.
AUGLAIZE
The Auglaize County Auxiliary met on March
15 at the home of Mrs. R. H. Schaefers. A
group of local high school students presented
an interesting discussion on socialized medicine.
The April meeting will be held at the home of
Mrs. E. F. Heffner.
CUYAHOGA
The winter meeting of the Woman’s Auxiliary
to the Cleveland Academy of Medicine was held
on Feb. 28 in the Allerton Hotel. Following
luncheon, Dr. Shepherd L. Witman, executive
director of the Council on World Affairs, dis-
cussed “What’s New in Democracy.” Hostesses
for the occasion were Mrs. S. N. Adams, Mrs.
John Davis, Mrs. Stanley DeVille, Mrs. R. C.
Ernest, Mrs. E. 0. Harper, Mrs. E. J. Humel,
Mrs. E. W. Parsons, Mrs. Garry G. Bassett and
Mrs. Herbert Wright.
Two lecture programs conducted by four doc-
tors’ wives were arranged by the Auxiliary for
March 21 and March 28, to “brief” auxiliary
members on socialized medicine. At the first
meeting held at the Medical Library Auditorium,
Mrs. N. L. Farnacy, graduate of the Cleveland
School of Law, spoke on “What Does the Govern-
ment Plan for Medicine?” Mrs. C. S. Higley
discussed “Is A Compulsory Program Neces-
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The Ohio State Medical Journal
sary?” Mrs. Higley is a former medical social
worker, active in many civic projects.
The second meeting, on March 28, presented
Mrs. U. V. Portmann and Mrs. Farrell Gallagher
as the speakers. Mrs. Portmann’s topic was
“What Do the Doctors Propose?” She is vice-
president of the Council on World Affairs and
active in community projects. Mrs. Gallagher
spoke on “What Can We Do?” She is state
auxiliary public relations chairman and legis-
lative chairman of the Diocesan Council, National
Council of Church Women.
The Cuyahoga County Auxiliary also had the
distinction of editing the February issue of the
bulletin of its Academy of Medicine.
DELAWARE
Health legislation was the topic of discussion
at the luncheon meeting held on March 21 by the
Woman’s Auxiliary to the Delaware County
Medical Society at Bun’s Restaurant. Mrs. Wray
Davis presented a report of the conference of
officials of county medical auxiliaries held on
March 14 in Columbus that was sponsored by the
Ohio State Medical Association.
Mrs. George T. Blydenburgh read a report of
a British physician who practiced socialized
medicine in England during 1948 and 1949. The
discussion was concluded with a question-and-
answer period, led by Mrs. Edward C. Jenkins,
concerning the problems and weaknesses of so-
cialized medicine.
Cook County
Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic,
Two Weeks, starting May 15, June 19, July 24.
Surgical Technic, Surgical Anatomy & Clinical
Surgery, Four Weeks, starting May 1, June 5,
July 10. Personal Course in General Surgery,
Two Weeks, starting September 25. Surgery of
Colon & Rectum, One Week, starting May 15,
June 5. Esophageal Surgery, One Week, starting
June 5. Breast & Thyroid Surgery, One Week,
starting June 26. Thoracic Surgery, One Week,
starting June 12. Gallbladder Surgery, Ten
Hours, starting June 19. Fractures & Traumatic
Surgery, Two Weeks, starting June 12. Basic
Principles in General Surgery, Two Weeks, start-
ing September 11.
GYNECOLOGY — Intensive Course, Two Weeks, start-
ing June 19, September 25. Vaginal Approach to
Pelvic Surgery, One Week, starting May 15.
OBSTETRICS — Intensive Course, Two Weeks, start-
ing June 5, September 11.
PEDIATRICS — Personal Course in Cerebral Palsy
Two Weeks, starting July 31. Personal Course in
Diagnosis & Treatment of Congenital Malforma-
tions of the Heart, Two Weeks, starting June 5.
MEDICINE — Intensive General Course, Two Weeks,
starting October 2. Electrocardiography & Heart
Disease, Two Weeks, starting July 17. Hematology
One Week, starting May 8. Gastro-enterology,
Two Weeks, starting May 15. Liver & Biliary
Diseases, One Week, starting June 5. Gastroscopy,
Two Weeks, starting May 15, June 12.
DERMATOLOGY — Formal Course, Two Weeks, start-
ing May 8. Informal Clinical Course every 2 weeks.
UROLOGY — Intensive Course, Two Weeks, starting
September 25. Cystoscopy, Ten Day Practical
Course, every two weeks.
General, Intensive and Special Courses in all
Branches of Medicine, Surgery and the Specialties
TEACHING FACULTY — ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Add
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CHICAGO 12, ILLINOIS
The Auxiliary voted to give to each of the
12 Delaware city and county high schools a sub-
scription to Today's Health.
ERIE
Mrs. E. J. Meckstroth will serve as the 1950-51
president of the Woman’s Auxiliary to the Erie
County Medical Society. The election of officers
followed the Auxiliary’s March luncheon at the
Business Women’s Club at which the guest
speaker, Dr. W. P. Skirball, discussed neuro-
psychosis.
Serving with Mrs. Meckstroth will be Mrs.
H. W. Lehrer as president-elect; Mrs. Paul N.
Squire as vice-president; Mrs. C. J. Reichenbach
as secretary; and Mrs. A. G. Groscost as treas-
urer. The luncheon tables were appointed in
a St. Patrick’s Day motif with shamrocks as
place favors. Hostesses were Mrs. Reichenbach,
Mrs. A. R. Warner and Mrs. Watson Parker.
Highlights of the Columbus conference held
for county auxiliary presidents by the Ohio
State Medical Association were presented by
Mrs. Lehrer, Mrs. Carl E. Swanbeck, Mrs.
Meckstroth and Mrs. Ross Knoble. It was an-
nounced that the Auxiliary was making plans
for a “doctors’ party” scheduled for April 29
at the Plum Brook Country Club.
FAIRFIELD
The Auxiliary to the Fairfield County Medical
Society met on March 10. Following a dessert-
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luncheon, Mrs. F. W. James presided over the
business session. Reports of standing com-
mittees were presented and projects discussed.
Mrs. James and Mrs. C. P. Swett told about the
Columbus conference for county auxiliary of-
ficials. Hostesses for the March meeting were
Mrs. L. E. Stenger, Mrs. V. A. Simiele and Mrs.
F. E. Spangler.
JEFFERSON
A donation to the Nurses’ Scholarship Fund
was voted at the March 27 meeting of the Jef-
ferson County Auxiliary, held at the home of
Mrs. Edward Weinman. A nominating com-
mittee for the election of new officers was ap-
pointed and includes: Mrs. Stanley Burkhart,
chairman; Mrs. Samuel Greenburg and Mrs. L.
J. Kerschgens. The afternoon’s program fea-
tured a talk by Mrs. H. E. Thompson on floral
arrangements. Refreshments were served later
by the hostess, with Mrs. Albert Sunseri assist-
ing.
KNOX
The Woman’s Auxiliary to the Knox County
Medical Society met on March 30 at the home
of Mrs. Richard Gomer. The business meeting
was conducted by Mrs. J. L. Baube who reported
on the Columbus conference held on March 14.
Mrs. Henry Lapp, Mrs. George Imhoff and
Mrs. R. L. Eastman were named to the nominat-
ing committee. Mrs. John Drake, Mrs. Charles
Tramont and Mrs. Julius Shamansky were
appointed to the ways and means committee.
Mrs. C. E. Cassaday, program chairman, in-
troduced Mr. L. S. Allen, local jeweler, who
spoke on the “Romance of Gems” and exhibited
a valuable collection. An arrangement of pink
roses centered the refreshment table at which
Mrs. James F. Lee presided. Joint hostesses
were Mrs. Raymond Lord and Mrs. Robert
Hoecker.
LICKING
Mrs. Roland Jones was elected president of
the Woman’s Auxiliary to the Licking County
Medical Society at its dinner meeting on March
28 at the Moundbuilders Country Club. The
tables were prophetic of Spring with their center
arrangements of forsythia, pussy willows and
tall yellow tapers.
Chosen by the Auxiliary to serve with Mrs.
Jones are: Mrs. Donald Sperry, president-elect;
and Mrs. Paul Grove, vice-president. Mrs.
Ralph Pickett was reelected secretary and Mrs.
Wendell Steele, treasurer. The Auxiliary voted
again to sponsor a high school girl interested in
a nursing career. The scholarship will be given
outright to the student who rates in the upper
third bracket of her class at graduation. She
will be given the opportunity to choose the
hospital in which she wishes to take her training.
Mrs. Jones and Mrs. J. Y. Salzman reported
on the Columbus conference held at the Fort
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Hayes Hotel on March 14. Plans for a rum-
mage sale were also discussed.
LOGAN
Mrs. John B. Traul was hostess when the
Auxiliary to the Logan County Medical Society
met on March 28 for its regular monthly meet-
ing. Mrs. Warren Mills presided in the ab-
sence of the president. The topic “Public Rela-
tions” was presented by Mrs. Charles Thompson,
following which a general discussion was held.
A social hour followed the business session
when refreshments were served.
OTTAWA
The Ottawa County Auxiliary held its March 9
meeting at the home of Mrs. James Rhiel.
Plans were made for a tea and a tour of the
hospital in April for junior and senior high
school girls in the county who are interested
in nursing.
RrCHLAND
A luncheon meeting was held on April 3 at
the Women’s Club by the Auxiliary to the
Richland County Medical Society. Mrs. Ralph
Wharton and Mrs. Sigmund Smedal were host-
esses. Arrangements of yellow roses, daffodils
and lavender iris centered the luncheon tables.
Mrs. F. J. Heringhaus, president, conducted
the business session. A report on the meeting
of the coordinating council was given by Mrs.
Smedal. Mrs. Robert Crawford stated that seven
members attended the state conference in
Columbus. The May meeting which will be
the last one until the Fall will be held on
May 22. At that time, election of officers will
take place and annual reports given.
Plans for the Wood County Hospital, Bowling
Green, and the Defiance Hospital, Defiance, are
featured for their “generally excellent design”
in a special section entitled “A Profile of Hos-
pital Construction” in the April, 1950, issue of
Hospitals , the journal of the American Hospital
Association.
A nationally integrated study of the nation’s
potential capacity to collect and store whole
blood will begin soon at a meeting in Wash-
ington of the agencies concerned, both Federal
and private. Invited to participate are the
American Red Cross, American Association of
Blood Banks, National Research Council, De-
partment of Defense, Federal Security Agency,
Atomic Energy Commission and the Veterans
Administration. The project is in charge of
Dr. Norvin C. Keifer, formerly of Geneva, Ohio,
and now medical director of the National Security
Resources Board.
Professional Protection
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CINCINNATI Office: H. 1. Franklin, Rep.,
1410 Traction Building, Tel. Main 3021
CLEVELAND Office: J. R. Ticknor, Rep.,
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COLUMBUS Office: R. G. Woehr, Rep.,
2800 Indianola Ave., Tel. Lawndale 6200
YOUR SACR0-ILIAC
PATIENTS
• •
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attention from our
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C/yiAP ANATOMICAL SUPPORTS also available
for prenatal, postnatal, postoperative, pendulous
abdomen, visceroptosis, nephroptosis, hernia, mam-
mary gland and other orthopedic conditions.
23 E. State Street
Columbus, Ohio
for May, 1950
519
Payment of A. M. A. Dues Explained
In Question-Answer Form
Many questions have been directed to the
Headquarters Office in Columbus as well as to
the A. M. A. Headquarters regarding payment
of the A. M. A. dues voted by the House of
Delegates at its December, 1949, meeting.
The following are typical of the many ques-
tions being asked and are reproduced herewith
together with answers furnished by the Secre-
tary of the A. M. A. This additional information
is given for the benefit of Ohio physicians who
may wish to review the information contained.
Question: Does the American Medical Asso-
ciation require the payment of dues by its mem-
bers?
Answer: (a) Members for whom the payment
of dues constitutes a financial hardship as deter-
mined by their local medical societies.
(b) Members in actual hospital training for
not more than five years after graduation from
medical school.
(c) Members who have retired from active
practice.
In all instances exemption may be allowed
only if the member is also exempt from state
and county medical society dues. (Note: This is
not possible in Ohio under the present By-Laws.)
Question: To whom should the American Medi-
cal membership dues be paid?
Answer: To the local or state society, depend-
ing on the system of payment established by
the state medical association concerned.
Answer: Yes. For the first time in its his-
tory, the members of the American Medical
Association in 1950 will pay membership dues.
These dues apply to all members of the Asso-
ciation except those in three specific categories.
Question: What is the amount of the dues for
1950?
Answer: $25.
Question: What are the American Medical
Association 1950 membership dues of a physician
who joins his county medical society after
July 1?
Answer: Dues for physicians who become
members after July 1, 1950, are $12.50. The dues
for all members before July 1 are $25.
Question: Does a member who transfers from
one state or county to another pay American
Medical Association membership dues a second
time?
Answer: No. A member pays his American
Medical Association dues only once in a calendar
year.
Question: By what authority were the dues
set at the $25 level?
Answer: On recommendation of the Board of
Trustees and approval by the House of Dele-
gates in December 1949 in accordance with the
provisions of the Constitution and By-Laws of
the American Medical Association.
Question: What members are exempt from
the payment of American Medical Association
membership dues for the year 1950?
Question: When should American Medical
Association 1950 membership dues be paid?
Answer: When the member receives his bill
from his local or state society. No remittance
CHAS. F. BOWEN, M. D.
332 East State Street
COLUMBUS 15, OHIO
X-RAY DIAGNOSIS
AND
TREATMENT
OF
CANCER
RADIUM
X-RAY
SURGERY
•
Office Home
AD. 8548 EV. 1344
THE SOCIETY for INVESTIGATIVE DERMATOLOGY
will hold its
ELEVENTH ANNUAL MEETING
at the Clift Hotel, San Francisco, California, on Sunday June 25, 1950
(See Archives of Dermatology and Syphilology, May, 1950, for Scientific Program.)
520
The Ohio State Medical Journal
of membership dues should be made directly to
the American Medical Association.
Question : What is the relation between Ameri-
can Medical Association membership dues and
Fellowship dues?
Answer: (a) The status of Fellowship and
Fellowship dues has not been changed by the
establishment of American Medical Association
membership dues.
(b) Members may become Fellows — subject to
approval by the Judicial Council — by requesting
such status on a form supplied by the American
Medical Association.
(c) Fellowship dues of $12 and membership
dues of $25 are separate dues. Members who are
or who become Fellows, therefore, pay a total,
combined Fellowship and membership dues, of
$37.
Fellowship dues include subscription to The
Journal of the American Medical Association or
to one of the special journals.
Question: What is a Service Fellow?
Answer: Commissioned medical officers of the
Armed Forces and the United States Public
Health Service and permanent medical officers
of the Veterans’ Administration may become
Service Fellows of the American Medical Asso-
ciation on nomination by their chief medical of-
ficers and approval by the Judicial Council.
Service Fellows are not required to pay Fellow-
ship dues and do not receive any publication of
the Association except by personal subscription.
Question: Must a Service Fellow be also a
member of the American Medical Association?
Answer: No. Service Fellowship is a special
category of Fellowship established for physicians
in full time Government service, many of whom
are not eligible for membership in their local
medical societies. However, a Service Fellow
who is a member of a local medical society may
elect to pay American Medical Association dues
for 1950 and thereby continue his membership
in the American Medical Association.
Question: What action is taken when there is
failure to pay American Medical Association
membership dues ?
Answer: Members who are delinquent in the
payment of American Medical Association dues
for one year and who fail to pay such delinquent
dues within 30 days after receipt of notification
from the Secretary of the American Medical
Association will forfeit membership in the
American Medical Association. Retention of
membership in the local and state medical so-
cieties under these circumstances will depend on
the local action of those societies.
RADIUM and RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician- Radiologist)
HAROLD SWANBERG, B. S„ M. D., Director
W. C. U. Bldg. Quincy, Illinois
A SERVICE OF SUPPLY
Bowman
TO THE MEDICAL ARTS
MEDICAL AND SURGICAL
EQUIPMENT and SUPPLIES
PHARMACEUTICALS
BIOLOGICALS
MEDICAL FURNITURE
SURGICAL and DIAGNOSTIC
INSTRUMENTS
The Bowman Brothers Drug Co.
CANTON, OHIO
CANTON at 7 79 Schroyer Ave., S.IV.
AKRON at 370 East Market Street
LIMA at 539 West Market Street
ZEMMER pharmaceuticals
A complete line of laboratory controlled ethical pharmaceuticals.
Chemists to the Medical Profession for 44 years.
THE ZEMMER COMPANY • Oakland Station • PITTSBURGH 13, PA.
for May, 1950
521
Survey Indicates Large Percentage
Favors Free Medical System
Compulsory health insurance is far from
popular among the city folk, according to a
survey recently completed by the Psychological
Corporation, New York, in 25 cities and towns
from coast to coast.
They asked the question:
“Which do you favor: (a) To have govern-
ment give free doctor and medical service which
would be paid for by a three per cent payroll
tax on all wages under $3,600, or, (b) the present
system of medical service?”
65 per cent favored the present medical system;
26 per cent favored government medicine;
9 per cent were uncertain.
Even in the lower income group, the lowest
third which is supposed to benefit most from
government medicine, 51 per cent were against
the plan while 37 per cent favored it.
In an April, 1947, survey on what people
consider good and bad Americanism, the follow-
ing question was asked:
“Which is better for America: (a) To have
the government give free doctor and medical
service which would be paid for by a tax like
the Social Security tax; or, (b) the present sys-
tem of medical service?”
63 per cent favored the present medical service;
30 per cent favored government medicine;
7 per cent were uncertain.
Insofar as the two surveys are comparable, it
would seem that in spite of government propa-
ganda in favor of socialized medicine, there has
been little change in the proportion of people
who favor government medicine.
Effects of America’s declining birth rate and
lengthening life span will be made the subject
of a five-year study by the University of Cali-
fornia’s Institute of Industrial Relations, sup-
ported by a Rockefeller Foundation grant of
$125,000.
COMING MEETINGS
Ohio State Medical Association, Annual Meet-
ing, Cleveland, May 16-18.
American Medical Association, Annual Session,
San Francisco, June 26-30.
American College of Radiology, San Francisco,
Calif., June 25.
American Pediatric Society, French Lick, Ind,»
May 8-10.
Conference of County Medical Society Officers,
San Francisco, June 25.
Eighth Councilor District Annual Meeting, Mc-
Connelsville, June 15.
INDEX TO ADVERTISERS
Abbott Laboratories 419
American Meat Institute 426
Ames Company, Inc 428
Ann Arbor School, The 508
Ayerst, McKenna & Harrison, Ltd. . 427
Bell, Kathryn S., Inc 519
Birtcher Corporation, The 507
Borden Company, 481
Bowen, Charles F., M. D 520
Bowman Bros. Drug Company 521
Camel Cigarettes 483
Cincinnati Sanitarium 423
Clinical and Pathological Laboratory 514
Columbus Orthopaedic Appliance Co. 517
Cook County Graduate School of Medicine 517
Endo Products, Inc 425
Fleet, C. B., Company, Inc. 430
Hanger, J. E., Inc 515
Harding Sanitarium _• 424
Holland Rantos Co. 434
Lederle Laboratories, Inc 415
Lilly, Eli, and Company Insert between
pages 436 and 437
Luzier’s, Inc. 418
McMillen Sanitarium 423
Mead Johnson & Company Back Cover
Medical Protective Company 519
Medico Press, The 504
Mercer Sanitarium 424
Miller, W. H., M. D 515
M & R Dietetic Laboratories, Inc. 429
Neil Training School 523
Nestle’s Company, Inc. 495
New York Polyclinic Medical School 497
Num Specialty Company 523
Oak Ridge Sanatorium 422
O'Connors Landing 516
Parke, Davis & Company 524
and Inside Back Cover
Pfizer, Chas. & Co., Inc 477
Philip Morris & Company 432
Picker X-Ray Corp. 436
Pogue, The Mary E., School 512
Quincy X-Ray & Radium Laboratories 521
Radium Emanation Corporation 499
Resthaven 514
Rexair Division, Martin-Parry Corp. 501
Rupp & Bowman Company 513
Sandoz Pharmaceuticals, Inc 501
Sawyer Sanatorium 413
Schering Corporation - 433
Searle, G. & Company _ 475
Society for Investigative Dermatology 520
Squibb, E. R., & Sons 417
Stoneman Press 510
Van Wagner Company 518
Wendt-Bristol Company 518
Wickhaven Sanitarium 424
Windsor Hospital - 424
Winthrop-Stearns, Inc 435
Wyeth, Inc. 431
Zemmer Company 521
- •
522
The Ohio State Medical Journal
Clinicians have long noted
that the forward bulk of the
heavy abdomen with its fat-
laden wall moves the center
of gravity forward. As the
load, the lumbar and cervical
curves of the spine are in-
creased, the head is carried
forward and the shoulders
become rounded. Often there
is associated visceroptosis.
Camp Supports have a long
history among clinicians for
■
their efficacy in supporting
the pendulous abdomen. The
highly specialized designs and
controlled adjustment help
viscera upward and backward .
There is no constriction of
the abdomen, and effective
support is given to the spine.
Physicians may rely on
the Camp- trained fitter for
precise execution of all in-
structions.
If you do not have a copy of
the Camp “Reference Book
for Physicians and Surgeons”,
it will be sent on request.
WHEN OBESITY IS A PROBLEM
S. H. CAMP and COMPANY
JACKSON, MICHIGAN
World's Largest Manufacturers
of Scientific Supports
Offices in New York • Chicago
Windsor, Ontario • London, England
THIS EMBLEM Is displayed only by reliable merchants
in your community. Camp Scientific Supports are never
sold by door-to-door canvassers. Prices are based on
intrinsic value. Regular technical and etfiteaHreinirtg of
Camp fitters insures precise and conscientious attention
to your recommendations.
for June, 1950
531
*7lte PUyliciasiX
By JONATHAN FORMAN, M. D.
Kate Fuller, M. D., by Dorothy Pierce Walker
($2.50. Macrae Smith Co., Philadelphia) , is the
story of a beautiful and learned intern, and
the obstacles encountered by the modern woman
in hospital work where men like women but
dislike them in their business. You may re-
member the author’s Five O’Clock Surgeon.
Society and Its Criminals, by Paul Reiwald
($4.50. International Universities Press, Inc.,
New York City), will provide a key for the large
number of persons who are concerned with the
modern problems of crime. It is a comprehensive
exposition of what psychoanalysis has taught us
about crime, and society’s attitude towards it.
Comroe’s Arthritis and Allied Conditions, com-
pletely revised and rewritten by Joseph L. Hol-
lander and 16 associates ($16.00. Fourth Edi-
tion. Lea & Febiger, Philadelphia) , stands as
the best in its field and as a fine memorial to
Bernard Isaac Comroe, M. D. Eleven hundred
pages by the outstanding specialists in America,
including Philip S. Hench’s discussion of Com-
pound E.
Mitchell’s Pediatrics and Pediatric Nursing, by
Robert A. Lyon, M. D., and Elgie M. Wallinger,
of Columbus Children’s Hospital ($3.75. Third
Edition. W. B. Saunders Col, Philadelphia),
presents an enlarged chapter on growth and de-
velopment and new emphasis on individual nur-
sery care and the psychological phases of medi-
cal treatment.
Eye, Ear, Nose and Throat Manual for Nurses,
by Roy H. Parkinson, M. D. ($3.00. Sixth Edi-
tion. C. V. Mosby Co., St. Louis, Missouri), is
divided into three parts : One for the under-
graduate, one for those in the operating room,
and one for the public health nurse in the field.
No field has been more profoundly influenced
by the advent of “the Miracle Drugs” than this
one.
Methods of Teaching in Schools of Nursing, by
Alice B. Brethorst, R. N., Ph. D. ($4.00. W. B.
Saunders Co., Philadelphia), gives us some 300
pages on pedagogical practices that the author
has found important in her 20 years of teaching
nursing.
Obstetric Management and Nursing, by Henry
L. Woodward, M. D., and Bernice Gardner, R. N.,
($4.00. Fourth Edition. F. A. Davis Co., Phila-
delphia), is a revised edition of this standard
text for nurses from Christ Hospital, Cincinnati,
Ohio. All new developments in the past five
years in the care of the normal mother and her
child are adequately covered.
Quinidine in Disorders of the Heart, by Harry
Gold, M. D. ($2.00. Paul B. Hoeber, Inc., New
York City), is a concise manual on how to ob-
tain the maximum therapeutic results from the
use of this drug in disorders of cardiac rhythm.
Particular stress is placed on the rationale of
every procedure recommended.
Vitaminology, by Walter H. Eddy, Ph. D. ($6.00.
Williams & Wilkins Co., Baltimore, Maryland),
gives the complete story to date of the chemistry
and functions of the vitamins. Each vitamin is
discussed authoritatively as to what it does, its
place in the chemical field, and its value in human
and domestic animal nutrition.
How To Stay Healthy, by Irving S. Koll, M. D.
($2.75. Ziff-Davis Publishing Co., Chicago) —
a popular little book of 200 pages which makes
good use of words to tell the story of positive
health by a practicing physician. It is a book
to give your health-conscious patient or to study
yourself if you do radio talks or popular lectur-
ing.
Doctor Will, by Pauline Stiles ($3.00. Bobbs-
Merrill Co., Indianapolis), a tale of the West
at the turn of the century. Another good story
about a humane physician of the days that are
gone.
Your Nasal Sinuses and Their Disorders, by
Albert P. Seltzer, M. D. ($2.50. Froben Press,
New York City), is a well-illustrated popular
exposition. The author, in your reviewer’s
opinion, evaluates injection, physical agents, al-
lergy, and emotional disorders as the causes of
“sinus.”
An Atlas of Traumatic Surgery with Illustrated
Histories of Wounds of the Extremities, by
Josep Trueta, M. D. ($7.50. C. C. Thomas,
Publisher, Springfield, Illinois), is based upon
the author’s war experience at the Wingfield-
Morris Orthopaedic Hospital, Oxford, England.
The photographs were chosen from thousands
because they do illustrate a point in management.
Electrocardiography, Fundamentals and Clini-
cal Application, by Louis Wolff, M. D., ($4.50.
W. B. Saunders Co., Philadelphia), teaches the
basic principles without referring to the clinical
patterns. The author’s experiences in teaching
this subject convince him of the necessity of
using this new approach. It is, however, strictly
a practical book.
Diseases of the Nervous System, by F. M. R.
Walshe, M. D. ($5.00. Sixth Edition. Williams
& Wilkins C<x, Baltimore, Maryland), presents
532
The Ohio State Medical Journal
an entirely rewritten text on neurosyphilis with
special reference to treatment. The sections on
acute poliomyelitis and intracranial abscess have
been enlarged and reemphasized. The fact that
the previous edition was translated into both
French and Spanish speaks for this book.
Questions, Medical State Board, and Answers,
by R. Max Goepp, M. D., and Harrison F. Flip-
pin, M. D. ($7.00. Eighth Edition. W. B.
Saunders Co., Philadelphia) , is the first edition
of this standard text which can be called “the
old dependable” for all who have crammed for
exams these 40 years to my personal knowledge.
Aviation Medicine, by Kenneth G. Bergin, M. D.
($7.00. Williams & Wilkins Co., Baltimore,
Maryland), is a comprehensive but concise
manual dealing with all phases of the subject.
It has been written by the physician to the
British Overseas Airways Corporation with the
help of many on both sides of the ocean.
A Manual of the Penicillia, by Kenneth B.
Raper and Charles Thom ($12.00. Williams &
Wilkins Co., Baltimore, Maryland), is a manual
prepared under the joint sponsorship and support
of the National Science Fund and members of
the staff of the Department of Agriculture. It
is a must for the library of everyone inter-
ested in the green molds.
Bedside Diagnosis, by Charles Mackay Seward,
M. D. ($3.50. Williams & Wilkins Co., Balti-
more, Maryland), is a delightful book by a
distinguished British physician. In these days
of laboratory tests and gadgets, we can all profit
by reading it.
A Manual of Physical Therapy, by Richard
Kovacs, M. D. ($3.75. Fourth Edition. Lea &
Febiger, Philadelphia), has been reprinted each
year for the last five years and now it comes
to us revised and brought up to date as a concise
manual of the entire subject.
Surgical Management of Vascular Diseases, by
Gerald H. Pratt, M. D. ($10.00. Lea & Febiger,
Philadelphia), represents the way this field of
surgery has developed into an important and
rapidly expanding surgical specialty. The au-
thor has specialized in this field for the past
twelve years. His research and publications are
familiar to all. This wide experience, as his
old chief, W. Wayne Babcock, observes in his
introduction, has particularly fitted him to write
this timely book.
Resuscitation and Anesthesia for Wounded
Men, by Henry K. Beecher, M. D. ($5.50.
C. C. Thomas, Publisher, Springfield, Illinois),
presents the lessons of the last decade in the
management of traumatic shocks. It deals
especially with the patient’s care during the
critical period from the time he is hurt until the
surgeon repairs his wounds.
Bridges’ Dietetics for the Clinician, by Harry
J. Johnson, M. D. ($12.00. Fifth Edition. Lea
& Febiger, Philadelphia) , has been brought up
to date by an associate of the author. It in-
corporates the practical advances in the field
of nutrition — what each of us needs to know.
Internal Medicine in Dental Practice, by Bern-
ard I. Comroe, M. D., Leon H. Collins, Jr., M. D.,
and Martin P. Crane, M. D., ($6.50. Third Edition.
Lea & Febiger, Philadelphia) , presents a “speak-
ing knowledge” of modern internal medicine
for the dentist.
Diseases of the Foot, by Emil D. W. Hauser,
M. D. ($7.00. Second Edition. W. B. Saunders
Co., Philadelphia) , was written to fill a need
among physicians by a famous orthopedic sur-
geon. Most of us know all too little about the
foot and its diseases. Four hundred pages of
most useful information.
The Medical Annual, 1949 ($7.00. Williams &
Wilkins Co., Baltimore, Maryland), is a year-
book of treatment and a practitioner’s index writ-
ten by a group of distinguished British physi-
cians.
Medicine Could Be Verse, by Charles G.
Farnum, M. D. ($3.00. Exposition Press, New
York City), is light verse — most humorous —
mostly about physicians — by a distinguished in-
dustrial surgeon. Delightful — a nice gift for
your physician friend.
Group Medicine and Health Insurance in Ac-
tion, by Robert E. Rothenberg, M. D., Karl
Pickard, M. D., and J. E. Rothenberg, Introduc-
tion by George Baehr, M. D. ($5.00. Crown
Publishers, New York City), is the detailed
story of the Central Medical Group of Brooklyn —
its origin, its plan, its operation, utilization
and business side, the legal aspects of its prac-
tices, personnel problems, standards, and phy-
sical requirements. All who are interested in
cooperatives, insurance, or group practice will
want to read these 300 pages — study them in
fact.
Practical and Theoretical Aspects of Psy-
choanalysis, by Lawrence S. Kubie, M. D., ($4.00.
International Universities Press, Inc., New York
City)-, is a revision of the book of 1936. The old
chapters have been largely rewritten and ex-
panded while new chapters on therapy and on
social and cultural implications of the method
have been added. It is the answer from the
practitioner’s point of view as to whether psy-
choanalysis can help in particular cases.
Manometric Techniques and Tissue Metabolism,
by W. W. Umbreit, R. H. Burris and J. F. Stauf-
fer. ($4.00. Burgess Publishing Co., Minne-
apolis, Minnesota) , is designed to be a practical
laboratory manual to place in the hands of the
beginner, produced bjr the staff at the University
of Wisconsin.
for lune, 1950
533
Entrance to Grounds
HARDING SANITARIUM,
For Nervous and Mental Disorders
WORTHINGTON,
OHIO
NINE MILES NORTH OF STATE HOUSE— COLUMBUS
HARRISON S. EVANS, M.D.
Aiedical Director
L. HAROLD CAVINESS, M. D.
GEORGE T. HARDING, M.D.
President of Board
Telephone: Columbus FR. 2-5367
CHARLES L. ANDERSON, M. D.
Clinical Director
CHARLES W. HARDING, M. D.
An institution for the study and treatment of NERVOUS and MENTAL DISORDERS
John H. Nichols, M. D., Medical Director Herbert A. Sihler, Director Edmund V. Sihler, Assoc. Director
Roger K. Kalina, M. D., Resident Medical Director Approved by American College of Surgeons
WINDSOR HOSPITAL, CHAGRIN FALLS, OHIO Phone: Chagrin Falls 7347
28707 EUCLID AVENUE
Located 12 Miles East of
Cleveland Public Square
WICK HAVEN
WICKLIFFE, OHIO
Phone Wickliffe 160
AN INSTITUTION FOR SELECTED NERVOUS AND MENTAL PATIENTS EMPLOYING
^ ^ — — ___
RATIONAL METHODS OF TREATMENT
(Member of American Hospital Association; Ohio Hospital Association and National
Association of Private Psychiatric Hospitals)
W. W. DANGELEISEN, M . D . , Medical Director
THE MERCER SANITARIUM (30 Miles East of Youngstown)
For Nervous and Mild Mental Cases — Restful, Quiet, Attractive Surroundings — All Private
Rooms. Psychotherapy, Shock Therapies, Physiotherapy, Hydrotherapy, Occupational Ther-
apy, Special Diets, Excellent Library and Recreational Facilities.
Licensed by State; Member of Pa. Hosp. Assoc.; Member of Amer. Hosp. Assoc.; Member National Association
of Private Psychiatric Hospitals*.
Medical Director, John L. Kelly, M. D., Diplomate in Psychiatry
534
The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association, a scientific society, non-profit corporation, with a definite
membership, for scientific and educational purposes.
Vol. 46 * June, 1950 No. 6
Jonathan Forman, M. D., Editor
Charles S. Nelson,
Managing Editor — Bus. Mgr.
R. Gordon Moore,
Asst. Managing Editor
The Etiology and Rationale of Treatment of Common
Bile Duct Pathology
H. VERN SHARP, M.D.
The Author
• Dr. Sharp, Akron, Ohio, is a graduate of
Ohio State University College of Medicine,
1928, M. Sc. (Surgery) University of Pennsyl-
vania, 1931; diplomate, American Board of Sur-
gery; fellow, American College of Surgeons; on
junior general surgical service at City Hospital
of Akron; and on privilege staff. People’s,
St. Thomas and Children’s Hospitals.
COMMON bile duct pathology manifests
itself in varying degrees of obstruction,
pressure changes within the ductal system,
infection, and tumor.
The lesions of the common bile duct which
cause the obstructive symptoms in the order
of their frequency of occurrence are: Stones,
empyema or acute cholecystitis, stricture, en-
largement of the head of the pancreas, and
tumors within the duct.
The effects of obstruction to the common bile
duct depend upon two factors ; a. duration of
the obstruction, b. the presence or absence of
infection. The biliary obstruction is usually
intermittent in type allowing for periods of re-
lief where the liver and ducts recover somewhat
from the effects of the biliary stasis. The
stasis here is analogous to that of the urinary
tract, and in the absence of infection, causes
a hydro-hepatosis with progressive dilatation
of the duct system and a corresponding atrophy
of the parenchyma. Complete blockage of a
duct by stone, stricture or accidental tie have
been reported with the entire lobe drained by
that duct undergoing atrophy. Infection, how-
ever, is the rule, with a progressive cholangitis
extending throughout the extra and intra-hepatic
biliary system, with resulting fibrosis, destruction
of the hepatic cells and proliferation of the
ducts, typical of obstructive biliary cirrhosis.
Stone in the common duct is the most common
cause of obstruction and is associated with an
Presented before the Section on Surgery at the Annual
Meeting of the Ohio State Medical Association, Columbus,
Ohio, April 19, 1949.
infection in the walls of the gallbladder and
the bile duct system. It causes hepatic and
pancreatic lesions of all grades of severity.
Stones may be present for years without caus-
ing objective symptoms until irritation of the
mucous lining of the duct causes inflammatory
reaction with edema about the stone and vari-
able occlusion of the duct. Judd and Marshall1
in 1931 called attention to startling figures when
they published an analysis of 1,608 cases from
whom stones were removed from the common
bile duct; 26.5 per cent of these cases gave
no history of jaundice. One in ten patients
who have stones in their gallbladder also have
stones in the common duct. Pancreatitis was
present as an associated lesion in 26 per cent
of cases and some degree of cholangitis was
present in most cases. Varying degrees of
hepatic and biliary cirrhosis were seen in the
liver especially where the condition was of long
standing. Comparable findings are recognized
541
by many surgeons who have evaluated their own
biliary tract cases.
Lahey2 is of the opinion that most stones
found in the common and hepatic bile ducts
have originated there as a result of disturbed
metabolism or infection secondary to a diseased
gallbladder. This assumption is open to ques-
tion but the fact remains that stones are present
in the extra-hepatic duct system in about 13
per cent of persons having stones in the gall-
bladder.
Acute cholecystitis and empyema of the gall-
bladder causes obstruction of the common bile
duct by pressure upon the extra-hepatic bile
ducts due to enlargement of the gallbladder and
pericholecystic inflammatory reaction and edema.
Obstruction due to stricture of the common
bile duct is not infrequent. The benign stricture
of the duct is due to injury, most frequently
following the trauma of a previous operation.
It may be due to infection of peri-cholecystic
disease, ascending cholangitis, stone or scar of
duodenal ulcer. Anomalous positions of the
cystic and right hepatic ducts are a cause of
injury at operation with resultant stricture. The
cystic duct runs parallel to the common hepatic
duct in 33 per cent of the cases and occasionally
the right hepatic duct empties into the cystic
duct. Varying positions of the cystic and right
hepatic arteries contribute to their possible tear
or slipping from a clamp with a hurried effort
to control hemorrhage and resulting accidental
injury to the hepatic ducts. The possibilities
of all degrees of trauma to the actual tying off
or severing of the major bile duct become ap-
parent. In malignant stricture of the common
bile duct, the obstruction is usually rapid and
the infection is a terminal event. The tendency
to metastasize is slow.
Obstruction due to enlargement of the head
of the pancreas is usually secondary to inflam-
matory conditions in the biliary tract although
it may be primary in the pancreas or a malig-
nancy in the head of the pancreas. It is evident
why even slight enlargement of the head of the
pancreas should cause obstructive symptoms of
the common bile duct when it is remembered
that in two out of three cases the common duct
passes through the substance of the head of the
pancreas.
A rise in the fluid pressure within the duct
system due to dyskinesia is a clinical entity
brought about by parasympathetic stimulation
or chemical irritation causing a spasm of the
smooth muscle fibers of the sphincter of Oddi.
All of the symptoms of temporary common duct
obstruction may result. A rise in the bile pres-
sure of the common duct to more than 350 mm.
of water pressure, which is the secretory pres-
sure of the liver, causes pain. This pain often
exactly simulates the type of pain complained
of before the removal of the gallbladder and
common duct stone.
In a differential diagnosis of common bile
duct pathology the history usually offers the
most helpful clue. Osier’s descriptive triad of
intermittent colicy pain, chiHs and fever, and
jaundice are characteristic and any one of the
combination should at once arouse curiosity in
the biliary duct system. The laboratory is of
aid in giving blood bilirubin levels, prothrombin
time as a clue to clotting time as well as an
estimate of liver damage, a fragility test to
differentiate hemolytic icterus, a urobilinogen
test of the urine to aid in diagnosing the type
of obstruction, and the use of a soft duodenal
tube to determine the amount and kind of bile
present in the intestinal tract.
RATIONALE OF TREATMENT OF COMMON
BILE DUCT PATHOLOGY
The medical treatment of diseases of the
biliary passages by diet, duodenal drainage,
cholagogues and biliary antiseptics is unsatis-
factory at its best and in many instances may
do actual harm by postponing the adoption of
radical surgical procedures. The medical man-
agement includes the effort to balance the phy-
siology by an adequate fluid, electrolyte, carbo-
hydrate and protein intake, vitamin K therapy
when indicated, and use of the water soluble
vitamin B and C in quantities well in excess
of estimated requirements.
One cannot lay too much stress on the early
relief of obstruction of the common bile duct.
Drainage of the infected biliary system is
essential before jaundice becomes profound or
the hepatic injury advanced. Removal of the
infected gallbladder at the primary operation
is the method of choice, but if this procedure
is too hazardous, drainage should be done with
the thought of removal later when the patient’s
condition warrants.
Cattell3 reports exploration of the common
duct in 48.8 per cent of 909 patients with the
finding of common duct stones in 128 of them,
or 14.1 per cent. Waltman Walters4 reports
common duct exploration on 25 per cent of 1,172
patients from whom the gallbladder was removed.
Stones were found in 126, or 42.6 per cent of
common bile ducts explored. The question may
be raised, “Why is it necessary to explore the
common duct in approximately one-half of all
patients operated upon for gallbladder disease?”
The answer being that there is no group of
symptoms or physical findings either before
or at the time of the operation which can serve
justly to exclude the presence of stones in the
common duct. The common bile duct should
be explored if there is a history of jaundice, if
at operation the duct is found to be dilated and
yellowish-white in color or even thickened, if
542
The Ohio State Medical Journal
small stones are present in the gallbladder and
there is a patent cystic duct, if the palpation
of the duct is at all questionable, when acute
and subacute pancreatitis is present and if
sediment is aspirated from the common duct
bile. If the history is fairly typical and a
dilated thickened duct demonstrable at the ex-
ploration, it may be advisable to explore the
ampulla by the transduodenal route before one
can be sure no impacted sediment or stone
is present in the ampulla.
After opening of the common bile duct, whether
for removal of the stone or exploration, a period
of drainage should be provided for by insertion
of a catheter or preferably a T-tube. Drainage
through this tube will relieve the associated
cholangitis, hepatitis and pancreatitis. It also
provides a medium for direct roentgen study.
By the injection of diodrast into the T-tube
and X-ray picture of the duct system, the
presence or absence of residual stones is deter-
mined and the extent of intrahepatic biliary
pathology as demonstrated by greatly dilated
inelastic and stunted ducts. Thus the increas-
ing practice of choledochostomy, coupled with a
routine postoperative cholangiography, is often
revealing. The careful separate observations of
Young,5 Brunning,6 and W. Mayo7 found at
postmortem examination in patients operated
upon for common duct stones that stones were
overlooked in from 16 to 25 per cent of the
cases. This appalling number of residual stones
in the bile duct system following surgery offers
a real problem to the surgeon and patient. It
is explained by the marked dilatation of the
intrahepatic bile ducts where many stones may
defy all the present methods of finding them.
Cholangiograms at the operating table are too
often unsatisfactory to be of routine value. The
attempt to force the passage of the stones by
means of dilating the spincter of Oddi or to
dissolve the stones to allow their passage has
met with success in some cases of retained com-
mon bile duct stones. Pribram8 reports success-
ful results in 38 cases where ether was instilled
into the tube followed by liquid paraffin. In his
experience the cholesterol was dissolved by the
ether and the liquid paraffin reduces the stones
into a soft pulp. He uses a double lumen
catheter which relieves the pressure caused by
the ether. Those using his solution, but using
T-tubes, have reported unfavorable constitutional
reactions. Other workers9 attempting to find
a non-toxic liquid which was readily obtainable
and would bring about the chemical reduction
of cholesterol and calcium salts used solution
G (which closely resembles magnesium citrate
U. S. P). Solution G causes bile flocculation but
actually does not reduce the bile duct stones
chemically. The satisfactory results in the pas-
sage of the duct stones while using solution G
must be explained in some other manner than
the dissolution of the stones.
Harris and Marcus10 first suggested the use
of nupercaine solution to attempt to relax the
sphincter of Oddi followed by normal saline
irrigation to force the stones into the duodenum.
I am familiar with four cases treated by one or
a combination of the mentioned solutions. The
series is admittedly small but the results are
so startling that they are out of all proportion
to a number.
CASE REPORTS
Case 1. L. B., female, 34 years of age. His-
tory of gallbladder attacks for three years ac-
companied by a mild jaundice. This attack is
of four days’ duration with a serum bilirubin
of 3.9 mgm. At operation, a thickened gallblad-
der containing numerous small stones was re-
moved. Many stones, measuring up to 1 cm. in
longitudinal diameter, were then removed from
the common bile duct and both hepatic ducts.
The ductal system was then flushed out with
saline and a Bake’s dilator of 8 mm. size passed
through the sphincter of Oddi and a small T-tube
inserted into the common bile duct. Chemical
analysis of the stones proved them to consist
of cholesterol with a faint trace of bile pigment.
Cholangiogram taken nine days after opera-
tion revealed, “marked dilatation of the common
duct which contains numerous calculi; possible
stones within the liver near the distal portion
of hepatic radicles.” Daily T-tube instillation
was begun of 10 cc. of 1:500 nupercaine solution
for 15 minutes followed by 30 cc. of normal
saline. During the first instillation the pa-
tient complained of pains similar to her gall-
bladder attacks. The succeeding treatments
caused very little discomfort.
At the end of two weeks daily instillations
of the nupercaine solution, a cholangiogram
reading gave, “loss of all but possibly two of
the non-opaque calculi.” At this time solution
G was started as a constant drip, 15 drops per
minute, into the T-tube. Three days later the
patient developed a sudden severe pain in the
right side of the abdomen and vomited. This
was soon relieved and it was thought it in-
dicated the passage of a stone into the duodenum.
Cholangiogram done five days later revealed
“no evidence of calculus at this time.”
This experience would tend to show how
easy it is to overlook stones when the bile
radicles have become so greatly distended, the
value of doing cholangiograms and results of
treatment where persistence is necessary.
❖ * *
Case 2. B. F., female, 31 years of age. His-
tory of typical gallbladder attacks for past ten
years accompanied by jaundice. At operation
a gallbladder containing a number of small
stones was removed. Three small stones were
removed from the dilated common duct and the
duct system thoroughly explored, flushed out,
and No. 8 Bake’s dilator passed through the
sphincter of Oddi. Small T-tube was then
placed within the common duct. Nine days after
operation and an uncomplicated convalescence,
including intermittent clamping of the T-tube
without symptoms, a routine cholangiogram was
taken with the following interpretation, “Excel-
lent filling of common duct and liver radicles.
One notes the presence of a non-opaque square
for June, 1950
543
defect at the ampulla, possibly represents a
non-opaque facetted common duct stone causing
obstruction/’
Treatment was begun using daily instilla-
tions of 10 cc. of 1:500 nupercaine solution
into the T-tube, clamping the tube 15 minutes
and flushing out with normal saline. Two days
later the cholangiogram revealed no evidence
of obstruction or non-opaque calculus and the
T-tube was removed two days later.
* * *
Case 3. B. W., female, 30 years of age. His-
tory of attacks of pain for ten years occurring
in the upper right quadrant of the abdomen
radiating into the back and accompanied by
nausea and vomiting. This attack began . two
weeks ago accompanied by a progressive jaun-
dice. At operation a small thickened gallbladder
was removed containing a single round stone
and muddy material. The dilated thickened
common duct was opened and found to contain
white bile, muddy material and the ampulla filled
with stones. Nine stones were removed from
the distal common duct and the final stone re-
moved with difficulty from the ampulla. The
ductal system was flushed out and a medium
sized T-tube placed into the common duct.
A cholangiogram taken nine days after the
operation, “shows the presence of five rounded
calculi lying in the common duct between the
inferior tip of the T-tube and the Vater ampulla.
No spillover into the duodenum.” On this
date treatment was begun by injecting 20 cc.
of 1:500 nupercaine solution slowly into the
T-tube, clamping the tube for 15 minutes then
irrigating the same with normal saline. At
this first treatment 10 cc. of irrigant caused
pain and no fluid returned upon aspiration. The
treatment on the following day was supplemented
by giving a pearl of amyl nitrate just preceding
and six minutes following the instillation of
nupercaine solution. Cholangiogram at this time
showed, “no change in number or position of
calculi within the duct.” A continuous drip
into the T-tube of solution G at the rate of
15 drops per minute was begun and the daily
treatment with nupercaine solution and saline
was continued. Twenty-four hours later there
was a return upon aspiration of a thick green
muddy-appearing fluid.
On the following day a tablet of nitroglycerine of
1/100 grains was given sublingually one minute
after the instillation of 20 cc. of 1:500 nuper-
caine solution. Much more of the type of debris
formerly removed was present in the aspirated
fluid. Cholangiogram at this time shows, “a
normal filling of the common duct and hepatic
duct to the level of a non-opaque calculus. In
comparison to the previous studies, this non-
opaque calculus is lodged approximately one-
half the distance through the distal common
duct that was previously filled. I am unable
to determine the presence or absence of calculi
distal to this obstructing stone.” It seemed
possible that all but a single stone had passed
into the duodenum but because the patient was
seriously ill with an obstructive jaundice and a
difficult problem to keep her physiology in bal-
ance, it was believed a second operation necessary
to relieve the common duct of its remaining
stone. The second operation was performed
twenty-four days following the first one and
thirteen days of daily treatments to attempt
passage of the stones into the duodenum.
At the second operation, a complete and
thorough examination within the common duct,
including the trans-duodenal investigation of the
ampulla of Vater and sphincter of Oddi, demon-
strated the absence of a calculus. The patient
made a rapid and complete recovery, the T-tube
was removed one month after her second oper-
ation and she has remained completely well for
two years. This case would emphasize persever-
ence as an important factor in the handling
of these cases.
^
Case 4. H. S., male, 63 years of age. His-
tory of repeated attacks of right upper quadrant
pains accompanied by jaundice for nine years;
two attacks in the past month. At operation
a thick-walled gallbladder containing flecks
of cholesterol material and thin white bile was
removed. The cystic duct was patent and mea-
ured 1 cm. in transverse diameter. The common
bile duct contained a considerable amount of
black precipitated substance, like stone and
gravel, packed into the ampulla and common
duct. This material was freed and removed
with difficulty by repeated use of stone forceps
and flushing of the duct with saline solution.
A T-tube was inserted so that the proximal
short limb was into the entrance of the cystic
duct and distal limb low in the common duct.
Saline solution passed freely into the duodenum.
Eight days following the operation jaundice
was getting progressively worse to a serum
bilirubin of 3.2 mgm. A cholangiogram taken
on this date showed. “An incomplete obstruction
at the sphincter of Oddi compatible with a
radio-opaque calculus at this level. The dye
passes into the duodenal loop.” A continuous
drip of twelve drops per minute of solution G
was started into the T-tube. Three days later
with the serum bilirubin at 12.2 mgm. and most
of the solution G drip returning about the T-tube,
30 cc. of 1:500 nupercaine solution was injected
into the T-tube without discomfort to the pa-
tient. The tube was clamped for 15 minutes
and then irrigated with saline solution. As-
piration from the T-tube recovered a large
amount of dark green detritus and thick mucin-
ous yellow bile followed by 200 cc. of old, bloody,
non-odorous thin fluid. It was believed that
this procedure accomplished the common duct
cleaning and most probably opened the stump
of the cystic duct and drained a sub-hepatic
collection of fluid. A cholangiogram taken at
this time revealed, “one notes a rapid passage
of the dye into the duodenum. There is a spill-
over of the dye into the tissue adjacent to the
cystic duct. No roentgen evidence of previously
described stone.” Rapid recovery followed this
date with a complete subsidence of the jaundice
and he left the hospital twenty-three days
following the operation with the T-tube clamped
for twelve hours at a time.
* * *
The vast majority of strictures of the extra-
hepatic ductal system are traumatic in origin.
This is sufficient to stress the importance of metic-
ulous care in the performance of cholecystec-
tomy. In the surgical repair of stricture of the
common bile duct meticulous search should be
made for the distal segment for experience
shows that reconstruction of the common bile
duct with restoration of normal continuity has
been followed by the highest incidence of sat-
isfactory results. If the distal segment cannot
544
The Ohio State Medical Journal
be demonstrated direct anastomosis of the proxi-
mal remnant of the duct to the duodenum has
been followed by satisfactory results in the
great majority of cases according to Walters11
and only rarely has it been found necessary to
utilize an isolated segment of jejunum in mak-
ing the anastomosis following the Roux-Y
principle. Walters12 has failed to be impressed
with the effects of loss of sphincter control at
the anastomosis and reflux of duodenal contents
into the biliary system but believes that ob-
struction at the site of anastomosis due to a
contraction of the circular anastomosis is re-
sponsible for the attacks of cholangitis if they
occur subsequent to operation. Permanent im-
plantation of tubes should be avoided. They are
useful splints for the anastomosis and to prevent
contraction of the scar tissue during the first
several months after operation. After that they
often become obstructed with debris made up
largely of bile salts and bile pigments. This
is equally true of vitallium as well as those
of rubber.
Enlargement of the head of the pancreas and
tumors within the ampulla of the duct are a
cause of biliary duct obstruction. If the lesion
is inflamatory, it will usually respond to pro-
longed drainage of the common bile duct by
T-tube. The radical operation for malignant
lesions is not too satisfactory and the end re-
sults have been discouraging. When one con-
siders the end results in relation to the risk of
operation, the expense and the distress imposed,
it seems reasonable to reserve the radical oper-
ation for carefully selected cases. In the re-
maining group, internal drainage will give tem-
porary relief from the obstructive jaundice. The
end results compare favorably with those who
have had the radical resection.
SUMMARY
1. Pathology of the common bile duct is mani-
fest by varying degrees of obstruction pressure
changes within the ductal system, infection, and
tumor.
2. Some discussion of each pathological entity
is given with the acceptable treatment.
3. Case reports of four cases of overlooked
common duct stone following choledochostomy
and their successful treatment by use of solu-
tions introduced into the T-tube.
4. A plea is made for early and meticulous
gallbladder surgery.
BIBLIOGRAPHY
1. Judd, E. Starr, and Marshall, James M. : Gallstones
in the Common Bile Duct. Arch. Surg. 23 : Aug., 1931, 175-
181.
2. Lahey, F. H. : Management of Biliary Tract Disease.
Surg. Clinic North America, 23:639, June, 1943.
3. Cattell, R. B. : Indications for Exploration of the
Common Bile Duct. Surg. Clinic of North America, June,
1943, Vol. 23, No. 3, 694-700.
4. Walters, W., Gray, H. Priestley J. and Waugh, J. :
Annual Report on Surgery of Biliary System and Pan-
creas for 1947. Proc. of Staff Meetings of the Mayo Clinic.
Dec. 22, 1948, 615-62.
5. Young, Quoted by F. Dehmal, Klin Wchnschr 15 :649,
1936.
6. Brunning, Deutsch Med Wchnschr, 38:1543, 1912.
7. Mayo W. 1 : Lancet 1 :1279, 1923.
8. Pribram, B. O. : New Methods in Gallstone Surgery.
Surg. Gynec. Ob., Vol. 81:521, 1945.
9. Goldman, B., Jackman, J., Eastman, R. : The Manage-
ment of Postoperative Choledocho-lithiasis. Surg. Gynec.
Ob., Vol. 81:521, 1945.
10. Harris, Franklin I., Marcus, Sanford A. : Common
Duct Stone Relieved by Injection of Nupercaine Solution
into the T-tube. J. A. M. A., 29-30, 1946.
11. Walters, Waltman, Gray, Howard K., Priestley, James
T., and Waugh, John M. : Annual Report on Surgery of
the Biliary System and Pancreas for 1947. Proc. Staff
Mayo Clinic Dec. 2, 1948, 615-651.
12. Walters, Waltman and Phillips, Spencer: Physiologic
Aspects of Repaired Structure of the Extrahepatic Bile
Ducts. Proc. Staff Meetings Mayo Clinic, Vol. 24, No. 1,
12-16.
The Story Behind the Word
Some Interesting Origins of Medical Terms
Bistoury — The name for this type of incision
knife comes from the old French term “bistouri”
a dagger. This in turn is derived from the name
of the City of Pistoria, now Pistoja in Tuscany,
Italy, which was once celebrated for their manu-
facture.
Chillblain — A term composed of two words
namely chill and blain. Chill being derived from
the Anglo-Saxon “cycle” or cold and blain com-
ing from the Anglo-Saxon word “blegen” mean-
ing a boil, pimple or sore.
Physiology — Actually meaning an inquiry into
the nature and origin of things and is derived
from the Greek word “phusiologia.” This in
turn coming from the Greek words “phusis” or
nature and “logos” or discourse.
Presbyopia — Literally means old sight and is
derived from the Greek words “presbus” (old)
and “ops” or “opa” (the eye).
Calf — This word as in “calf of the leg” is
derived from the Gaelic word “calp” or “calpa”
and also the Icelandic word “kalfi.” The primary
meaning being a lump.
Doctor — The title doctor primarily and origi-
nally meant a teacher and is derived from the
Latin word “doceo,” I teach.
Iodine — Obtains its name from the beautiful
violet color of its vapor. The name is derived
from the Greek words “ion” or violet and “eidos”
or likeness.
Prostate — This gland secures its name from
its anatomical location and descriptively means
“the gland standing before the bladder.” It is
derived from the Greek words “pro” or before
and “stasis” a setting or standing.
Speculum — This instrument is so named be-
cause of its function or use in permitting the
diagnostician to look into body cavities. It is
derived from the Latin speculum or mirror which
in turn comes from the Latin word “specio”
(I look at).
Arsenic — This poisonous mineral substance
derives its name from the Greek word “arseni-
chos” meaning masculine or male and was so
called because of its superior strength.
— Harry Wain, M. D., Mansfield, Ohio.
for June, 1950
545
The Newer Antibiotics: A Brief Review of the Biological
And Clinical Properties of Bacitracin, Polymyxin,
Aureomycin, Chloromycetin and Neomycin
LOUIS WEINSTEIN, M.D., Ph.D.
The Author
• Dr. Weinstein, Brighton, Massachusetts,
graduated from Boston University School of
Medicine, 1943 ; chief of service, department
of infectious diseases, Massachusetts Memorial
Hospitals, Boston; assoc, prof, of medicine,
Boston University School of Medicine; and
lecturer in infectious diseases. Harvard Medical
School.
THE discovery of penicillin is epoch making
not only because it led to the development
of an antibacterial agent of unprecedented
potentiality in the alleviation of human suffering
but also because it served as the spark that
set off a determined, scientifically directed search
for other agents active in the therapy of many
infectious diseases; carefully planned research
for antibiotics has almost entirely replaced their
serendipitous discovery. So great have been the
efforts in this field that the number of papers
on this subject published each year number in
the hundreds. Many substances with antibac-
terial or antiviral properties have been de-
scribed in the last seven to eight years, and
there are at least a hundred on which experi-
mental work has been done. Most of these are
not usable for one reason or another, but sev-
eral have already been shown to be of prac-
tical value in the treatment of human disease
and there are more which await only clini-
cal trial to prove their merit. These antibiotic
substances have been isolated from as wide
and varied sources as plants, Actinomycetes,
Streptomycetes, molds, bacteria, protozoa, and
human tissues.
During the last three and one-half years, four
new substances which have been tested in hu-
man infections have been developed. A fifth,
recently reported by Waksman, shows promise
in in vitro and in vivo experiments in animals
and already has been used in man. Bacitracin,
polymyxin, (Aerosporin), aureomycin (Duomy-
cin), and Chloromycetin (Chloramphenicol) have
all been investigated during the past three
years, and I shall attempt to summarize
briefly the available knowledge concerning each
of these drugs.
AUREOMYCIN
Aureomycin is derived from the liquor in
which Streptomyces aureofaciens, discovered by
Duggar and Hesseltine, grows. It has been pre-
pared as the hydrochloride and it is this com-
pound that is used clinically. The drug has a
pH of 4.5 and is stable for more than six
months as a dry powder. In high concentra-
tion in distilled water at 37° C or 4°C, most of
Presented before the Section on Pediatrics at the Annual
Meeting of the Ohio State Medical Association at Colum-
bus, Ohio, April 19-22, 1949.
From the Haynes and Evans Memorial of the Massachusetts
Memorial Hospitals and the Department of Medicine, Boston
University School of Medicine, Boston, Massachusetts.
the activity is retained but in dilute solutions
in broth, plasma or blood agar, a rapid de-
crease in potency occurs at 37°C and a some-
what slower fall at 4°C. It deteriorates rapidly
in neutral or alkaline solution at room temper-
ature. Whole blood and serum exert an antag-
onistic effect on aureomycin although actual
killing of bacteria takes place if sufficient drug
is present. The clinical effects of minimal blood
levels of this drug are quite striking when its
instability and antagonism by serum are con-
sidered; this is possibly due to a difference in
the mode of action of the antibiotic agent in the
body and in vitro.
In vitro and in vivo experiments in animals
have revealed that the infectious agents listed
below are susceptible to the action of aureomycin.
Gram Positive
Bacteria
Gram Negative
Bacteria
Gram Positive
Cocci
B. cereus
E. coli
Strep, pyogenes
B. subtilis
A. aerogenes
Strep, fecalis
B. mycoides
S. pullorum
D. pneumoniae
Staph, aureus
P. vulgaris
M. tuberculosis
K. pneumoniae
N. catarrhalis
S. typhi
S. gallinarum
Brucella
H. influenzae
Gram Negative
Rickettsia
Viruses
Cocci
N. gonorrheae
R. prowazeki
Lymphogranu-
N. meningitidis
C. burneti
loma venereum
R. rickettsi
Psittacosis
group
Among the bacteria, Pseudomonas pyocyanea
and Proteus vulgaris are practically unaffected
by the drug. It also has no effect on the fol-
lowing viruses: poliomyelitis, B strain of influ-
enza, canine distemper, rabies, Newcastle dis-
546
The Ohio State Medical Journal
ease, mumps, and Venezuelan equine encephal-
omyelitis. The most sensitive group of organ-
isms are the aerobic spore-bearing bacilli. The
action of aureomycin is bacteriostatic with the
amounts used in animal or human infections. It
has been estimated that from 20 to 50 times
more drug is required to produce a bactericidal
effect than is necessary to affect bacteriostasis.
No aureomycin resistant or dependent strains
have been developed in vivo ; it is possible to
decrease the sensitivity of microorganisms to
this agent in vitro, however. S. typhi has been
made four-fold and Proteus vulgaris 533 times
more resistant to aureomycin by repeated trans-
fer in drug-containing media. There is no
evidence of cross resistance between aureomycin
and other antibiotics such as penicillin and
streptomycin.
When aureomycin is given by the intramuscu-
lar or oral route, it appears in the urine within
the first hour and the maximum amount is ex-
creted in the next four to eight hours. Fol-
lowing a single oral dose of 0.5 to 0.75 gm.
about 13.5 per cent can be recovered during
the following 55 hours. In patients receiving
1 to 2 gms. daily by mouth, the maximum
urinary concentration is about 250 gamma per
ml.; excretion is prolonged and antibacterial
activity is still demonstrable three or four days
after the last administration of the drug.
Aureomycin is excreted in the bile. In individuals
with normal meninges, very little or none of
the antibiotic agent can be detected in the cere-
brospinal fluid when the drug is given orally or
parenterally. Passage across the blood-brain
barrier in instances where the meninges are in-
flamed is irregular but, at best, appears to be
quite poor.
Aureomycin may be administered either par-
enterally or by mouth and is absorbed quite
rapidly by either route. It is difficult to define a
single scheme of administration which will suf-
fice for all treatable diseases; the quantities
used in various infections are discussed below.
However, the following general dosage schedule
has been suggested: In severely ill patients, a
“priming” dose of 1/6 the total daily amount
is given hourly for three hours, and then ad-
ministered at four-hour intervals until the tem-
perature has been normal for twenty-four hours.
After this the total daily quantity is reduced
by one-half or to 30 mgm. per kilogram of body
weight; this is divided into four doses and given
every six hours. In moderately severe infec-
tions, 30 mgm. of the drug per kilogram of
body weight divided into four or six equal
parts given at four to six-hour intervals is
recommended.
The treatment of typhoid fever with aureomy-
cin has yielded equivocal results and evaluation
of the effectiveness of the drug is very difficult.
Four patients with this infection who were given
10 mgm. of the antibiotic agent per kilogram of
body weight parenterally showed no alteration in
their clinical course, the blood cultures remaining
positive throughout therapy. In another group
of five patients treated orally, four children
cleared their bacteremia in one to two days
(treatment started between the fifth and tenth
day of illness) and a man 60 years of age showed
persistence of bacteria in the bloodstream
throughout the entire course of therapy. The
urine and stools of all of the patients were free
of S. typhi after the second day of treatment.
Aureomycin, 1 to 3 grams given over a period
of one to two days, is effective in curing acute
gonorrhea in males. When compared to a single
injection of 300,000 units of penicillin given
intramuscularly in a prolonging agent, however,
the over-all results are distinctly inferior. Fail-
ures are most frequent in instances where the
drug is given for only one day with a total
dose of only 1.0 to 1.5 gms. Treatment on two
successive days produces a response which is
more like that which usually follows an ade-
quate dose of penicillin.
Pneumococcal pneumonia has been found to
respond quite favorably to the administration
of aureomycin in a dose of 0.5 gms. given
every six to eight hours for five to ten days
depending on the severity of the pneumonitis.
Subjective and objective improvement occurs
rapidly and defervescence may be complete in
eighteen to thirty-six hours after the beginning
of treatment.
Urinary tract infections have been treated
with aureomycin in several clinics. A dose of
0.5 gms. twice a day for seven days as initial
therapy and 2 gms. per day in cases requiring
re-treatment because of recurrent infection has
been recommended. In general, there is a
marked and rapid diminution in pyuria during
therapy. Dysuria, nocturia, and frequency
diminish in most cases concurrently with the dis-
appearance of pyuria, and sterilization of the
urine takes place during the course of treatment
in most patients. In some individuals Proteus,
Pseudomonas, and uncommonly E. coli may ap-
pear for the first time or persist in the urine
during aureomycin administration. In many
cases, infection with either the initial type of
organism or with a different species recurs
within a few days after cessation of therapy.
Proteus and Pseudomonas are not at all eradi-
cated from the urine or are eliminated only with
great difficulty. As a matter of fact, the data
obtained in one study seem to indicate that
Proteus may flourish while aureomycin is being
given. In cases of chronic urinary tract infec-
tions, good results of a permanent nature are,
as a rule, infrequent, but temporary relief may
result in about two-thirds of the cases. The
problems that arise in the treatment of urinary
tract infections with aureomycin are quite iden-
for June, 1950
547
tical with those present when sulfonamides or
streptomycin are used. In instances where mixed
infections, chronic obstruction, or foreign bodies
such as stones or indwelling catheters are present
in the urinary tract, permanent results are very
difficult to obtain. The necessity for surgical
treatment to relieve the obstruction to the flow
of urine is just as great when aureomycin
is administered as it is when any other chemo-
therapeutic agent is given.
Aureomycin has been used successfully in
the treatment of lymphogranuloma venereum.
Good results have been obtained with the admin-
istration of 0.3 gms. orally or 20 mgs. intra-
muscularly four times a day. The buboes, sec-
ondary infections, and the acute reaction dis-
appear rapidly with the administration of the
drug. As might be expected, the rectal stric-
tures are not at all affected by this therapy,
but acute inflammatory reactions in the rectum
and the acute proctitis which may occur at
times are very beneficially influenced. It has
also been noted that aureomycin will heal the
ulcerations of granuloma inguinale.
A number of cases of Rocky Mountain Spotted
Fever have been treated with aureomycin and
the response has been excellent. Two dosage
schedules are suggested; 30 mgs. per kilogram of
body weight in a twenty-four-hour period
divided into four doses; or, 0.3 to 0.7 gm. orally
every six hours. In most of the cases of this
infection treated with this drug defervescence
has been complete in from twelve to seventy-two
hours, and the disease has run a markedly
shortened clinical course.
One infection in which aureomycin appears to
produce quite striking improvement is so-called
“virus pneumonia.” Although it is difficult,
in many cases, to interpret the results produced
by the administration of the drug, since the en-
tire course of the disease may be short-lived,
a number of instances of severe “virus pneu-
monia” have been reported in which treatment
with aureomycin has produced very rapid de-
fervescence and disappearance of clinical symp-
toms and signs. Several dosage schemes have
been used; an initial dose of 1.5 gms. followed
by 1 gm. every six hours orally; or, 1 gm.
every six hours for the first day and 0.5 gm.
every six hours thereafter until the temperature
has been normal for two or three days. Many of
the cases of this disease that have been treated
with aureomycin have been verified by the dem-
onstration of cold agglutinins and agglutinins
for streptococcus MG.
Nineteen cases of Q fever have been treated
with aureomycin. In four patients in whom in-
tramuscular therapy with small doses was em-
ployed, the results were not satisfactory. In
fifteen individuals who were given the drug
orally, improvement occurred in all but one
promptly after the commencement of therapy;
the fifteenth, a chronic infection with C. burneti,
failed to respond to large doses. Relapses oc-
curred in two patients in the orally treated
group following cessation of therapy; a second
course of aureomycin produced complete defer-
vescence in both.
Aureomycin has been claimed to be effective
in various infections of the eye. Ocular disease
produced by Strep, pyogenes, Staph, aureus, D.
pneumoniae, K. pneumoniae (Friedlander bacil-
lus), N. gonorrheae, Pseudomonas pyocyaneus,
Proteus vulgaris, H. influenzae, Morax-Axenfeld
bacillus, and N. meningitidis are all said to be
susceptible to treatment with this drug. In
most instances, the local application of a 0.5
per cent solution of aureomycin borate is
thought to be satisfactory. Several viral infec-
tions of the eye such as inclusion conjunctivitis,
trachoma, lymphogranuloma venereum, herpes
simplex corneae, and follicular conjunctivitis have
been reported as responding to the local and/or
parenteral administration of aureomycin. This
antibiotic agent has also been suggested for
trial in epidemic keratoconjunctivitis, herpes
zoster, non-hemolytic streptococcal, H. ducreyi,
syphilitic, and Brucella infections of various parts
of the eye, and disease produced by Moraxila
duplex, as well as marginal keratitis and uveitis.
The drug appears to be without value in ery-
thema multiforme, ocular pemphigus, Parinaud’s
conjunctivitis, sympathetic ophthalmia, vernal
conjunctivitis, molluscum contagiosum, Mooren’s
ulcer, and Streptothrix concretions.
The effectiveness of aureomycin therapy in
human brucellosis due to Brucella melitensis
has been reported recently. Twenty-four patients
with this infection were treated with 0.5 gms.
four times a day for two weeks. Immediate
therapeutic results surpassed those obtained with
any other agent. Relapse of the infection with
recurrent bacteremia after cessation of treat-
ment has been noted, however.
A miscellaneous group of infections of which
one or a few cases have been treated with
aureomycin and in which good results have been
obtained are the following: Meningococcemia,
E. coli bacteremia and brain abscess, non-
specific urethritis due to the pleuropneumonia
group of organisms, Staphylococcal infections of
the skin, breast, and brain, tuberculous sinuses
of the skin, Strep, fecalis meningitis, and en-
docarditis, and Brill’s disease. The drug has
been found ineffective in measles, mumps, whoop-
ing cough, polio-encephalitis, noma, and ery-
thema multiforme.
No serious toxic effects have been noted with
aureomycin. When amounts as large as 4 gms.
are administered on the first day followed by
2 gms. daily thereafter, the commonest complaint
is looseness of the bowels with frequent bulky
and soft stools; true diarrhea is uncommon.
Nausea and occasionally vomiting may occur
548
The Ohio State Medical Journal
after one or more doses in some patients. In
individuals with cystitis a disagreeable sen-
sation of “drawing” or “squirming” in the pelvis
has been reported; these abnormal sensations
may be related to the high acidity of the urine
during ingestion of large quantities of the drug.
Intramuscular injections produce considerable
pain at the site of administration. No anemia,
leukopenia, renal irritation, liver impairment,
rash or fever has thus far been reported fol-
lowing the administration of aureomycin.
In animals the administration of aureomycin
does not seem to interrupt the development of
immunity if massive doses of infectious material
are injected and drug treatment started before
symptoms appear. If relatively small doses of
infecting agent are given and antibiotic admin-
istered before the development of any manifesta-
tions, an immune response may or may not de-
velop. One of the sequelae of aureomycin treat-
ment which must be kept in mind constantly is
the appearance of new infections: Proteus vul-
garis infections of the urinary tract which
seemed to start after administration of the
drug have been reported by two investigators.
CHLOROMYCETIN
Chloromycetin or Chloramphenicol is produced
by Streptomyces venezuelae n. sp., isolated by
.Burkholder from Venezuelan soil; the organism
is related to S. lavendulae. Ehrlich and his co-
workers first demonstrated the antibiotic agent
in cultures of this organism. The drug is a
neutral compound, withstands boiling in distilled
water for five hours, and is unaffected by stand-
ing at room temperature for more than twenty-
four hours in aqueous solutions over the pH
range 2 to 9. Its solubility in water at 25°C
is about 2.5 mgm. per ml. and it is also soluble
in propylene glycol, methanol, ethanol, butanol
and acetone. Chloromycetin has been produced
synthetically.
Chloromycetin is effective in the following ex-
perimental infections in animals or embryonated
eggs:
Effective
Questionably
Effective
Not Effective
K. pneumoniae
Newcastle
Malaria
S. paradysenteriae
Virus
Syphilis
(Flexner)
S. paradysenteriae
Guinea Pig
(Sonne)
Tuberculosis
Psittacosis virus
Type A. Influenza
Virus
R. prowazeki
Virus of St. Louis
Lympogranuloma
Encephalitis
venereum
Borrelia
D. pneumoniae
recurrentis
Strep, pyogenes
In vitro studies show Chloromycetin to have
no antifungal or antiprotozoal effects. It is
only about one-tenth as active as streptomycin
against streptomycin sensitive strains of M.
tuberculosis, one to two times more effective
than streptomycin against B. mycoides and
Staph, aureus, and two to sixteen times more
efficient against Brucella, S. typhi, E. coli, H.
pertussis, and K. pneumoniae. It is only one-
fiftieth as antibacterial as penicillin against
Staph, aureus but is seven to thirty-six times
more active against gram negative organisms.
The synthetically prepared material has the
same degree of Rickettsiostatic, virustatic, and
bacteriostatic effect in vitro and in vivo as does
the naturally occurring compound.
Chloromycetin is well absorbed from the
gastro-intestinal tract and may be given either
orally or parenterally; serum levels are roughly
identical with either route. This antibiotic sub-
stance is excreted or inactivated fairly rapidly;
less than 10 per cent appears in the urine. It
is bound to the extent of about 45 per cent by
serum albumen. A single dose in animals is
excreted or destroyed in about six hours. In
man, Chloromycetin can be given orally in single
doses of 2 grams or in daily doses of 1 gram
for ten days without any untoward results.
Relatively high levels are present in the blood
thirty minutes after administration of the drug;
it is present in the urine at the same time and
reaches a maximum level in about eight hours.
About 10 per cent of administered Chloromycetin
is recoverable in active form in the urine. Blood
levels after a single dose are well above 10
gamma per ml. at two hours and above 5 gamma
per ml. at the end of eight hours. Penetration
of the normal meninges does not take place;
studies in cases of meningitis are still too in-
adequate to allow any statement.
Among the bacterial diseases which appear
to respond to treatment with Chloromycetin are
typhoid fever and urinary tract infections. One
group of ten patients with typhoid fever treated
with this drug has been recorded in the liter-
ature. The following dosage was used; 50 mgm.
per kilogram of body weight as the initial
quantity followed by 0.25 gm. every two hours
until the temperature became normal and the
same amount continued every three or four
hours in the absence of fever for the next five
days. Evidence of improvement was noted
usually in twenty-four hours and the average
time required for complete defervescence was 3.5
days. Bacteriologic studies revealed eradication
of the organisms from the blood stream immedi-
ately subsequent to the administration of the first
dose of the drug, and sterile urine throughout
the course of the illness; stool cultures still con-
tained S. typhi at the time of discharge from
the hospital in three cases. Relapse occurred in
two individuals after ten and sixteen days with-
out fever but both responded well to a second
course of therapy. One instance of intestinal
perforation and another of hemorrhage from the
for June, 1950
549
bowel were seen in this group. In our own
clinic, a 20-year-old girl with typhoid fever to
whom Chloromycetin was first administered
orally on the tenth day of illness showed a re-
turn of temperature to normal eighteen hours
after institution of treatment and rapid clear-
ing of bacteremia although urine and stool cul-
tures were positive late in the course of the
disease.
Chloromycetin is of value in the management
of urinary tract infections but is of about the
same order of efficiency as the sulfonamides,
streptomycin and aureomycin. The administra-
tion of two grams, 0.5 gm. every six hours, a
day leads to clearing of pyuria and rapid dis-
appearance of urinary tract symptoms in most
cases. Infections with Pseudomonas pyocyaneus
show little or no response. The presence of
mixed infections, chronic obstruction and foreign
bodies in the urinary tract imposes the same
difficulties in producing complete cures as when
any other antibacterial agent is used.
Rocky Mountain Spotted Fever has been
treated successfully with Chloromycetin. An
initial dose of 75 mgm. per kilogram of body
weight administered orally in two or three parts
at hourly intervals followed by 0.25 gms. every
three hours for those less than 16 years of age
and 0.5 gm. every three hours for older indi-
viduals has proved effective. Abatement of
symptoms and cessation of spread and recession
of the rash usually take place within forty-eight
hours after initiation of treatment. Deferves-
cence is accomplished usually within seventy-six
hours and convalescence is established on the
third day of therapy. Good clinical results have
also been produced with Chloromycetin in the
management of scrub typhus in twenty-five pa-
tients. The first oral dose in this group was
about 50 mgm. per kg. of body weight followed
by 0.2 to 0.3 gm. every two to four hours
for a variable time. A beneficial effect was
observed after only twenty-four hours of ther-
apy in some cases.
The two viral infections which appear to re-
spond to Chloromycetin are “virus pneumonia”
and lymphogranuloma venereum. The admin-
istration of 0.5 gm. orally every four hours seems
quite effective in the viral pneumonitis. The re-
sults of therapy are of about the same order
as those produced by aureomycin.
No toxic effects have yet been noted in pa-
tients receiving Chloromycetin by either the oral
or parenteral route. The drug is extremely bit-
ter; in children who cannot take capsules the
taste may be masked by very sweet vehicles or
the antibiotic agent given parenterally.
POLYMYXIN
Polymyxin (Aerosporin), a polypeptide pro-
duced by Bacillus polymyxa, was first isolated
by Stansly, Sheperd and White. This drug has
a remarkable specificity for gram negative bac-
teria. Its bacterial spectrum is presented below:
Sensitive Organisms
Non-sensitive Organisms
A. aerogenes
B. mycoides
Br. abortus
B. subtilis
E. typhosa
Cl. welchii
E. coli
C. diphtheriae
H. Influenzae
D. pneumoniae
K. pneumoniae
E. rhusiopathiae
N. intracellularis
M. tuberculosis
P. multocida
Staph, aureus
P. vulgaris
Strep, pyogenes
Ps. pyocyanea
Strep, fecalis
S. suipestifer
S. enteritidis
S. paratyphi
S. schottmulleri
S. pullorum
Sh. dysenteriae
Sh. paradysenteriae
Sh. sonnei
Sh. gallinarum
V. cholerae
Strep, viridans
Polymyxin is therapeutically effective in ex-
perimental infections in mice due to K. pneu-
moniae, H. pertussis, and P. multocida. The drug
has been found to be definitely more effective
than streptomycin against certain gram nega-
tive bacteria and is from two to eighty times
more active than the latter agent against suscep-
tible organisms. Its activity is primarily bacteri-
cidal while that of streptomycin is bacteriostatic.
Pharmacologic studies of polymyxin have been
restricted, in the main, to animals. This anti-
biotic substance is not absorbed from the gastro-
intestinal tract and when given parenterally dis-
appears rapidly. In normal animals it is not
detectable in the cerebrospinal fluid, bile, or
urine. In man it cannot be found in the spinal
fluid in the presence of meningeal inflammation.
There is only one report in the literature on
the clinical application of polymyxin. Ten cases
of pertussis in very young children were treated
with 0.8 mgm. per kilogram of body weight
given four-hourly. Although a very definite
response to treatment in the first forty-eight
hours is reported, the results appear somewhat
doubtful when inspected closely.
Histamine-like reactions, hypesthesia, and
fever have been observed during the course of
polymyxin therapy; these are thought to be due
to the presence of impurities rather than to the
drug itself. The one very serious toxic effect
produced by this antibacterial agent is damage
to the kidney. All specimens of polymyxin
that have been used produce varying degrees of
renal tubular dysfunction varying in severity
from fixation of urine specific gravity alone to
any combination of oliguria, albuminuria, cylin-
druria, hematuria, pyuria, azotemia and de-
pressed renal function. Because of this serious
550
The Ohio State Medical Journal
nephrotoxicity the clinical use of polymyxin is
contraindicated at present.
BACITRACIN
Bacitracin, an antibiotic agent first described
in 1945 by Johnson, Anker and Meleney, is pro-
duced by a particular strain of B. subtilis
(“Tracy I”)- It is neutral in reaction, water
soluble, non-toxic and relatively heat stable
(100°C for fifteen minutes). It is soluble in
water, methanol, ethanol, isopropanol, n-butanol
and cyclohexanol but not in other organic sol-
vents. The drug is stable for as long as a
year when stored at 0° to 5°C but loses 30 to 50
per cent of its activity when kept at room
temperature for two weeks.
Because of evidence of nephrotoxicity the
systemic administration of bacitracin has been
quite limited. Injury to the kidney seems to be
produced only by certain batches of the drug and
appears to be due to by-products of manufacture
rather than to the antibiotic substance itself.
In spite of this a number of human beings
have been given this drug systemically. Solu-
tion of bacitracin in 2 per cent novocaine in
normal saline and administering alkali so that
the pH of the urine is maintained at 6 or more
is said to reduce the incidence of harmful renal
effects. No local toxic or irritating effects have
been observed.
Bacitracin has proved effective against most
strains of hemolytic and non-hemolytic Strep-
tococci, coagulase positive Staph, aureus, D. pneu-
moniae, N. gonorrheae, anaerobic cocci, the or-
ganisms of gas gangrene, Cl. tetani, C. diphth-
eriae, diphtheroids, S. pallida, the spirochetes re-
sponsible for infections of the mouth, Actin-
omyces, and E. histolytica. Little or no action
has been demonstrated on the aerobic gram
negative non-sporulating bacilli such as E. coli,
Proteus vulgaris, Pseudomonas pyocyanea, etc.,
some gram positive organisms and fungi. A few
strains of H. influenzae have been found sensitive.
Organisms resistant to penicillin and sulfon-
amides may be very susceptible to bacitracin;
the contrary is also true.
Clinically, bacitracin has been used most ex-
tensively in localized, superficially located infec-
tions. Two preparations are recommended for
use in surgical infections: (1) a water solution
Containing 200 to 400 units of the drug for injec-
tion into furuncules, carbuncles, and deep and
superficial abscesses; and (2) a water soluble
ointment containing the same amount of the anti-
biotic substance for treatment of open lesions
such as ulcers. Various affections of the skin —
impetigo, ecthyma, folliculitis, infected eczema-
toid dermatitis, vesicopustular eruptions, fur-
unculosis, pustular psoriasis and acne varioli-
formis have been treated quite successfully.
The preparation recommended for treatment
of this type of disease is an ointment containing
480 units of drug per gram of carbowax-
propylene glycol base. A rare instance of con-
tact dermatitis may be observed.
The effectiveness of bacitracin in some ocular
infections has been recorded. Acute and chronic
conjunctivitis, acute keratoconjunctivitis and
corneal ulcer have been found, in the main, to
respond to the local application of a solution
containing 1000 units of the drug per ml. of
physiologic saline.
Meleney, et al., treated 105 patients with
surgical infections by the systemic administra-
tion of bacitracin. A large proportion of these
cases had failed to respond to other forms of
treatment. Favorable results were produced in
cellulitis, deep abscesses, infected accidental
wounds, synergistic gangrene, meningitis and
human bite infections. The most striking effects
were observed in cases of synergistic gangrene
in which a destructive process of many months’
duration was halted by the antibiotic agent
within twelve hours of its first application.
Orally administered bacitracin seemed to exert
some degree of beneficial activity in ulcerative
colitis and regional ileitis although no definite
conclusions were warranted.
NEOMYCIN
The most recently described antibiotic is
neomycin. This agent was isolated by Waksman
and Lechevalier from cultures of Streptomyces
fradiae, a soil inhabitant. It is active against
numerous gram positive and gram negative
bacteria but has no antifungal effect. In vivo,
it is also effective against both streptomycin-
sensitive and resistant gram positive and nega-
tive organisms. It has, thus far, not exhibited
any toxicity for animals. It appears to possess
considerable activity against M. tuberculosis and
other Mycobacteria; in some cases its effective-
ness is greater than that of streptomycin. De-
velopment of lack of sensitivity to this new
substance has not yet been demonstrated.
Neomycin has been applied clinically only
to a limited extent; if it can be given to man
without producing serious toxic effects it may be
promising in the treatment of cases of tubercu-
losis and other infections in which streptomycin-
treatment has resulted in the development of
drug-resistant strains of bacteria.
DISCUSSION
The review of the clinical properties of the
antibacterial agents presented above reveals
progress in two directions: (1) The new chemo-
therapeutic substances are effective in infections
which in the past have generally been untreat-
able by any specific means, e. g., the psittacosis-
lymphogranuloma virus group of diseases, “virus
pneumonia,” typhoid fever, scrub typhus, etc.;
(2) the most recently described antibiotics are
active in cases in which very adequate chemo-
therapy is already available as, for example,
pneumococcal pneumonia, gonorrhea, urinary
for June, 1950
551
tract infections, etc. In the first group no
problems are raised concerning the choice of
drug with the possible exception of choosing
between aureomycin and Chloromycetin, since
both seem to be equally effective in the viral
and Rickettsial infections. In the second group,
however, the matter of employing the most ef-
fective agent is much more involved; thus while
both aureomycin and penicillin will cure disease
produced by the pneumococcus, the latter is the
agent of choice, at the moment, if for no other
reason than that it is relatively cheap, and suc-
cessful clinical experience with it is far greater
than with any of the other drugs. In urinary
tract infections, treatment with one of the new
antibiotic chemicals may be ill-advised since the
process may be due to an organism which is not
very sensitive to it; e.g., Pseudomonas pyo-
cyaneus and Proteuis vulgaris are little, if at all,
affected by aureomycin.
The tendency for physicians to employ a drug
such as aureomycin which has a fairly wide
antibacterial spectrum in cases in which no
attempt to establish a definite etiologic diagnosis
is made may sometimes prove disastrous because
the agent may be completely ineffective. The
use of one antibiotic after another, in hit and
miss fashion, in the treatment of a case of in-
fection may eventually produce a favorable re-
sponse in some instances but is a dangerous
procedure since it often delays proper therapy
too long, results in unnecessary hypersensitiza-
tion, may lead to the appearance of resistant
organisms, and produces a false sense of security.
Since aureomycin and Chloromycetin have be-
come readily available we have had the oppor-
tunity of studying several patients who failed
to respond to treatment with penicillin followed
by streptomycin, aureomycin, and finally Chlor-
omycetin; in all instances these individuals
had such untreatable diseases as rheumatic fever,
virus infections, or lymphomas. While the ex-
hibition of three or four agents in succession
or simultaneously is still feasible, although most
undesirable at present, one cannot but wonder
what will happen when a dozen or more effective
antibacterial drugs become available, as they
well may, in the next ten or fifteen years. Ob-
viously, treatment with all of the drugs, to-
gether or separately, would be impossible.
Unless a chemotherapeutic substance which is
active against all bacterial and viral infections is
developed, and this seems very unlikely in view
of what is known concerning the differences in
the metabolic activities of various microorgan-
isms, the need to establish exact etiologic diag-
noses will increase as the number of antibacterial
drugs multiplies. This will be particularly true
if the agents which are produced in the future
have the specificity characteristic of penicillin,
streptomycin, bacitracin, or polymyxin. The
wholesale use of the antibiotic substances without
establishing the cause of an infection and, in
truth, often for the treatment of obscure fever,
can only be decried. The time required to deter-
mine the etiology of an infectious disease is
often time saved in the total course of an illness
because the risk of application of the wrong
agent is reduced and, even more important, the
diagnosis of fevers due to infectious causes is
not delayed too long by waiting for chemotherapy
to produce an effect. While specific situations
may demand the immediate application of an
antibiotic substance in the presence of an
obvious critical infection, it is most important
to carry out the procedures necessary to estab-
lish a definitive diagnosis before a drug is given
even though treatment is applied before the
results are available; the time required to do
this is so short that the delay in the exhibition
of chemotherapy is negligible. The need for
laboratory study of cases of infection has in-
creased, rather than decreased, with our im-
proved methods of therapy; information concern-
ing the bacterial flora of patients who are re-
ceiving antibiotics is important not only at the
inception but also during the entire period of
treatment in order to check the response to
therapy and to detect any changes in bacterial
populations that may result in new infections due
to organisms which are not sensitive to the anti-
bacterial or antiviral agent being used.
BIBLIOGRAPHY
Aureomycin
1. Anigstein, L., Whitney, D. M., and Beninson, J. :
Aureomycin — A New Antibiotic with Antiriekettsial Prop-
erties : Its Effect on Experimental Spotted Fever and En-
demic Typhus. Ann. N. Y. Acad. Sci., 51 :306-317, 1948.
2. Bliss, E. A., and Chandler, C. A. : In Vitro Studies
of Aureomycin, A New Antibotic Agent. Proc. Soc. Exp.
Biol, and Med., 69:467-472, 1948.
3. Braley, A. E., and Sanders, M. ; Aureomycin in Ocu-
lar Infections. Ann. N. Y. Acad, of Sci., 51 :280-289, 1948.
4. Bryer, M. S., Schoenbach, E. B., Bliss, E. A., and
Chandler, C. A. : Treatment of Experimental Infections
with Aureomycin. Ann. N. Y. Acad, of Sci., 51:254-266,
1948.
5. Bryer, M. S., Schoenbach, E. B., Chandler, C. A.,
Bliss, E. A., and Long, P. H. : Aureomycin. J. A. M. A.,
138:117-118, 1948.
6. Chandler, C. A., and Bliss, E. A. : In Vitro Studies
with Aureomycin. Ann. N. Y. Acad. Sci., 51:221-227,
1948.
7. Collins, H. S., Wells, E. B., Paine, T. F., and Fin-
land, M. : Urinary Excretion of Aureomycin. Proc. Soc.
Exp. Biol, and Med., 69: 174-175, 1948.
8. Collins, H. S., Paine, T. F., and Finland, M. :
Aureomycin in Treatment of Pneumococcal Pneumonia and
Meningococcemia. Proc. Soc. Exp. Biol, and Med., 69 :263-
265, 1948.
9. Collins, H. S., Paine, T. F., Wells, E. B., and Fin-
land, M. : Aureomycin- — A New Antibiotic: Evaluation of.
Its Effects in Typhoid Fever, Severe Salmonella Infections
and in a Case of Colon Bacillus Bacteremia. Ann. Int. Med.,
29:1077-1092, 1948.
10. Collins, H. S., Paine, T. F., and Finland, M. : Clin-
ical Studies with Aureomycin. Ann. N. Y. Acad, of Sci.,
51:231-240, 1948.
11. Dornbursh, A. C., and Pelack, E. J. : The Determina-
tion of Aureomycin in Serum and Other Body Fluids. Ann.
N. Y. Acad. Sci., 51:218-220, 1948.
12. Dowling, H. F., Lepper, M. H., Sweet, L. K., and
Brickhouse, R. L. : Studies on Serum Concentrations in
Humans and Preliminary Observations on the Treatment of
Human Infections with Aureomycin. Ann. N. Y. Acad. Sci.,
51:241-245, 1948.
13. Duggar, B. M. : Aureomycin — A Product of the Con-
tinuing Search for New Antibiotics. Ann. N. Y. Acad. Sci.,
51:177-181, 1948.
14. Finland, M., Collins, H. S., and Paine, T. F. : Aureo-
mycin— A New Antibiotic. J.A.M.A., 138:946-949, 1948.
15. Finland, M., Collins, H. S., and Wells, E. B.: Aureo-
552
The Ohio State Medical Journal
mycin in the Treatment of Primary Atypical Pneumonia.
New Eng. Jour. Med., 240:241-246, 1949.
16. Harned, B. K., Cunningham, R. W., Clark, M. C.,
Cosgrove, R., Hine, C. H., McCauley, W. J., Stokey, E.,
Vessey, R. E., Yuda, N. N., and Subba Row, Y. : The Phar-
macology of Duomycin. Ann. N. Y. Acad. Sci., 51:182-210,
1948.
17. Harrell, G. T., Meads, M., and Stevens, K. : “Aureo-
mycin” — A New Orally Effective Antibiotic. Effective in
Rocky Mountain Spotted Fever. South. Med. Jour., 42 :4-13,
1949.
18. Kneeland, Y., Ross, H. M., and Gibson, C. D. ; Aureo-
mycin in the Treatment of Primary Atypical Pneumonia.
Amer. Jour. Med., 6 :41-50, 1949.
19. Lennette, E. H., Meiklejohn, G., and Thelen, H. M. :
Treatment of Q Fever in Man with Aureomycin. Ann. N. Y.
Acad. Sci., 51:331-343, 1948.
20. Little, P. A. : Use of Aureomycin in Some Experi-
mental Infections in Animals. Ann. N. Y. • Acad. Sci.,
51:246-253, 1948.
21. Paine, T. F., Collins, H. S., and Finland, M. : Bac-
teriologic Studies of Aureomycin. Jour. Bact., 56 :489-497,
1948.
22. Paine, T. F., Collins, H. S., and Finland, M. : Labora-
tory Studies with Aureomycin. Ann. N. Y. Acad. Sci., 51:228-
230, 1948.
23. Price, C. W., Randall, W. A., and Welch, H. : Bac-
teriological Studies of Aureomycin. Ann. N. Y. Acad. Sci.,
51:211-217, 1948.
24. Ross, S., Schoenbach, E. B., Burke, F. G., Bryer,
M. S., Rice, E. C., and Washington, J. A. : Aureomycin
Therapy of Rocky Mountain Spotted Fever. J.A.M.A.,
138:1213-1215, 1948.
25. Schoenbach, E. B., and Bryer, M. S. : Treatment of
Atypical Pneumonia with Aureomycin. J.A.M.A., 139 :275-
279, 1949.
26. Schoenbach, E. B., Bryer, M. S., and Long, P. H. :
The Pharmacology and Clinical Trial of Aureomycin : A
Preliminary Report. Ann. N. Y. Acad. Sci., 51 :267-279,
1948.
27. Spink, W. W., Braude, A. I., Castaneda, M. R., and
Goytia, R. S. : Aureomycin Therapy in Human Brucellosis
Due to Br. melitensis. J.A.M.A., 138 : 1145-1148, 1948.
28. Wong, S. C., and Cox, H. R. : Action of Aureomycin
Against Rickettsial and Viral Infections. Ann. N. Y. Acad.
Sci., 51:290-305, 1948.
29. Wright, L. T., Sanders, M., Logan, M. A., Prigot, A.,
and Hill, L. M. : The Treatment of Lymphogranuloma
Venereum and Granuloma Inguinale in Humans with
Aureomycin. Ann. N. Y. Acad. Sci., 51 :318-330, 1948.
30. Wright, L. T., Sanders, M., Logan, M. A., Prigot, A.,
and Hill, L. M. : Aureomycin : A New Antibiotic with
Virucidal Properties. J.A.M.A., 138 :408-412, 1948.
Chloromycetin
1. Bartz, Q. R. : Isolation and Characterization of
Chloromycetin. Jour. Biol. Chem., 172:445-450, 1948.
2. Controulis, J., Rebstock, M. C., and Crooks, H. M.,
Jr. : Synthesis of Chloromycetin. Jour. Am. Chem. Soc., In
press.
3. Ehrlich, J., Gottlieb, D., Burkholder, P. R., Ander-
son, L. E., and Pridham, T. G. : Streptomyces venezuleae
n.sp.. The Source of Chloromycetin. Jour. Bact., 56 :467-
477, 1948.
4. Ley, H. L., Jr., Smadel, J. E., and Crocker, T. T. :
Administration of Chloromycetin to Normal Human Sub-
jects. Proc. Soc. Exp. Biol, and Med., 68 :9-12, 1948.
5. Payne, E. H., Knaudt, J. A., and Palacios, S. : Treat-
ment of Enid^mic Typhus with Chloromycetin. Jour. Trop.
Med. and Hyg., 51:68-71, 1948.
6. Pincoffs, M. C., Guy, E. G., Lister, L. M., Wood-
ward, T. E., and Smadel, J. E. : Treatment of Rocky
Mountain Spotted Fever with Chloromycetin. Ann. Int.
Med., 29:656-663, 1948.
7. Smadel, J. E., and Jackson, E. G. : Chloromycetin,
An Antibiotic with Chemotherapeutic Activity in Experi-
mental Rickettsial and Viral Infections. Science, 106 :418-
419, 1947.
8. Smadel, J. E., and Jackson, E. B. : Effect of Chloro-
mycetin on Experimental Infection with Psittacosis and
Lymphogranuloma Venereum Viruses. Proc. Soc. Exp. Biol,
and Med., 67:478-483, 1948.
9. Smadel, J. E., Woodward, T. E., Ley, H. L., Jr.,
Philip, C. B., Traub, R., Lethwaite, R., and Savoor, S. R. :
Chloromycetin in the Treatment of Scrub Typhus. Science,
108:160-161, 1948.
10. Smadel, J. E., Leon, A. P., Ley, H. L., Jr., and
Varela, G. : Chloromycetin in the Treatment of Patients
with Typhus Fever. Proc. Soc. Exp. Biol, and Med., 68 :12-
19, 1948.
11. Smadel, J. E., Jackson, E. B., Ley, H. L., Jr., Leth-
waite, R. : Comparison of Synthetic and Fermentation Chlor-
amphenical (Chloromycetin) in Rickettsial and Viral Infec-
tions. Proc. Soc. Exp. Biol, and Med., 70:191-194, 1949.
12. Smith, R. M., Joslyn, D. A., Gruhzit, O. M., McLean,
I. W., Jr., Penner, M. A., and Ehrlich, J. : Chloromycetin:
Biological Studies. Jour. Bact., 55:425-448, 1948.
on the Beneficial Effect of Chloromycetin in the Treatment
of Typhoid Fever. Ann. Int. Med., 29:131-134, 1948.
Polymyxin
1. Brownlee, G., and Bushby, S. R. M. : Chemotherapy
and Pharmacology of Aerosporin, A Selective Gram Nega-
tive Antibiotic. Lancet, 1 :127-132, 1948.
2. Stansly, P. G., Sheperd, R. G., and White, H. J. :
Polymyxin : A New Chemotherapeutic Agent. Bull. J. Hopk.
Hosp., 81:43-54, 1947.
3. Stansly, P. G., and Schlosser, M. E. : Studies on
Polymyxin : Isolation and Identification of Bacillus Polymyxa
and Differentiation of Polymyxin from Certain Known Anti-
biotics. Jour. Bact., 54 :549-556, 1947.
4. Stansly, P. G., and Schlosser, M. E. : Studies on
Polymyxin: An Agar Diffusion Method of Assay. Jour.
Bact., 54:585-597, 1947.
5. Stansly, P. G., and Ananenko, N. H. : Resistance of
Polymyxin to Some Proteolytic Enzymes. Arch. Biochem.,
15:473-474, 1947.
6. Stansly, P. G., Schlosser, M. E., Ananenko, N. H.,
and Cook, M. H. : Studies of Polymyxin : The Production
of Fermentation Liquor. Jour. Bact., 55 :573-578, 1948.
7. Stansly, P. G. : Studies on Polymyxin : An Assay
Method for Blood and Urine. Proc. Soc. Exp. Biol, and
Med., 68: 301-304, 1948.
8. Swift, P. N. : Treatment of Pertussis with Aero-
sporin. Lancet, 1 :133-135, 1948.
Bacitracin
1. Anker, H. S., Johnson, B. A., Goldberg, J., and
Meleney, F. L. : Bacitracin : Methods of Production, Con-
centration and Partial Purification, with A Summary of the
Chemical Properties of Crude Bacitracin. Jour. Bact., 55 :249,
1948.
2. Barry, G. T., Gregory, J. D., and Craig, L. C. :
The Nature of Bacitracin. Jour. Biol. Chem., 175 :485, 1948.
3. Bellows, J. B., and Farmer, C. J. : The Use of Baci-
tracin in Ocular Infections. Part I. Tolerance and Perme-
ability in the Rabbit Eye. Amer. Jour. Ophth., 31 :1071,
1948.
4. Bellows, J. B., and Farmer, C. J. : The Use of Baci-
tracin in Ocular Infections. Part II. Bacitracin Therapy of
Experimental and Clinical Ocular Infections. Amer. Jour.
Ophth., 31:1211, 1948.
5. Bond, G. C., Vander Brook, M. J., Wiley, J. L., and
Nook, M. A. : Oral Administration of Bacitracin. Proc. Soc.
Exp. Biol, and Med., 68 :395, 1948.
6. Bond, G. C., and Nook, M. A. : Assay on Bacitracin
in Body Fluids. Science, 107 : 228, 1948.
7. Darker, G. D., Brown, H. B., Free, A. H., Biro, B.,
and Goorley, J. T. : The Assay of Bacitracin. Jour. Amer.
Pharm. Assoc. (Scient. Ed.), 37:156, 1948.
8. Eagle, H., Newman, E. V., Greif, R-, Burkholder,
T. M., and Goodman, S. C. : The Blood Levels and Renal
Clearance in Rabbits and Man of an Antibiotic Derived
from B. subtilis (Bacitracin). Jour. Clin. Invest., 26:919,
1947.
9. Eagle, H., Musselman, A. D., and Fleishman, R. :
The Action of Bacitracin and Subtilin on Treponema Pal-
lidum in Vitro and in Vivo. Jour. Bact., 55:347, 1948.
10. Eagle, H., and Fleishman, R. : Therapeutic Activity
of Bacitracin in Rabbit Syphilis, and Its Synergistic Action
with Penicillin. Proc. Soc. Exp. Biol, and Med., 68 :415,
1948.
11. Evans, F. L.: A Note on the Susceptibility of Hemo-
philus influenzae Type B of Bacitracin. Jour. Bact., 56:507,
1948.
12. Hoff, D. A., Bennett, R. E., and Stansly, A. R. : A
Sensitive Cylinder-Plate Assay for Bacitracin. Science,
106: 551, 1947.
13. Johnson, B. A., Anker, H., and Meleney, F. L. :
Bacitracin : A New Antibiotic Produced by a Member of
the B. subtilis Group. Science, 102 : 376, 1945.
14. Meleny, F. L., and Johnson, B. A.: Bacitracin
Therapy : The First Hundred Cases of Surgical Infections
Treated Locally with the Antibiotic. J. A. M. A., 13:675,
1947.
15. Meleney, F. L., Altemeier, W. A., Longacre, A. B.,
Pulaski, E. J., and Zintel, H. A. : The Results of the Sys-
temic Administration of the Antibiotic, Bacitracin, In Sur-
gical Infections: A Preliminary Report. Ann. Surg., 128:714,
1948.
16. Miller, J. L., Slatkin, M. H., and Johnson, B. A.:
Local Use of Bacitracin. Jour. Invest. Dermat., 10:179,
1948.
17. Scudi, J. V., and Antopol, W. : Some Pharmaco-
logical Characteristics of Bacitracin. Proc. Soc. Exp. Biol,
and Med., 64:503, 1947.
18. Scudi, J. V., Clift, M. E., and Krueger, R. A. : Some
Pharmacological Characteristics of Bacitracin: II. Absorp-
tion and Excretion of Bacitracin in the Dog. Proc. Soc.
Exp. Biol, and Med., 65 :9, 1947.
19. Scudi, J. V., Covet, I. A., and Antopol, W. : Some
Pharmacological Characteristics of Bacitracin : III. Chronic
Toxicity Studies of Commercial Bacitracin in the Dog and
Monkey. Proc. Soc. Exp. Biol, and Med., 66 :558, 1947.
Neomycin
1. Waksman, S. A., and Lechevalier, H. A. : Neomycin,
A New Antibiotic Active Against Streptomycin-Resistant
Science, 109:305,
13. Woodward, T. E., Smadel, J. E., Ley, H. L., Jr., Bacteria, Including Tuberculous Organisms.
Green, R. R., and Mankikar, D. S. : Preliminary Report307, 1949.
for June, 1950
553
Fibrositis and Segmental Neuralgia
JOSEPH M. STRONG, M.D.
The Author
• Dr. Strong, Elyria, Ohio, is a graduate of
Western Reserve University School of Medi-
cine, 1935; on orthopedic staff, Elyria Me-
morial Hospital; and asst, orthopedic surgeon
at Gates Memorial Hospital for Crippled
Children.
ONE of the most common complaints con-
fronting physicians in general practice is
low back pain or pain in the extremities.
It is also true that many of these patients
leave the doctor’s office undiagnosed and treat-
ment is often disappointing. Frequently these
patients make the circuit of various doctors,
finally ending up with some charlatan. Truly
these patients are perplexed, but no more so than
the physicians who have diligently tried to meet
their problem only to realize failure. I venture
to say that there are no more than a handful
among you readers who have not lost sleep
attempting to speculate on the cause of some
patient’s backache which has been resistant to
treatment.
In the past few decades, many advances have
been made which have reduced the group of
undiagnosed back conditions. After one has
eliminated the congenital deformities, mechanical
instabilities, ruptured discs, skeletal injuries, back
pains referred from other systems, and other
known causes of back pain, there still remains a
certain group of cases with characteristic signs
and symptoms which have been classified as
intramuscular fibrositis. The discussion in this
paper will be confined to fibrositis of the back
and its secondary effects in the extremities due
to referred pain. The term segmental neuralgia
is used to describe these secondary changes.
TYPES OF CASES FALLING INTO THE
FIBROSITIC SYNDROME GROUP
For the purpose of this discussion, cases of
the fibrositic syndrome are classified on the basis
of history and symptoms into five groups, as
follows :
1. Patients of this group have had backache
as long as they can remember. The backache
is not severe enough to complain about but
recently the pain, described as dull and con-
tinuous, is now troublesome. At first heat and
massage were beneficial but now treatment seems
useless. Chiropractic manipulations helped for
a few days at a time but now these are also
worthless. Damp cold weather increases the
intensity of the pain in most, but in some,
weather changes are not a factor. On arising
in the morning, the back is stiff. Some patients
have difficulty in getting out of bed but once they
do, and move about, the stiffness gradually
subsides and the pain completely disappears.
Sitting in a chair for long periods produces con-
siderable back stiffness. Movement and mild
Presented before the Section on General Practice at the
Annual Meeting of the Ohio State Medical Association, Co-
lumbus, April 20, 1949.
exercise seem to give some relief. Occasionally
some patients set their clocks to awaken them
several times during the night, in order that
they may move about to prevent severe stiffness
and pain in the morning. Frequently, attacks
of acute pain arise in the back with associated
dull ache in one or more of the extremities,
such as the shoulder, hip, or arm. These attacks
are so severe at times as to confine the patient
to his bed. The acute attack usually subsides
in time with or without treatment.
A number of patients in this group have had
several abdominal or back operations without
securing any benefit. The acute attacks of
referred pain have been misdiagnosed for ab-
dominal disorders. They have had pain for
many years without having received much benefit
from treatment. They are miserable and have
developed somatopsychic symptoms. Emotional
stress appears to increase their pain.
The younger patients (the youngest at present
which I have seen was 14 years old) will often
trace their first backache to a traumatic incident,
such as a fall, severe jarring, or a period of
chilling. The older patients have usually for-
gotten the time of onset of their back condition.
2. The second group of patients notice the
onset of back pain following a rapid muscular
movement, such as:
(a) Reaching down to pick up an object
and, on coming up, a sudden pain developed
in the lower back which prevented him
straightening up.
(b) Making a sudden twist to reach for
something.
(c) Suddenly interrupting a smooth move-
ment, for example; During the act of shovel-
ing, the patient is distracted and abruptly
stops his stereotyped movement.
In most of these cases, the trauma is usually
too trivial to produce sprains or strains. This
group presents a troublesome problem to the
industrial physician.
There is no complaint of referred pain into
554
The Ohio State Medical Journal
the extremities. The pain is usually well localized
to the lower back, at first diffusely, but later, to
a surprisingly constant, well-defined area.
Many of these patients respond to manipula-
tions or procaine injections into the tender
area. They decry the physician who has treated
them with back strapping, diathermy, massage,
and other forms of treatment with no benefit, and
will state that one manipulation of the back by
a chiropractor immediately relieved him of his
pain. Immediate cures are few indeed, but they
do occur.
The pain is so intolerable at times that the
patient may drop to the floor at the occurrence
of the attack and will scream if attempts are
made to move him. Occasionally, I have had
to inject these patients with procaine in the
back before they could be moved into bed.
One important point is usually missed. If
questioned carefully the majority of these pa-
tients will admit that several days or weeks
before their attacks, their backs did not feel
quite right or that there was vague stiffness
which they felt was not severe enough to mention.
3. The third group is the same as the second,
except there is no history of minor trauma
preceding their acute attacks. The pain may be
noticed quite vaguely some morning on arising
and grows in intensity. The patient may show
sciatic scoliosis and muscle spasm. There may
be a list when he walks. However, he gives no
history of referred pain into the extremities.
This type of patient responds quite well to
manipulation, procaine injection, and heat and
massage, or, if left alone, the attack will sub-
side spontaneously in time.
4. The fourth group includes patients of the
second and third group in which there is radiation
of pain into the extremities. The referred pain
is usually more or less diffuse but roughly cor-
responds to the distribution of a nerve root. The
patient on close interrogation will state that
there is a “gnawing feeling about the hip, knee,
calf, etc.” The symptoms of many of these
individuals may so closely resemble a ruptured
disc that operations for removal of discs may
be undertaken when no such pathology is present.
Yet, the patient may be improved. This cure,
I attribute, to the muscle stripping which is
necessary during the operation.
5. The fifth group is the segmental neuralgias.
Many of these patients with painful shoulders,
hips, knees, thighs, etc., have undergone careful
and thorough examination and no diagnosis could
be made. Very often, they may be benefited by
stellate ganglion or paravertebral blocks. Most
dramatic of all are the long standing cases
which respond to procaine injection of the so-
called “trigger area” in a muscle. Often, these
patients are treated as neuridites but there is
no neurological evidence of such a condition.
The fibrositic syndrome must not be confused
with the psychogenic backache. The psychogenic
backache may superficially resemble a fibrositic
syndrome but on the whole, the history and
findings given above are not present. Patients
with the fibrositic syndrome do not respond to
psychotherapy.
PHYSICAL FINDINGS
1. Presence of tender areas in remarkably well
defined locations in the back. Well defined fat
nodules described in the literature are not to
figure 1
Figure 1. Schematic drawing showing most frequent
sites of myalgic areas. Black dot represents most frequent
site and circle represents less frequent areas.
for June, 1950
555
be confused with the tender areas or nodules
in the muscles.
2. Apparent complete absence of systemic
infection.
3. Negative laboratory tests although Stein-
berg reports that creatinuria is a common finding.
The most common locations of tender areas
are: (Figure 1)
1. Over the transverse processes of the first
to the third lumbar vertebra, most often over
the third.
2. Over the erector spinal group at the in-
sertion into the sacrum or near the posterior
superior iliac spine.
3. At the origin of the hamstring muscles
at the ischial tuberosity.
4. Trapezius muscle above spine of the scapula.
5. Suboccipital region.
Other painful areas are present less frequently.
The presence of tender nodules in muscles has
been denied by many. If one looks patiently
and persistently for these lesions, he soon
becomes aware that these areas are abnormal
as compared to the surrounding muscle. There
are certain areas in normal muscle which are
sensitive. In unilateral myalgic lesions the
difference is remarkable and impressive. The
sensitivity is much greater in the affected area.
THE FIBROSITIC LESION
Stockman considered the cause of the fibrositic
syndrome to be an inflammatory hyperplasia of
intramuscular connective tissue. Attempts have
been made by others to confirm this, but it is
safe to state that no one has conclusively demon-
strated that such lesions are inflammatory or
hyperplastic in nature. Clinical experiments
which I conducted by using a myotome for muscle
biopsies designed by Shank and Hoagland, failed
to reveal any evidence of inflammatory fibrous
tissue. Specimens were taken from the regions
of the myalgic lesions.
The term fibrositis has its basis on uncon-
vincing and unconfirmed clinical or experimental
evidence and should not be used to describe this
group of back disorders.
The presence of an inflammatory or hyper-
plastic fibrous lesion is not necessary to explain
the palpable nodules.
Micheal Kelly states, “the fibrositic syndrome
consists of a muscular lesion with wide spread
reflex effects.”
The nodules in the generalized type of case
are by no means constant in location. One day
they can be palpated in one area and the next
day in some other. If they were composed of
inflammatory fibrous tissue, surely they would
persist. Following procaine injection into the
myalgic areas, very often the “nodules” com-
pletely disappear. I have had several patients
with shoulder pain which showed these “nodules”
in the trapezius muscle. Following stellate
ganglion block, the lesions were very difficult to
define. The same is obtained with procaine in-
jection into the affected muscular area. The ap-
plication of heat in the form of diathermy, on
occasions, may temporarily abolish the nodules.
On the other hand, in some patients, heat in-
creases their pain and the nodules are more pro-
nounced. It is my opinion that these areas are
muscle segments in a spastic state.
MECHANISM OF PRODUCTION OF THE
MYOSPASTIC SYNDROME
The author feels that the lesion present in these
cases is actually a localized spasm of muscle
usually at the myotendinous junction in locations
which have an abundant supply of nerve endings.
To explain this lesion, it is necessary to
have a knowledge of pain production: the sym-
pathetic system with its effect on circulation
and its involvement in visceral and somatic re-
flex pain. There is insufficient time for a lengthy
discussion of these subjects, but certain salient
facts will be mentioned.
1. Insufficient knowledge exists as to how pain
is produced or how muscle is innervated with
pain-producing nerve fibers. What physico-
chemical process stimulates these fibers is not
known. However, it dias been shown that as a
result of muscle anoxemia, muscle pain be-
comes prominent. This is seen in extremities
with inadequate blood supply as in intermittent
claudication. Lewis suggests that there is pro-
duction of a pain-producing substance as a re-
sult of muscle activity. Whether the pain fibers
are components of the sympathetic system alone
has not been satisfactorily proven. The sym-
pathetic system, however, does play a part.
2. We know that vasomotor control is carried
out by the sympathetic system and if vasocon-
striction is sustained, pain soon is felt, i. e., as in
Reynaud’s disease or freezing of the extremities.
Leriche has presented his theory of “circus”
mechanism in production of pain following
trauma. The involvement of the sympathetic
system is clearly explained. A good example
is the relief of pain and swelling following
local procaine injection into a sprained ankle.
Very often the pain and swelling persists for
months after the torn or stretched ligaments
have healed. The elimination of pain in causalgia
by stellate ganglion blocks or paravertebral
sympathectomy is recognized by most physicians.
The sympathetic system with its vasomotor effect
is a participating factor in the production of the
syndrome under discussion.
The vasomotor effect in the skin due to sudden
changes in temperature of the surrounding air
increases the discomfort in cases of fibrositis.
3. The reflex mechanism of visceral referred
pain is now accepted. One need only to recall
the shoulder pain experienced when the diaphrag-
matic pleura is inflamed or the referred pain in
556
The Ohio State Medical Journal
the arm in coronary disease. This referred pain
from viscera is accomplished by means of the
sympathetic system.
4. Referred pain down the extremities from
deep somatic structures has been proved by many
workers; Steindler, Lewis, Kellgren. By means
of injection of six per cent hypertonic saline
into muscles of the back, Lewis and Kellgren
produced pain in remote areas. They demon-
strated that as a result of irritation of trauma
of muscle, pain could be referred to the peripheral
distribution of the somatic nerve. This referred
pain does not correspond exactly with the
anatomical distribution of skin dermatomes. The
muscles about the interspinous ligaments were
injected in their experiments.
The experimental work above corresponds
closely with the clinical findings in this group
of cases. In many patients, palpation of the
deep painful areas will produce the referred
pain of which the patient complains. During
procaine injections, if the injecting needle strikes
the reflex producing area, the referred pain
is accentuated immediately. Procaine injections
(5 cc.) completely abolish the local and referred
pain. Some patients are completely cured with
one injection and with others there is a recur-
rence of the pain in several hours, necessitating
further injections.
Let us trace a typical referred pain syndrome.
(Figure 2)
A calculus anywhere along the ureter will
produce referred pain into the external inguinal
Figure 2. Modified schematic drawing of innervation of
kidney, spinal joint, and paravertebral muscles and peri-
pheral nerve distribution to inguinal region. (Modified from
Quain’s Anatomy).
ring and occasionally the testicle. Now this
structure is supplied by nerve fibers of spinal
cord segments, Li and L?. As a result of this
referred pain, the diagnostician, from past ex-
perience, associates a ureteral disorder and in-
vestigates along these lines. However, a similar
picture presents itself when there is involve-
ment of the deep somatic muscular structures
attached to the transverse process of the first
lumbar vertebrae. The somatic and visceral
referred pain is so similar that differentiation is
impossible unless the back is closely examined
for myalgic areas. Often, involvement of the
structures about the lumbar joints may likewise
be referred in the same manner. This pain
is referred along the recurrent branch of the
posterior sensory root just before the spinal
nerve leaves the intervertebral foramen along
the peripheral nerve distribution. So pain felt
in the peripheral distribution of the first lumbar
segment may arise from a pathological condition
of the ureter, lumbar articulation, or from muscle
supplied by the sensory branches of that nerve.
Other examples could be cited but this will
suffice to show the relationship of referred pain
to involvement of structures supplied by a given
spinal nerve.
The author is convinced that in the produc-
tion of this back ailment, a reflex sympathetic
system “circus” phenomenon is set up producing
a vasomotor response in certain muscles at the
myotendinous attachment.
Exactly what occurs in this region is not
known as yet but localized muscle spasm is
set up with stimulation of pain fibers producing
a false localization of pain in the peripheral
distribution of spinal nerves.
I feel that there is more evidence to support
such a mechanism than the long established
fibrositis theory. To describe this syndrome, I
suggest the following name, “Myospastic Syn-
drome.”
SUMMARY
An attempt has been made to classify cases
of low back pain which fall into the class of
fibrositis. This group has a very definite
clinical history and physical findings.
Scientifically, insufficient evidence exists to
warrant the acceptance of the presence of in-
flammatory changes in intramuscular fibrous
tissue as an explanation of the palpable nodules
found in these cases.
Briefly, evidence has been presented to show
that this entire syndrome can be explained on
a mechanism involving the sympathetic nervous
system with its vasomotor effect, the localized
muscle spasm with subsequent production of local
and referred pain in a segmental distribution.
Whether the etiology be of a rheumatic,
traumatic, or an infectious nature, a myalgic
lesion develops from which secondary phenomena
for June, 1950
557
originate. A reflex action is set up and all
forms of therapy whether they be medical,
mechanical, manipulative, or chemical tend to
break up the reflex mechanism.
Many errors in diagnosis have resulted be-
cause the occurrence of this syndrome was not
appreciated, leading to unnecessary surgery or
medical treatment. Many cases diagnosed as
sacro-iliac, lumbosacral strains or neuritis of the
extremities are actually myospastic syndromes.
Stress is placed on more complete examination
of the back. The more frequent locations of
tender areas have been presented. Guarded
manipulations of the back and the judicious use
of procaine is recommended.
A better and more logical theory to explain
the so-called fibrositis syndrome is offered.
CONCLUSION
1. A classification of patients falling into
so-called fibrositic syndrome group is presented.
2. The presence of fibrositic involvement of
muscle in these cases is not accepted by the
author.
3. Typical locations of myalgic areas are
mapped out.
4. A theory to explain the mechanism of
the production of the fibrositic syndrome utiliz-
ing as a basis localized myospasm with referred
pain mediated through the sympathetic nervous
system is offered.
5. The term “Myospastic Syndrome” is sug-
gested to replace the term “Fibrositic Syndrome.”
BIBLIOGRAPHY
1. Comroe: Arthritis; Lea & Febiger, Philadelphia, 1945,
Chapter on Fibrosities, pp. 679-702.
2. Kellgren : Observations on Referred Pain Arising
From Muscle; Clinical Science, 3: pp. 175, 1937-1938.
3. Kellgren : A Preliminary Account of Referred Pains
Arising From Muscle; British Medical Journal, 1: pp.
325, 1938.
4. Kellgren : On the Distribution of Pain Arising From
Deep Somatic Structures With Charts of Segmental Muscle;
Clinical Science, 4 : pp. 35 & 303, 1939-1940.
5. Kelly : The Nature of Fibrositis. A Study of the Causa-
tion of the Myalgic Lesion ; Annals Rheumatic Diseases,
5: pp. 69-77, 1946.
6. Kersleg : Pa n and Its Problems ; Practitioner, 159 :
pp. 60-65, July, 1947.
7. Kuntz : The Autonomic Nervous System. Lea &
Febiger, Philadelphia, 1945, pp. 438-455.
8. Lewis : Pain, Macmillan Co., 1947.
9. Shank & Hoagland : A Myotome For Biopsy of Muscle ;
Science, 98 : No. 2557, pp. 592.
10. Smithwick (cited by White) : The Autonomic Nervous
System ; New York, Macmillan Co., 1935, pp. 288.
11. Steinberg, C. L. : Fibrositis (Muscular Rheumatism)
Including Dupuytren’s Contracture ; A New Method of
Treatment; New York State Journal of Medicine, 47: pp.
1679-1682, 1947.
12. White & Smithwick : Autonomic Nervous System ;
New York, Macmillan Co., 1944, pp. 225-245.
13. Wright: Applied Physiology: Oxford Medical Pub-
lications, 1947, pp. 183-204.
Note: The author wishes to express his appreciation to
Dr. Clarence H. Heyman, Dr. E. J. Stanton, and Dr. A. L.
Berman, for their advice in the preparation of this article.
The physician must regard cough as a symp-
tom and although relief should be afforded the
patient while the cause of cough is investigated,
merely suppressing cough with a narcotic often
will prove harmful. — Cough, Louis H. Clerf,
M.D., The Mississippi Doctor, July, 19 U9.
KEEPING UP WITH MEDICINE
• If you are past 65 years of age the chances
are 55 out of 100 that you will die of a cardio-
vascular disease.
s}: :jc
• Despite the fact that all or nearly all of
the cases of essential hypertension can be
shown to have reduced renal blood flow, little
kidney change is noted grossly or microscopi-
cally in a number of cases.
• You and you alone, have the ability to think
the kind of thoughts that you want to think.
* * *
© One-half the peoples of this earth live on
less than 2250 calories per day and the crude
death rate among such people averaged, around
1930, thirty or more per 1000. Whereas only
one-fifth of the peoples of this earth enjoyed
average daily diet of 2875 calories, or more,
their crude death rate in 1930 was as low as
12 per 1000.
ijc ;*c
• One objective of our educational program
should be to develop the skills necessary to
avoid accidents.
^ ^
• A world-wide fear is being whipped up which
may well hypnotize our minds, making us pas-
sive and ready to surrender. This may well be
mass application of the mental tortures that
lead to submission, confession, and mental dis-
integration.
s*e sjc
• It is important that every asthmatic be on
a regime of therapeutic exercises aimed at in-
creasing expiration, relaxing the auxiliary
muscles and stretching them as well as power-
building of these same muscles. Abdominal
breathing and increase of the diaphragmatic
movements are the most important parts of
this program. The same goes for emphysema.
• Cardiovascular diseases do not necessarily
prevent a person from earning a living in a
suitable job and enjoying himself in appropriate
recreation.
❖ * *
• In addition to the psychological and psycho-
matic pressures, we should also consider the
psychosocial stresses and strains upon the total
personality as a cause of DISease.
*
• Disturbances in the mouth from improper
diet have been described in cases of fat indiges-
tion. These conditions are accompanied by bad
breath and are cured by a change in diet. — J. F.
558
The Ohio State Medical Journal
Cancer Mortality Falls
GEORGE M. WILCOXON, M. D.
The Author
• Dr. Wilccxon, Alliance, Ohio, is a graduate
of University of Chicago, The School of Medi-
cine, 1934; diplomate, National Board of Medi-
cal Examiners; member, American Congress of
Obstetrics and Gynecology; chairman. Gyne-
cological staff, City Hospital, Alliance; and
head of Smear Laboratory, Carnegie Medical
Building, Cleveland.
THERE is an improvement in the cancer
mortality rate in women. This is one of
the most welcomed signs of the year. The
fight against cancer in women is beginning to
show dividends. We are beginning to reap the
fruits of a persistent campaign of popular edu-
cation and propaganda regarding cancer. It
was rather repulsive to most physicians to read
signs which suggested one out of five would die
of cancer unless you gave to the cancer fund.
Many physicians were definitely against the
cancer write-ups in the various magazines,
radio programs and the general propaganda
about cancer. But there is not a single sincere
physician who can raise an objection to the
American Cancer Society’s advertisement, “The
Wonderful Story of the Stitch in Time that
Saved Nine.” This is a great advance, it raises
morale, it elevates confidence. The factual dates
and pictures of those cured of cancer has a
stimulating effect. Since the better propaganda
overbalances the objectionable, we are apparently
over that growing stage of the campaign. Now
we have a drop in the cancer mortality rate in
women of approximately eleven per cent. This
cannot be dismissed lightly as it means about
eleven thousand of our women are going to be
with us for a few more years.
In spite of the gains in cancer deaths the real
fight against cancer is just beginning because
about 100,000 women in the United States are
expected to die from cancer this year. This
death toll which is second only to heart disease
is likely to rise as the number of older women
in our country increases. Cancer in women
leads heart disease in the 30 to 60 age groups
and accounts for almost three out of ten deaths
at these ages. However, it is to the women
of this period of life that the greatest hope for
the control of cancer exists today.
BEST RECORD
The death rate from cancer in women is at
the lowest level on record. Every age group
between 25 and 74 years has benefited by this
decline. In Connecticut, women who had cancer
and survived for at least five years increased
from 25 per cent for those first treated in 1935
to 40 per cent for those first treated in 1941.
In contrast to the favorable situation at ages
beyond 25 years the apparent death rate from
cancer in girls and young women has been going
up. The cancers at the early ages differ some-
what from the cancers at later ages, especially
as to where they are found and the types, the
squamous cell carcinoma of the cervix develop-
Submitted October 5, 1949.
ing in the younger age groups while the
adenocarcinoma of the fundus occurs in the
older women.
WOMEN ALERTED
There are a number of items wdrich account
for these encouraging trends. Women have be-
come particularly responsive to the American
Cancer Society campaign and have become more
alert to the early danger signals of cancer. They
are thus seeking medical attention earlier in the
course of the disease, when the chances of cure
are more favorable. For example, among new
patients with suspected or proved cancer first
seen in the examining clinic at Memorial Hospi-
tal in New York, there has been a marked de-
cline in the frequency of delay after first symp-
toms. Patients who had delayed three months
or more decreased from 62.3 per cent of the
total in 1923-1938 to 42.8 per cent in 1946.
This is a drop of 20 per cent in eight years.
Why are women seeking examinations for
cancer more frequently than men? Many rea-
sons might be advanced but two important
reasons are outstanding. Women’s magazines
have given tremendous publicity to the value of
early diagnosis in cancer and many women
have club programs which encourage them to
think about and discuss the cancer problem.
Secondly, the newest and best test for cancer
has been applied to women. The Papanicolaou
test for cancer of the female genitalia has made
tremendous strides in the diagnosing of early
cancers. There are probably many reasons why
women have been going to their doctors for
examinations but the main thing is that they
have been doing this very important thing and
therefore they (the women themselves) have
been most instrumental in lowering the cancer
death rate in women.
DETECTION FOR WOMEN
In the Cleveland Cancer Detection Clinics in
1947, two and one-half times as many women
as men voluntarily were examined. In 1948
for June, 1950
559
there were even more women than in the previous
year. For every man examined at the clinics
there were 3.25 women. This is one of the real
reasons why the cancer death rate in women
is falling under the constant attack against one
of mankind’s greatest enemies. Women are be-
coming conscious of the fact that they can save
their own lives by regular examinations. Can-
cer in women in the city of Cleveland is bound
to drop because of the effectiveness of their
system of Detection Clinics.
Education and understanding are knocking
down the barriers to cancer. People are be-
coming unafraid to admit they have cancer.
People are learning that they may be made
well again if they can stop a cancer before it
is too late for modern treatment to be effective.
Finding cancer early by frequent examinations
is the most effective means against cancer
known to science today.
FREQUENT EXAMINATIONS
Every physician in the United States and
Canada can have the means available to take
the Papanicolaou test in his office. This test is
very accurate in determining cancer in the genital
tract of women. Every woman under forty
years of age should have at least one test a
year and those over forty years should have a
test every six months. It takes an experienced
reader to interpret the Papanicolaou test. There
are enough readers and laboratories at the pres-
ent time to take care of the present demand.
By using this method it is now possible to dis-
cover cancer that is impossible to detect clinically
by any other method. It is possible to discover
a cancer that has not grown enough to give the
patient a single symptom. It was unknown to
discover this form of cancer before with the
exception of when an organ had been removed
for some other reason.
Because it is possible to use the Papanicolaou
test to discover these cancers it will require an
entirely new classification of cancers, not only
nationally but internationally. At the recent
American Medical Association meeting a new
classification of uterine cancers was suggested.
LOWER RATE
Cancer Detection Clinics all over the country
are helping to lower the cancer mortality rate.
They are finding early cancers which have a
high cure rate. In women, cancers of the
breast and uterus alone constitute about two-
fifths of the deaths from all malignant neoplasms.
If cancers of other genital organs are added to
cancers of the breast and uterus a total of 41
per cent of all cancers in women is reached. If
one analyzes the cancer mortality in women be-
tween the ages of 35 and 44 years it is astonish-
ing to find that 58.9 per cent of all the cancer
deaths in women are from the cancers of the
breast, uterus and other genital organs. This
rate falls as the women become older as shown
in Table I.
Table I
CANCER DEATHS IN WOMEN 1946-1947*
f-H W
02
m
m
GG
m
GQ
02
4-> Cg
eg
eg
eg
eg
5
eg
eg
Primary Site
O 0>
QJ
QJ
fcH
QJ
tH
QJ
QJ
QJ
QJ
£
1-74
1-14
15-24
25-34
35-44
45-54
55-64
65-74
Digestive
38.4
3.5
11.0
18.4
21.5
30.4
39.7
49.5
Breast, Uterus
Other Genital
41.0
2.5
12.0
47.3
58.9
51.1
41.3
32.0
Organs
Respiratory
System
3.6
1.3
3.7
3.3
2.9
3.1
4.1
3.8
Urinary Organs
3.1
7.8
1.0
1.1
1.6
2.6
3.2
3.8
Brain, Central
Nervous System
1.6
16.5
9.4
6.1
2.5
1.7
1.4
.4
Bone
1.1
9.5
8.9
1.7
.9
.8
1.0
1.0
Leukemia,
Aleukemia
3.0
46.8
24.1
6.9
3.9
2.5
2.0
1.7
Hodgkin’s Disease .9
1.7
12.6
6.3
1.3
.8
.6
.4
All Other Cancers 7.3
10.4
17.3
8.9
6.5
7.0
6.7
7.4
* Metropolitan Life Insurance Company, White Females.
It is interesting to note that digestive cancers
increase as women become older. Physicians
working in Cancer Detection Clinics should be
especially well acquainted with cancer statistics —
in fact, all physicians doing general examinations
should know cancer statistics. If a physician is
familiar with the first two lines in Table I he
will have a firm grasp on 79.4 per cent of all
cancer deaths in women. It would be well for
Cancer Detection Clinics and physicians to have
these statistics where they can refer to them
during examinations. It is the cancers of these
and other accessible sites which have accounted
for the major part of the recent decline in
cancer death rate among women. Since these
cancers are most likely to be disclosed by the
type of examination offered in the average Can-
cer Detection Center an improvement may be
expected in the future. Detection Centers should
strive to examine the women between the ages
of 35 and 54 years as that is where the greatest
improvement in cancer deaths can be made. As
successful methods of Cancer Detection Centers
are adopted by other medical facilities and by
the private physicians in their own offices, the
cancer death rate in women will drop accordingly.
SUMMARY
1. There is an improvement in the cancer
mortality rate in women in our country.
2. The American Cancer Society deserves
some of the credit for this successful advance
in the cancer field.
3. The women of our country deserve the
largest share of credit because they are present-
ing themselves for early examinations. A few
years ago modesty prevailed on the part of the
physician and women patients and women were
reluctant to present themselves for physical
examination.
4. Detection Centers are helping to lower the
cancer mortality rate.
560
The Ohio State Medical Journal
Hysterectomy: An Analysis of 225 Cases
JOHN F. MOHAN, M. D.
THIS paper is an analysis of 225 hysterec-
tomies performed at the DeCourcy Clinic
during the years of 1946, 1947 and 1948.
It is written as a sequel to a report of 510
hysterectomies published in 1943 by Dr. Joseph
L. DeCourcy. In this group there were 350
panhysterectomies, 140 supracervical hysterec-
tomies, and 20 vaginal hysterectomies. There
were two deaths in the series, both following
the supracervical operation.
Our approach to the problem of hysterectomy
has been to consider each case individually and
to select that operative procedure which would
seem best suited to the problem which that
particular patient presents.
Such factors as age, the general physical con-
dition of the patient, and the type and extent
of pathology are taken into consideration in
selecting an operative plan.
Patients with fundal or adnexal pathology
complicated by infected, lacerated, and eroded
cervices are generally treated with the total
hysterectomy. In all operative cases of ovarian
and fundal carcinoma, panhysterectomy has also
been the operation of choice.
The supracervical hysterectomy is employed in
cases of extensive adnexal inflammatory disease,
endometriosis, and in certain previously operated
cases where the pelvic scarring and adhesions
render the more radical operation an increased
risk to the patient. This technique is also
employed in patients who are poor surgical risks
because of hemorrhage or other complications,
and in those cases with fibroid tumors so placed
as to make access to the parametrial areas or
bladder reflection difficult, and so increase the
probability of ureteral or bladder damage. When
dealing with very large fibroids the supravaginal
operation is also elected.
In this clinic the vaginal hysterectomy is con-
fined to those cases with extensive degrees of
uterine prolapse. We believe that without ex-
tensive procidentia the vaginal operation be-
comes a very unsurgical procedure. The opera-
tion is performed more by sense of touch than
by actual sight, and hemostasis becomes difficult
and hazardous. In addition the possibility of
bladder, ureteral and intestinal damage is
greatly increased. The vaginal approach also
lends itself poorly to dealing with such adnexal
complications as may be encountered.
INCIDENCE
Table I shows the incidence of the different
types of hysterectomy in our present series of
Submitted May 24, 1949.
The Author
• Dr. Mohan, Cincinnati, Ohio, is a graduate
of George Washington University School of
Medicine, 1937; diplomate, American Board
of Obstetrics and Gynecology; on staff, Good
Samaritan Hospital.
225 cases along with their occurrence as to
parity, race, and age grouping.
The incidence of supracervical hysterectomy
as seen in the above table, is somewhat higher
in the Negro race than in the white race. This
is due principally to the predilection of colored
people to the development of very large fibroids
and extensive cases of pelvic inflammatory
disease.
The 36.4 per cent incidence of supracervical
hysterectomy as compared to a 9 per cent in-
cidence of total hysterectomy among the nulli-
Table I
o
V
u
i Q>
.2 S3
> O
5 o
a
£< CT2
O >>
m *c
o
ej <D
o
IT TJ1
^ >>
No.
%
No.
%
No.
%
COLOR:
White
67
89.3%
105
81.4%
20
95.2%
Negro
8
10.7%
24
18.6%
1
4.8%
PARITY :
Nullipara
9
12 %
47
36.4%
1
4.8%
Multipara
66
88 %
82
63.6%
20
95.2%
AGE IN DECADES
20
4
5.3%
13
10 %
30
27
36 %
50
38.8%
40
35
46.6%
52
40.3%
3
14.3%
50
8
10.7%
8
6.2%
11
52.4%
60
6
4.7%
6
28.6%
70
1
1.3%
1
4.8%
parous patients
was
due
to the lower
rate of
cervical pathology among this group. The
multiparous women, having borne children, are
more prone to extensive degrees of cervical
infection and laceration and are generally treated
by the total operation.
The highest incidence of the abdominal hys-
terectomies was found to be in the third and
fourth decades of life. This was to be expected
as it is at this time that pelvic lesions begin
to show the more severe symptoms. Uterine
fibroids have reached their greatest develop-
ment, the incidence of abnormal uterine bleed-
ing is on the increase, and pelvic carcinoma is
for June, 1950
561
more frequent. These factors, combined with the
natural reluctance of both the patient and the
physician to operative intervention at an earlier
age, would lead one to expect a greater incidence
of hysterectomy in those years approaching the
menopause.
The vaginal hysterectomy was found to be
more common in the fifth and sixth decades of
life with 52.4 per cent occurring in the fifth
decade. This was to be expected as all cases
of vaginal hysterectomy were limited to patients
with extensive degrees of procidentia, and the
more extensive uterine prolapse is more commonly
found in this age group.
There was one incidence of third degree
procidentia in a member of the Negro race.
This case is singled out for comment because
we believe that complete uterine prolapse is
uncommon among colored women.
DIAGNOSES
Table II shows the occurrence of the various
diagnoses in this series. This is an over-all pic-
ture, some of the patients being listed as often
as two or three times depending on the path-
ological findings.
Table II
Uterine Fibroid 129
Chronic Pelvic Inflammatory Disease 91
Chronic Cervicitis 67
Ovarian Tumor 19
Endometrial Polyp 13
Endometriosis . .. 16
Prolapse 28
Adenomyosis __ __ 10
Carcinoma Uterine Fundus - 6
Carcinoma of Cervix . 4
Postoperative Adhesions 6
Tuberculous Salpingo-oophoritis 1
Ovarian Carcinoma 2
Five of the cases of carcinoma of the fundus
were first treated with radium and followed in
six weeks by panhysterectomy. Treatment was
completed by deep X-ray therapy. The sixth
patient was treated by panhysterectomy and
deep therapy.
One of the cases of carcinoma of the cervix
was missed prior to operation and was discovered
following supracervical hysterectomy for uterine
fibroids. The second case fell into group I —
pathologically and clinically, and was treated
by total hysterectomy. The other two cases
of epidermoid carcinoma of the cervix were
more extensive and were first treated by
radium and deep X-ray therapy, and followed
by panhysterectomy.
This is contrary to our practice in this clinic
where carcinoma of the cervix is usually treated
by radium and deep X-ray.
There were 16 cases of endometriosis by clini-
cal diagnosis at operation. In some of the
cases the diagnosis was not substantiated by the
pathologist. This is frequently the case in en-
dometriosis as the microscopic diagnosis is de-
pendent on the pathologist receiving a section
containing the typical endometrial glands.
ADDITIONAL OPERATIVE PROCEDURES
Table III shows the additional operative pro-
cedures performed in conjunction with those
hysterectomies.
Table III
Bilateral salpingo-oophorectomy 145
Appendectomy 102
Perineorrhaphy _ 56
D & C 16
Anterior Wall Repair 20
Cauterization of Cervix 24
Lt. salpingo-oophorectomy 12
Rt. salpingo-oophorectomy 10
Bilateral salpingectomy- — rt. oophorectomy 5
Small bowel resection _ 1
Bilateral oophorectomy — rt. salpingectomy 1
The large number of salpingo-oophorectomies
is due to the high incidence of pelvic inflam-
matory disease and to the fact that the largest
number of the abdominal hysterectomies occurred
in the waning years of reproductive life. It
has been our policy to be less conservative with
patients past the age of 35 with a view to limit-
ing the necessity of repeat pelvic operations,
which in the past have been so common, particu-
larly following conservative procedures in the
presence of pelvic inflammatory disease.
In this small series of 225 cases, forty-five of
the patients had had previous pelvic operations.
In addition, in the menopausal group, the removal
of questionable adnexae may be considered
prophylaxis against the development of ovarian
malignancy.
It is our custom on all laparotomies to perform
incidental appendectomies on all cases in which
there is no contraindication, and in which the
condition of the patient permits.
Perineorrhaphy was performed in all cases
in which it was indicated. This operation is
necessary in many cases requiring hysterectomy,
particularly in multipara, in order to obtain the
best functional and clinical results.
Cauterization of the cervix was done in all
cases of supracervical hysterectomy in which
there was any evidence of cervical infection.
OPERATIVE COMPLICATIONS
Table IV shows the complications that oc-
curred during the operative procedures.
Table IV
Perforation of the uterus at D & C 2
Resection of Small Bowel 1
Repair of Injury to Small Bowel 2
Perforation of the Bladder .. — 1
Perforation of the Sigmoid Colon 1
Vesico Vaginal Fistula — 1
There were two cases in which perforation
of the uterus occurred during a D & C. One
case was a patient with a fundal carcinoma,
and the other patient was an elderly woman
562
The Ohio State Medical Journal
with an atrophic uterus. Both perforations
were followed by hysterectomies.
There were three cases of injury to the
small bowel. In one case the injury was exten-
sive enough to require resection of a portion
of the bowel. The other two cases responded
to simple suturing to repair the laceration.
There were two cases of injury to the blad-
der. One was a perforation during a supra-
cervical hysterectomy in which the incision in the
bladder was closed by an inverting Connell suture
and an indwelling catheter was inserted. The
patient recovered without incident. The other
case was a vesico-vaginal fistula following total
hysterectomy. The fistula was successfully re-
paired from above, six weeks following the
hysterectomy. It was apparently the result of
including a portion of the bladder in the running
lock suture used to close the vaginal vault.
The perforation of the sigmoid was not noted
at operation and a fecal fistula developed on
the third postoperative day. This fistula closed
spontaneously in ten days. There were no com-
plications including injury to the ureter in this
series of cases.
POSTOPERATIVE COMPLICATIONS
In Table V are shown the postoperative com-
plications.
Table V
Paralytic ileus . 8
Pelvic Peritonitis _ 3
Vaginal Hemorrhage 3
Pneumonia 4
Atelectasis 1
Toxic Psychosis 1
Fecal Fistula 1
Because of the fact that we have limited
the more extensive lesions and poorer operative
risks to the supracervical operation, the greater
percentage of postoperative complications and
all of the postoperative deaths in both of our
series have been following the supracervical pro-
cedure. This has been particularly notable in the
incidence of paralytic ileus. The more frequent
occurrence of ileus following supracervical hys-
terectomy was due to the greater amount of
bowel handling necessitated by the freeing of
the many and dense adhesions of the more severe
cases of pelvic inflammatory disease which were
generally treated by this technique.
There were three cases of postoperative
vaginal hemorrhage. One followed panhysterec-
tomy and the other two followed the supra-
cervical operation. The hemorrhage following
the panhysterectomy was due to bleeding from
the vaginal cuff. In the two cases done by the
supracervical technique, the bleeding in one case
followed cauterization of the cervix and in the
other the bleeding was from a perineorrhaphy.
The bleeding in all cases was controlled by the
use of a vaginal pack.
MORBIDITY
The figures in Table VI show the morbidity
average in this series for the three types of
hysterectomy. The first day postoperative was
not included in the figures.
Table VI
Days Over Davs Over
100.4° 99.4°
Supra cervical hysterectomy
1.06
2.55
Panhysterectomv __ _ ____
... 1.56
2.34
Vaginal hysterectomv
3.4
3.6
These figures are probably distorted due to the
frequent use of penicillin and sulfa drugs. In
some of the more severe cases of pelvic in-
flammatory disease and in cases complicated by
extensive adhesions, sulfonilamide powder was
placed in the abdomen before closing. In
these cases, and. in others in which we feared
infection, prophylactic penicillin and sulfadiazine
were used postoperatively. If it were not for
the use of these drugs the morbidity figures in
this series would have been higher.
It will be noticed that the figures for the
supracervical and panhysterectomy parallel each
other very closely. This is contrary to expecta-
tions because, as noted previously, the supra-
vaginal technique was used more widely in the
cases presenting the more extensive pathology
and in the poorer operative risks. It would seem
logical to have these patients run the higher
morbidity. In most of the reports in the liter-
ature the morbidity for the supravaginal opera-
tion exceeds the morbidity for the panhysterec-
tomy. This finding may be due, again, to our
use of prophylactic antibiotics.
The morbidity figures for the vaginal opera-
tion are considerably higher than for the ab-
dominal hysterectomies. This finding concurs
with most other reports.
There was one postoperative death in this
series of 225 hysterectomies. This death oc-
curred in a patient who had a supracervical
hysterectomy for bilateral ovarian dermoid
tumors. The patient never recovered conscious-
ness following the anesthetic, and she died on
the second postoperative day. Autopsy examina-
tion showed thrombosis of the middle cerebral
artery due to a fat embolus.
In the previous series of 510 cases reported
in 1943 there were two postoperative deaths,
both following the supracervical operation. The
present series makes a total of 735 hysterec-
tomies with three deaths or a mortality rate of
.41 per cent.
BIBLIOGRAPHY
1. De Courcy, J. L. : Abdominal versus Vaginal Hys-
terectomy. O. S. M. J., Vol. 39, No. 8, August, 1943.
2. Weir, W. C. : Am. Jour, of Obstetrics and Gynecology.
Vol. 56, No. 6, 1021-1228, Dec., 1948.
for June, 1950
563
A Report on Postgraduate Work in Rotunda Hospital,
Dublin, Ireland
F. GRAHAM FALLON, M.D.
THE Rotunda Hospital of Dublin, Ireland,
is the oldest maternity hospital in the
world, having* 1 been founded in 1743. The
hospital at present contains 175 beds — 113 mater-
nity, 32 gynecology, and 30 in the Infant De-
partment. The hospital supervises 6,000 deliv-
eries a year — 4,000 in the hospital and 2,000
in the district.
Besides the usual personnel connected with
every hospital, there is the Lay Superintendent
and the Medical Superintendent, who is respect-
fully called the Master. The present Master,
O’Donel Browne, is King’s Professor of Mid-
wifery in Dublin University. Associated with
him are two assistant masters and the equivalent
of three residents. The Rotunda Hospital is
affiliated with Dublin University, better known
as Trinity College.
Postgraduate work at the Rotunda provides
facilities for delivery of normal and abnormal
cases under supervision. It provides opportunity
to assist at and perform gynecological and ob-
stetrical surgery; to receive clinical instruction
in the examination and diagnosis of gynecologi-
cal cases; to attend lectures in gynecology,
obstetrics, gynecological pathology, and pedia-
trics; and to attend antenatal and postnatal
clinics. This program of work is spread out
over the entire week, with a routine schedule
for each day. Some of the lecture work is
given by staff men of the hospital, by previous
masters or assistant masters, a master being ap-
pointed for a single term of seven years.
The Antenatal Clinic is held every day except
Saturday and Sunday. Approximately sixty to
eighty expectant mothers are seen each day.
Part of the work of the postgraduate student
is taking blood pressure in the Antenatal Clinic.
Here it was not unusual to see women under 40
years of age with eight to fourteen children.
None of the patients showed a blood pressure
over 140. From the antenatal group, any inter-
esting or abnormal cases are screened out; and
following the Antenatal Clinic, these selected
cases are reviewed by the Master or one of his
assistants.
The hospital is not operated for profit, al-
though some private cases are cared for here.
An attempt is made to procure part pay from
some patients; but the large majority are poor
patients unable to pay.
Submitted October 7, 1949.
The Author
• Dr. Fallon, Cleveland, Ohio, is a graduate
of St. Louis University School of Medicine,
1928; senior visitant, Division of Obstetrics
and Gynecology, St. John’s Hospital; and
formerly. Demonstrator in Anatomy, Western
Reserve University School of Medicine.
There is considerable poverty in Dublin, but
no starvation. During my stay there, I had an
excellent opportunity to observe the native life,
as it is necessary for a Postgraduate to do some
work in the District. I paid particular atten-
tion to the children in the streets and in the
homes, and saw few undernourished or underfed
children. They were not thin and scrawny. On
the contrary, they were fat, well nourished and
developed, although poorly clad. The hospital
was located near the poorer section of the city,
which may have accounted for much of the
poverty I personally saw.
ANESTHESIA AND ANALGESIA
I saw no spinal anesthesia used at all, but
did not learn why it was not popular. For
analgesia, pethedeine is used. Here it is known
as demerol. This is supplemented with trilene
and a gas mask. The patient breathes in her
own analgesia. For delivery, drop ether or
nitrous oxide and ether is used. Intravenous
sodium pentothal has been used for a few cases,
which were calculated to be brief. It was stated
that if the delivery would not take more than
eight minutes, sodium pentothal was thought to
be safe. Of course, the obvious argument against
sodium pentothal is that one cannot always
foretell the length of the second stage of labor.
About their surgical technique, I think the
story can be summarized in these words: They
are not as meticulous as we are, however, their
morbidity and mortaliy rates and the incidence of
infection are no greater.
I was impressed by the excellent obstetrical
judgment and the methods by which they ar-
rived at their conclusions in evaluating a border-
line case. After due consideration of the history
of the case, X-ray pelvimetry is done. Then the
patient is brought to the delivery room, prepared
and anesthetized with intravenous sodium
564
The Ohio State Aledical Journal
pentothal, and a thorough vaginal examination
is made. The final decision for the disposition of
the case is then made. High forceps are rare. If
it is determined that a case can deliver vaginally,
the patient is allowed to labor until the head is
brought down where low forceps will deliver
the baby, unless there is definite indication for
previous interference.
TREATMENT OF ECLAMPSIA
A patient is admitted having convulsions.
She is given morphine sulphate grains XA, 500 cc
twenty per cent glucose and one gram sodium
pentothal in 500 cc distilled water. She may
be given three pints a day of this sodium pen-
tothal solution. If the blood pressure goes
down and albumin in the urine clears up, treat-
ment is expectant. If, however, after two to
three days’ treatment, the blood pressure again
rises, they do a section.
Low Caesarian sections are definitely preferred
to the classical sections because they have fewer
ruptured uteri in subsequent pregnancies.
Of course, as you might guess, breast feed-
ing is very popular and is very much encouraged.
I suppose you will be amused and think it
terribly obsolete when I tell you that all well
babies are kept in a cradle, which hangs at the
foot of the mother’s bed; and in the Coombs
Hospital, in Dublin, the mother keeps the baby
in the bed with herself. Babies are bathed by
the nurses at the side of the mother’s bed.
They have no impetigo, and use neither peni-
cillin intramuscular nor penicillin ointment
prophylactically. I was particularly interested
in this point. They attribute the absence of
impetigo to their care of the newborn. Im-
mediately after birth, the doctor or a sterile
nurse ties the cord and expresses any residual
blood out of the cord. The cord is powdered
with boric acid powder and starch, wrapped
in sterile gauze, and the binder is sewed on
the baby. The baby is not bathed until the
sixth day and the vernix is allowed to remain
on the baby.
CARE OF PREMATURE BABIES
All premature babies are given 300,000 units
of intramuscular vitamin D, grain thyroid
the first day and 1/10 grain daily until the
heat regulatory system of the body is normal.
They are given vitamin A concentrated, five
drops daily and twenty-five milligrams vitamin
C daily. One-half strength Ringer’s solution
Vz dram for every two pounds of weight every
two hours. After the baby starts to feed he is
given one-half breast milk and one-half five per
cent glucose solution.
FOR CEREBRAL BABIES
For babies who have had long labor with
ruptured membranes, oxygen is given together
with 25,000 units of penicillin every three hours
until one million units have been given and
1/10 grain streptomycin every six hours is ad-
ministered.
For expectant mothers with iron deficiency
anemia, ferrivenin is given intravenously, and
contains saccharated oxide of iron. Each ampoule
contains 100 milligrams of elementol iron. The
results are very gratifying.
Bisoxyl is used for treatment of leutic mothers
and babies. It contains a very high percentage
of bismuth in the form of its oxychloride. It
is absorbed rapidly and is practically painless.
One of the men on the staff is using it in his
private practice for the treatment of Rh nega-
tive mothers who have lost one or more children,
with suprising results. The rationale of this
treatment is that it draws the antibodies to the
site of the injection.
Except in the northern part of Ireland, the
practice of medicine is free enterprise.
The Irish people have made great progress
since gaining their freedom from England, and
you may expect greater progress in the next
ten years.
Value of Routine Proctoscopy
It has been estimated that from 60 to 90 per
cent of colonic and rectal polyps will undergo
malignant change. Assuming these estimates to
be reliable, it is obvious that cases of lower
bowel cancer are prevented, and more could be
prevented by the proper removal of these polyps
when found. As 50 to 70 per cent of all colonic
polyps occur within reach of the 25 cm. procto-
scope, and as about 40 per cent of patients
with these lesions in this series were without
symptoms, the value of the routine use of the
proctoscope is obvious. In each 100 individuals
examined about three cases of preventable
cancer will have been found. — Dan B. Greer,
M. D.; Med. Annals of The District of Columbia,
Vol. XIX, No. 3, March, 1950.
Treatment of Brucellosis
Several facts should temper one’s expectations
of both aureomycin and Chloromycetin. Their
in vitro effects are primarily bacteriostatic
instead of bactericidal, and they are quite inferior
to the effects of combined streptomycin and sul-
fadiazine. In well-controlled experiments on
laboratory animals, the effectiveness of both
aureomycin and Chloromycetin was less than that
of combined streptomycin-sulfadiazine. In the
treatment of naturally infected cows with large
doses of aureomycin, the excretion of brucella in
the milk recurred promptly after cessation of
treatment in every instance. — C. Wesley Eisele,
M. D., Chicago; Wisconsin Med. Journal, Vol.
49 — No. 3 March, 1950.
for June, 1950
565
Culture Is Based on History; and History Is Based
Upon the Written Word
PART i
JONATHAN FORMAN, M. D.
The Author
9 Dr. Forman, Columbus, Ohio, is a graduate
of Ohio State University College of Medicine,
1913; chairman of Board of Directors, Frank-
lin County Historical Society; chairman, Ohio
Committee on Medical History and Archives,
Ohio Archaeological and Historical Society;
treasurer, American Association for History
of Medicine; professor of the History of Medi-
cine, Ohio State University.
IN recent months there have appeared quite
a goodly number of books on the history of
medicine. As is to be expected these vary
from the dry scholarly volumes of the profes-
sional historians to the lively stories and
autobiographies of those more popular medical
writers who like to look into the past.
All of this is to the good. The more that
we know about the past, the more wisely can
we face the uncertainties of the future. The
more that we physicians realize how we, of the
healing arts, have always been integrated into
the social structure of every period in the his-
tory of the race, the less apt we are to feel
that we are set apart for change. So we shall
realize that we shall not be nationalized as a
profession unless insurance companies, banks
and the legal profession suffer a like fate. We
shall, therefore, oppose not only “State medi-
cine” but more directly socialism. We shall
realize that we are in the era of state capi-
talism, approximately the situation in the Fascist
states and move now into state socialism which
calls for a dictator from the ruling classes or
from the laboring classes. This is of real signif-
icance to us. We will try, if we understand
history, to rally all our people against socialism,
not because it might harm us or even destroy
our form of government but because Karl Marx
is the anti-Christ. There are confused minds
like Norman Thomas who heartily believe that
we can be two opposite things at once and
do the impossible; that is, be a Christian and
a Socialist. This is a disillusion. Christianity
and Socialism cannot be mixed. The basic idea
of the Judeo-Christian concept of why we are
here is the dignity of Man and the importance
of the individual human being and his right to
discharge his duty in the development of his
own character and soul.
ANTIQUITY
One of the interesting of the more scholarly
studies in the field of the history of medicine
is Robert 0. Steur’s Aetiological Principle of
Pyaemia in Ancient Egyptian Medicine ($1.50,
Johns Hopkins University Press, Baltimore).
The study of the word “whdw” has brought
forward evidence of the Egyptian outlook with
regard to mummification and the etiology of
suppurative conditions, to explain how the con-
cept of “septicemia” was based upon a general
principle of physical destruction (“whdw”) ap-
plicable to the living and, after physical death,
to the corpse. Thus the Egyptians attributed
to “whdw” a wider meaning which transcends
the concept of a strictly aetiological term.
Another supplement to the Bulletin of the
566
The Ohio State Medical Journal
history of medicine is a translation of Paracelsus
Volumen Medicinae Paramirum ($1.75, Johns Hop-
kins Press, Baltimore, Md.). It will repay us
all to study the life and works of this great
man who to most of us is only a character in
the ritual of the medical fraternity or a name
we find occasionally in our books. If we are
to be able to evaluate the anti-intellectualism of
our time — and God knows this needs to be en-
couraged as higher education becomes big busi-
ness— then we should know this fearless man
who smashed the icons of the ancients, particu-
larly Galen, while he extolled the ethical calling
of the physician and described with clarity “the
huge pattern on which both God and the phy-
sician weave and Nature provides the loom and
other essentials.”
We should be able to see this pattern as
it runs through the healing Arts from the begin-
ning. Benjamin Lee Gordon helps us to go
back to the beginning with his new book Medi-
cine Throughout Antiquity ($6.00, F. A. Davis
Co., Philadelphia). He gives us an excellent
resume of medicine, as it was conceived, de-
veloped and practiced by the various peoples
of antiquity. Dr. Gordon has succeeded admir-
ably in his attempt to collect and systematize
facts and so to give us in a single volume a
comprehensive account of the essential aspects
of ancient medicine. You might do medicine a
lot of good by telling some clubs in your area
about some of the contents. Have you ever
thought how efficient a dose of propaganda for
the Christian ideology as opposed to Marxism
could be woven into a discussion of ancient
medicine?
Another book on the history of medicine is
not an essential contribution to curative medi-
cine. Nevertheless it can be a great contribution
to the culture of our people for the basis of
all culture is a knowledge of history. Bernard
J. Ficarra, M. D., has written eight delightful
essays, Essays on Historical Medicine, (Froben
Press, New York City). The author has blended
ancient facts into a new perspective. He offers
the past and present together in sharp focus.
“American Pioneer Surgeons; Amputation and
Prosthesis Throughout the Centuries; Famous
Cripples; Surgical References in Shakespeare;
Blood Transfusion; Walter Reed at King’s
County; An Historical View of Pathology; Fa-
mous Autopsies” are the titles of the respective
essays.
THE STUDY OF MEDICINE
The story of medicine is always a fascinating
one. One that every physician should do some-
thing about. It is my contention that if each of
us would take off time and prepare a 45-minute
paper on how human beings have developed the
art of caring for their sick we could do this
in such a way that people would come to realize
that medicine is an Art and never will be a
science. Then our talk about physician-patient
relation would have a new meaning for the
public. They would understand how the na-
tionalization of medical care would defeat its
own purpose by destroying our professional
status and making of us just simple technicians.
In The Story of Medicine, by Joseph Garland,
M.D., ($2.75, Houghton Mifflin Co., Boston), the
author has written a book on a level of read-
ability that gives it wide appeal and one from
which you can readily rework your paper for
P. T. A.’s, Women’s Clubs and Service Luncheon
Clubs in your area. Then, too, if you would
like to refresh and brighten up a bit your own
knowledge of how your day’s work came to be
what it is, read Garland’s 239 pages. j
The Greek Doctors, by John William Charles
Wand, Bishop of London, England; ($1.05,
The Faeth Press, Ltd., London; Morehouse-
Gorham Co., New York), was thought to have
to do with ancient medicine. The office was
not familiar with the author or his previous
book on Latin Doctors, or we would have known
these were the doctors of the eastern and
western church respectively. They were writ-
ten to teach the rather unusual principle in
church administration that a bishop should be
the leader of his people.
IN COLONIAL DAYS
Aesculapius Comes to the Colonies, by Maurice
Bear Gordon, M. D., ($10.00, Ventnor Pub-
lishers, Inc., Ventnor, N. J.) is the study of the
early days of medicine in the thirteen original
colonies, fittingly enough by the son of the
author of Medicine Throughout Antiquity de-
scribed above. It is a frank book as such a
book should be. The author glamorizes none
of our forefathers. Medicine in America was
not born with a silver spoon in its mouth. It
has come up the hard way. We, its servants,
have been men of “guts” but bigoted and un-
cultured, living intensely and hating with pas-
sion. Always, as the author brings out, that
five per cent of “S. O. B.’s” active in our midst
bringing discredit to our profession. The cor-
ruption and inefficiency in the medical depart-
ment during the Revolutionary days under Ship-
pen remains one of the blots, reminiscent of the
canned beef of the Spanish American War. I
would urge that you read this book and put it
in your library. It will make both realists
and patriots of you and yours.
In 1818 The First Medical College in Vermont
($4.50, Vermont Historical Society, Montpelier,
Vt.), opened its doors at Castleton. Dr. Frederick
Clayton Waite, emeritus professor of Histology
at Western Reserve University gives us the
complete history of its 44 years. Medical col-
leges in small towns were a prominent feature
of American medical education in the nineteenth
for June, 1950
567
century. As the cities grew opinion became
divided as to the worth of these country schools.
Most of them lost out in competition with the
urban medical schools. Dr. Waite is known to
most Ohio physicians for his vigor as a teacher
and to the medical world as a whole for his
research into the history of medicine in the
United States. For over 30 years he has been
interested in “country medical” schools and has
given most of his spare time and vacations to
his researches about them. No one else has
begun to accumulate so much material about
them as he. He wrote the story of The
Medical Department of Willoughby University
of Lake Erie, in 1934, for the centennial volume
of the medical college of the Ohio State Univer-
sity. Then, A History of the Medical School
of the Western University, in 1945; The Ver-
mont Historical Society published his History of
the Woodstock School, and now the Castleton
School. Here he has given us the story in inti-
mate detail of the activities of a prosperous and
comparatively long-lived country medical col-
lege as a basis of understanding the operation
and many difficulties encountered by an institu-
tion of such type. It was the rural people of the
east that settled our midwest. Hence our early
physicians here in Ohio were largely of rural
origin and those that held M. D. degrees for the
most part received their formal education in
these eastern country schools. The author has
given us much information about similar institu-
tions as well as a discussion of most of the con-
ditions that applied to all country medical
colleges.
PHARMACY
Dedicated to the memory of Johann Wolfgang
von Goethe, Baron of the German empire, high-
est executive of the Grand Duchy of Saxon
Weimar and one of the greatest poets of all
time as well as uncrowned king of the intellec-
tual world of his day, is a book written by
George Urdang, Ph. G., D. Sc. Nat., Sc. D., and
published by the American Institute of History of
Pharmacy entitled Goethe and Pharmacy ($2.50
Madison , Wis.). Pharmacy seems to have given
Goethe the fundamental concept of order and the
principle of system. Furthermore pharmacy gave
to her men achievements and information which
he cherished and collected. A delightful essay
which I am sure you will enjoy and a nice
Christmas present for your favorite druggists.
Then there is another book which most of
us physicians would do well to read. It is
Pharmacy Forward, by Frederick John Wulling,
Dean of the College of Pharmacy of University
of Minnesota, 1892-1936; ($3.00 Emmerson G.
Wulling, LaCrosse, Wis.). This book consists
of “selections mostly not published before” from
the diary, autobiography, speeches and reports,
significant of a lifetime effort in the profession
of pharmacy. From the age of 17 when the
boy was apprenticed to a pharmacist until two
months before his 82nd birthday when he closed
his busy, vigorous life, pharmacy was central
in his thoughts and activities. In view of the
efforts of our officers and those of the Ohio
State Pharmaceutical Association to understand
each other better we physicians will do well
to catch the fire that burned in this great
soul and his ideals of standards, organizations,
records, and research.
A Century of Medicine in Jacksonville and
Duval County, Florida, ($3.50 University of
Florida Press, Gainesville, Fla.), by Webster
Merritt tells the story of its title. It is more
of a compilation of source material and bio-
graphical sketches than an interpretation of the
history of north Florida as influenced by the
medical profession.
The Bellevue Story. — Probably no American
hospital presents more drama, despair, and
miracles involving names. Page Cooper begins
his version of The Bellevue Story ($3.00,
Thomas Y. Crowell Co., New York) by remind-
ing us that Stephen Foster died there alone
and unrecognized with a half-written lyric pen-
cilled on a scrap of envelope, and finishes by
describing the bright new $15,000,000.00 mask
that is being built for the spirit that is the real
Bellevue. A delightful book that will make the
visit of any one of us to New York the richer,
if we have read it first.
Speaking of hospitals and the medical schools
they have created, Bertram M. Bernheim, M. D.,
has written The Story of the Johns Hopkins
($3.50, Whittlesey House, McGraw-Hill Book Co.,
New York City). It tells how four great doctors
created a great medical school around their
hospital. It is a human story told in an in-
teresting fashion. It is the story of a great
experiment in medical education. The author
came to Hopkins in 1901 and has been with the
institution for nearly 50 years as boy-man-
student-teacher.
This then is not a dry recital of Hopkins'
accomplishments. It is a picture that gives you
the feel, the color, and the spirit of the in-
stitution. The author has presented likenesses
of the chief actors in the drama. The lesson
for you and me in all of this is that culture
based on a knowledge of history, a refinement
of feeling based upon culture, and an apprecia-
tion of the finer things of life based upon all
of these, made it possible for its staff to serve
humanity better. If medicine is to be saved as
a profession in this mechanical age; if we, as
physicians, are to master the Machine, wre must
instill into our hearts and into the souls of
our young men the culture, refinement, and ap-
preciation that comes from a knowledge of
history.
(To be Concluded in July Issue)
568
The Ohio State Medical Journal
Proceedings of The Council . . .
Important Matters Acted Upon at Sessions Held in Columbus, April 22-23;
Statements of Policy on Numerous Questions Adopted; Committees Report
MEETINGS of The Council of the Ohio
State Medical Association were held at
the State Headquarter's Office, Columbus,
on Saturday, April 22, and Sunday, April 23,
1950. All members of The Council, with the
exception of Dr. J. Craig Bowman, were in at-
tendance. Others attending were: Dr. Forman,
editor of The Journal; Dr. Sherburne, an
A. M. A. Delegate; Dr. David Chambers, Cleve-
land, Mr. John Lansdale, Jr., Cleveland at-
torney; Mr. Wayne E. Stichter, Toledo, legal
counsel of the Ohio State Medical Association;
Mr. Charles H. Coghlan, executive vice-president
of Ohio Medical Indemnity, Inc., and Secretaries
Nelson, Saville and Page, and Mr. Moore, news
editor of The Journal.
On motion duly made, seconded and unani-
mously carried, the minutes of the last meeting
of The Council held on Dec. 18, 1949, were
approved.
MEMBERSHIP QUESTIONS
The Executive Secretary reported on member-
ship statistics as follows: Total paid membership
as of April 21, 1950, 7,221, compared to a total
membership of 7,479 as of Dec. 31, 1949.
The Council authorized the collection of annual
-dues from new members on a pro-rated basis
for the third and fourth quarters of 1950 as
follows: New members affiliating in the third
quarter of the year, $10.00; new members affiliat-
ing during the fourth quarter of the year, $7.00.
Communications from several members of the
Association, now employed by the Veterans Ad-
ministration and stationed in other states, ex-
pressing a desire to continue membership in the
Ohio State Medical Association, were read and
discussed. On motion duly made, seconded and
unanimously carried. The Council instructed the
Executive Secretary to accept membership dues
from such members providing they are not
eligible to become active members of the State
Medical Society in the state in which they are
now located and providing their continuation of
membership has the approval of the appropriate
county medical society in Ohio through which
State Association dues shall be collected in the
<customary manner.
The Executive Secretary reported that 412
Fifty-Year emblems and certificates had been
prepared and distributed for presentation to
eligible physicians. A poll of members of The
Council revealed that the great majority of the
emblems and certificates have been presented.
Ceremonies were scheduled by some of the so-
cieties during the month of May.
A. M. A. DUES
Follow-up procedure with respect to collection
of 1950 A. M. A. membership dues was dis-
cussed. The Executive Secretary reported that
as of April 19, 1950, 4,305 members of the
State Association had paid 1950 A. M. A. mem-
bership dues, representing approximately 60
per cent of the paid-up membership of the
State Association as of that date. On motion
duly made, seconded and unanimously carried,
The Council recommended that a communication
be sent to all members of the Association who
have not paid A. M. A. dues over the signa-
ture of the incoming president, Dr. Swartz. It
was suggested that the letter should point out
the reasons why a physician should belong to
the American Medical Association. It was recom-
mended, also, that a communication be sent to
the secretary of each county medical society with
a list of physicians who have not paid A. M. A.
dues, suggesting that the local secretary make
personal contact, if possible, with such phy-
sicians and urge them to send in their A. M. A.
membership dues to the Columbus Office for
forwarding to the Chicago Office of the A. M. A.
A letter from Dr. George F. Lull, secretary
and general manager of the American Medical
Association, asking for information regarding
the cost incurred by state medical societies in
collecting A. M. A. 1950 dues, was read and dis-
cussed. On motion duly made, seconded and
unanimously carried, The Council instructed the
Executive Secretary to provide Dr. Lull with this
information,
CAN’T WAIVE DUES
A number of communications from physicians
requesting exemption from payment of A. M. A.
membership dues because of age, retirement,
financial hardship, etc., were read and discussed.
The Council expressed the opinion that no
member of the Ohio State Medical Association
would be eligible to apply for waiver of A. M. A.
dues inasmuch as the Constitution and By-Laws
of the Ohio State Medical Association provide
for but one class of members, namely, active,
dues-paying members and do not contain a pro-
vision for the waiver of dues in hardship cases.
It was pointed out that the A. M. A. does not
waive dues unless the State Association and the
local medical society to which a man belongs
for June, 1950
569
waive local and state dues. It was the sense
of The Council that no change in the Constitution
and By-Laws of the State Association should be
recommended at this time.
A communication from a member recommend-
ing that The Council go on record as favoring
and instructing Ohio’s delegates to the House
of Delegates of the A. M. A. to present a resolu-
tion to the effect that all members of the
A. M. A. who paid the 1949 $25.00 assessment
shall be given full credit for 1950 membership
dues without the payment of an additional
$25.00, was considered. The Council by unani-
mous vote expressed itself as not favoring
the recommendation.
The annual audit of the books of the State
Association and The Journal for the calendar
year 1949, made by a firm of certified public
accountants, was presented to The Council for
review and discussion. On motion duly made,
seconded and unanimously carried, the report of
the accountants was approved and ordered filed.
AMENDMENTS APPROVED
An amendment to the Constitution and By-
Laws of the Darke County Medical Society,
adopted at a regular meeting of that society
January 17, 1950, was presented for review by
The Council. On motion duly made, seconded
and unanimously carried, such amendment was
approved.
An amendment to the Constitution and By-
Laws of the Stark County Medical Society,
adopted by that society at a meeting on Febru-
ary 9, 1950, was read and discussed. On motion
duly made, seconded and unanimously carried,
such amendment was approved. However, in
the same action The Council instructed the
Executive Secretary to point out to the Stark
County Medical Society that physicians becoming
associate members of that society under the
amended section, with the exception of interns
and residents and those who have retired from
active practice, would not be exempted from
active membership in the Ohio State Medical
Association and would be required to pay cur-
rent State Association dues, even though they
might be exempted from the payment of local
dues by the Stark County Medical Society by
action of The Council of that society. Chapter I,
Section 5, of the By-Laws of the Ohio State
Medical Association was cited as the basis for
the foregoing interpretation and opinion.
The Council authorized the reissuance of the
charter of the Fairfield County Medical Society
to replace the charter of that society which had
been lost, and authorized the Executive Secre-
tary to present this action to the House of
Delegates at the 1950 Annual Meeting for rati-
fication as required by the Constitution and
By-Laws.
ANNUAL MEETING PLANS
The Executive Secretary reviewed all arrange-
ments for the 1950 Annual Meeting in Cleveland,
May 16, 17 and 18. Members of The Council
were assigned to the various Instructional
Courses and the Medical Topics of the Day for
the purpose of calling such sessions to order
and introducing the Moderators.
It was the sense of The Council that it would
be advisable to try to hold the 1952 Annual
Meeting in Cleveland rather than in Columbus
because of the lack of adequate facilities at
the present time in Columbus. The Executive
Secretary was instructed to take up this matter
with the Cleveland Convention Bureau and to
present a report to the Reference Committee
on Time and Place of Annual Meeting at the
time of the 1950 Annual Meeting.
OHIO MEDICAL INDEMNITY
Mr. Coghlan and Mr. Nelson reported on the
recent meeting of stockholders of Ohio Medical
Indemnity, Inc. They announced that all mem-
bers of the Board of Directors had been re-
elected and that Mr. Walter H. Allman, Canton,
had been elected to the Board to succeed the
late Judge Henry Harter. At the annual meeting
of the Board of Directors immediately follow-
ing the stockholder’s meeting, all of the of-
ficers of the company were renominated and
re-elected. (See report elsewhere in this issue.)
The following communication dated April 20,
1950, from Mr. Coghlan, executive vice-president
of Ohio Medical Indemnity, Inc., was read and
discussed:
“For your information the following resolu-
tion was passed by the Board of Directors of
Ohio Medical Indemnity, Inc., at its annual
meeting held on April 19, 1950.
“Resolved, That the Board of Directors
of Ohio Medical Indemnity, Inc., recom-
mends that prompt study be given to the
feasibility and advisability of the develop-
ment of a plan, within the present structure
of Ohio Medical Indemnity, Inc., whereby
the amount of the indemnity payable under
the Subscriber’s contract would be accepted
by the physician rendering the service as
full payment in those cases in which the
subscriber’s gross annual income is less than
$ (to be determined).
“The Board of Directors of Ohio Medical
Indemnity, Inc., further recommends that
this resolution be transmitted to The Council
of the Ohio State Medical Association, with
the request that this Council advise the
Board of Directors of Ohio Medical Indem-
nity, Inc., of its wishes in this matter.”
On motion duly made, seconded and unani-
mously carried, the question presented in Mr.
570
The Ohio State Medical Journal
Uoghlan’s letter was referred to the Committee
on Medical Service Plans for study and report
back to The Council. In the same action the
President was authorized to enlarge the mem-
bership of the Committee on Medical Service
Plans if he desires to do so.
CLEVELAND SITUATION
At this point, Dr. Chambers and Mr. Lansdale
were invited to report on the existing situation
in Cleveland with respect to negotiations being
carried on with the Cleveland Blue Cross Plan
and Medical Mutual of Cleveland. They reviewed
in detail the proposed expansion of the Blue
Cross contract to include certain medical serv-
ices, and discussed the proposal now before
the Cleveland Academy of Medicine to work out
an agreement with Medical Mutual of Cleveland
for a service contract, providing at least 51
per cent of the physicians in Cuyahoga County
would subscribe to such agreement. It was
pointed out that these matters are still in the
discussion stage and that no definite action
"had been taken to date.
On motion duly made, seconded and unani-
mously carried, The Council requested the Cleve-
land Academy of Medicine to go slowly on these
matters and not to take any action without due
consultation with the Ohio State Medical Asso-
ciation. The . same action provided that the
committee of the Cleveland Academy of Medi-
cine handling such matters should be asked to
sit with the Committee on Medical Service
Plans of the Ohio State Medical Association
when it holds conferences on the question of
whether or not Ohio Medical Indemnity should
be converted into a service plan.
The Executive Secretary was instructed to
inform Dr. James G. Kramer, Akron, that Ohio
Medical Indemnity and the Blue Cross plans
of Ohio have under discussion the question of
providing coverage for infants for the first 30
days after birth which would meet the prob-
lem of the prematures. No definite plan has
heen worked out, but these organizations realize
the importance of the question and are hoping
to arrive at a feasible solution, it was reported.
COMMITTEE REPORTS
Dr. Mundy and Mr. Page reported on the
transactions of the Committee on Rural Health
held on April 2, 1950. The Executive Secretary
reported on the meeting of the Committee on
Education held on the same day. The reports
of these committees and the recommendations
incorporated were approved.
The Executive Secretary reported on a dinner-
conference held by the representatives of the
Ohio State Medical Association and represen-
tatives of the Ohio State Pharmaceutical Asso-
ciation, Saturday evening, March 30, 1950, at
the Fort Hayes Hotel. He reviewed some of
the questions which were discussed in an in-
formal way at this conference, and stated that
a committee of three from the Ohio State Medical
Association and three from the Ohio State
Pharmaceutical Association, had been named to
draft a statement of policy covering some of
the points which had been discussed, such state-
ment of policy to be presented later to the
proper authority of each association for review
and consideration.
DISABILITY INSURANCE
A report on a joint meeting of the Com-
mittee of Public Relations and Economics and
the Committee of Industrial Health and Work-
men’s Compensation held in the Columbus Of-
fice on Sunday, April 16, for the purpose of
considering the question of compulsory tem-
porary disability insurance was presented by
the Executive Secretary. The committee report
was approved.
POOR RELIEF PROBLEM
The Executive Secretary presented a report on
matters considered by the Committee of Public
Relations and Economics at a meeting on the
afternoon of April 16 in Columbus. He read com-
munications, which had been considered by the
committee, from the superintendent of the Salem
City Hospital Association and the secretary of
the medical staff of that institution. These com-
munications asked for the opinion of The Coun-
cil regarding an agreement which had been
entered into by the hospital with the relief
authorities of Columbiana County for the fur-
nishing of medical care and hospitalization to
indigent patients. The committee reported that
it had reviewed both of these letters carefully,
as well as the agreement referred to. This
material also was made available to members
of The Council for review and study.
STATEMENT ADOPTED
After a prolonged discussion, The Council,
by unanimous vote, adopted the following State-
ment of Policy which had been drafted and ap-
proved by the Committee on Public Relations
and Economics for presentation to The Council:
“In some counties in Ohio, an agreement has
been entered into by the local relief agency
and a hospital, providing for an all-inclusive
per diem rate to be paid to the hospital for
the care of persons eligible to receive hospital
and medical care as a part of poor relief.
“Under the terms of this agreement, the
hospital contracts to furnish for the all-inclusive
rate, not only hospital services but medical
services, the medical services to be furnished
free by members of the medical staff of the
hospital.
“The opinion of the Ohio State Medical Asso-
ciation on this matter has been requested.
“The Council recognizes the right of physicians
to give their services without charge if they
for June , 1950
571
care to do so. In fact, physicians always have
done so.
“However, The Council is of the opinion that
the situation under consideration involves un-
lawful and unethical acts, namely:
“1. A hospital which agrees to furnish medical
services under the terms of a contract which
provides that the hospital shall be paid for all
services — hospital and medical services — received
by patients admitted to the hospital, is engaged
in the corporate practice of medicine which is
illegal in Ohio.
“2. A physician supplying medical services in
a hospital under such an agreement is guilty
of violating the Principles of Medical Ethics of
the American Medical Association, even though
he may have consented to furnish professional
services without charge.
“Therefore, The Council recommends that
members of a medical staff of a hospital who
may wish to enter into an agreement for fur-
nishing professional services, with or without
charge, deal directly with the patients receiving
such services or with the welfare or relief
agency assuming liability for the care of such
patients.”
LEGISLATIVE QUESTIONS
The actions and recommendations of the Com-
mittee on Public Relations on other matters
referred to it, such as the need for legislation
to make it easier for Ohio’s medical schools
to secure unwanted dogs for scientific experi-
mental purposes, multiple screening tests and
other miscellaneous question, were approved by
The Council.
A communication from Dr. Edward L. Burns,
Toledo, on behalf of the Ohio Society of Path-
ologists was read and discussed. The com-
munication pointed out some of the problems
confronting pathologists, especially that the
practice of pathology can be carried on in Ohio
by those who do not hold a license to practice
medicine. D!r. Burns’ communication was re-
ferred to the Committee of Public Relations and
Economics for study and a report back to The
Council at a later date.
PRIVILEGED COMMUNICATIONS
A communication from Mr. R. Crawford Mor-
ris, chairman of a sub-committee of the Negli-
gence Law Committee of the Ohio State Bar
Association was read and reviewed. Mr. Morris’
letter asked for the opinion of the Ohio State
Medical Association on certain proposed amend-
ments to Section 11494 of the General Code
relative to privileged communications. The
policy adopted by the Association in February,
1949, with respect to Senate Bill 151 pending
at that time before the Ohio General Assembly
was reviewed. On motion duly made, seconded
and unanimously carried. The Council approved
the amendments to Senate Bill 151 suggested by
Mr. Morris; namely, the deletion of lines 20 to
31 inclusive and the insertion in lieu thereof of
the following sentence: “If the patient volun-
•
tarily testifies, the physician may be compelled
to testify on the same question.”
The Council, by unanimous vote, reindorsed the
Statement of Policy issued on this question in
February, 1949, believing that it would cover
the proposed amendments which had just been
approved by The Council and would set forth
the reasons for deletion of lines 20 to 31
inclusive.
WORKMEN’S COMPENSATION
Dr. Worstell, chairman of the Committee of
Industrial Health and Workmen’s Compensation,
presented a report on the meeting of that com-
mittee held in Columbus on Sunday, April 16.
The recommendations and actions of that com-
mittee were approved.
The Executive Secretary reviewed details con-
cerning the pre-primary campaigns. Also, he
suggested procedures for district conferences
preceding the general election in November.
His recommendations were approved.
A letter from the chairman of the Policy
Committee of the Los Angeles Physicians Aid
Association, asking the Ohio State Medical As-
sociation for financial support toward the con-
struction of a home for financially dependent
doctors of medicine in the San Fernando Valley,
was discussed. The Council instructed the Ex-
ecutive Secretary to secure further information
on this project, especially information as to
how many former Ohio physicians would be
eligible to benefits offered by the contemplated
home. Pending receipt of additional informa-
tion, The Council deferred action.
Dr. Davis submitted a report on behalf of
the Advisory Committee to the Woman’s Auxi-
liary. He recommended that the Ohio State
Medical Association provide four prizes of $10.00
each, to be awarded at the 1950 Annual Meet-
ing of the Woman’s Auxiliary by the Advisory
Committee, to local auxiliaries doing the best
job of obtaining subscriptions for “ Today’s
Health,” formerly the magazine “ Hygeia .” On
motion duly made, seconded and unanimously
carried, this recommendation was approved.
BLOOD BANKS
A letter and other material from Dr. Paul I.
Hoxworth, Cincinnati, president-elect of the
American Association of Blood Banks, request-
ing the Ohio State Medical Association to en-
dorse that organization, was considered. On
motion duly made, seconded and carried, The
Council endorsed the program and activities of
the American Association of Blood Banks, be-
lieving that it offers an opportunity for certain
communities to have an efficient blood donor
program where participation in the Red Cross
Blood Bank program is not feasible. In taking
this action, the members of The Council ex-
pressed the opinion that the final decision as to
whether a local blood bank program should be
572
The Ohio State Medical Journal
DETAILED REPORTS OF THE ANNUAL MEETING WILL APPEAR
IN THE JULY ISSUE
Detailed reports of the Annual Meeting of the Ohio State Medical Asso-
ciation held in Cleveland, May 16-18, will appear in the July issue of The Ohio
State Medical Journal. This report will include detailed accounts of the pro-
ceedings of the House of Delegates, election of new officers, reports of attendance
and other interesting news on the meeting.
under the sponsorship of the Red Cross or the
American Association of Blood Banks should rest
with the local medical society, such decision
to be based on local needs and desires.
The Council reviewed a letter from Dr. Paul
B. Magnuson, chief medical director of the
Veterans Administration, Washington, D. C.,
setting forth the Veterans Administration’s rea-
sons for its present policy against dual ap-
pointments. The Council indicated its sympathy
with the statements made by Dr. Magnuson,
and instructed the Executive Secretary to com-
municate this action to certain members who had
written to the Association on this question.
The Council authorized a contribution in the
amount of $500.00 to the World Medical Associa-
tion, covering the calendar year 1950.
ECONOMY MOVE ENDORSED
A report was presented regarding the eco-
nomy program of the Office of Secretary of
Defense, involving curtailment of certain armed
forces hospital and medical activities. The
Council, on motion duly made, seconded and
unanimously carried, voiced its support of the
economy program being sponsored by Secretary
of Defense Johnson and Dr. Richard Meiling,
medical director of the Office of Secretary of
Defense, and instructed the Executive Secretary
to send a communication to them, expressing
the confidence of the Ohio State Medical Asso-
ciation in their program; and that similar letters
be submitted to the American Medical Associa-
tion and to other state medical societies.
A communication from the American Medical
Golfing Association, asking for a contribution
for prizes, was discussed. It was the sense of
The Council that no contribution should be made.
Members of The Council then reported on
activities in their respective Districts, after
which The Council adjourned to meet in Cleve-
land on Monday evening, May 15.
Attest: Charles S. Nelson,
Executive Secretary.
ARE YOU REGISTERED TO VOTE?
IF NOT, ACT PROMPTLY
College of Surgeons Initiates
Fellows for 1949
Following is a list of 1949 initiates from Ohio
into the American College of Surgeons
Drs. Kenneth H. Abbott, Columbus; Duane E.
Banks, Akron; Norman E. Basinger, Elyria;
Robert C. Beardsley, Zanesville; Edward J.
Bender, Cincinnati; Henry W. Brown, East Cleve-
land; Robert E. Brubaker, Akron; John R.
Buchanan, Youngstown; Ord W. Burkholder,
Toledo; Henry A. Burnstein, Toledo; Arthur K.
Cieslak, Cleveland; William Dreyfuss, Cleveland;
Robert H. Elrod, Toledo;
F. Miles Flickinger, Lima; Lewis O. Frederick,
Dayton; Eugene M. Fusco, Columbus; Edward
R. Garvin, Toledo; T. Kernan Golden, Youngs-
town; Aaron I. Grollman, Cincinnati; Philip B.
Hardymon, Columbus; Arthur M. Harrison,
Toledo; John W. Hauser, Cincinnati; Henry L.
Hoffman, Cleveland; Charles E. Holzer, Jr.,
Gallipolis;
Richard C. Jones, Logan; Edward Y. Lakner,
Cleveland; John M. Lowery, Columbus; Anne S.
Master, Cleveland; John R. Master, Cleveland;
Donald F. McGrath, Toledo; Richard L. Meiling,
Columbus; Marvin C. Menard, Cincinnati; Wil-
liam G. Meyer, Columbus; Ward C. Meyers,
Toledo; Alfred D. Miessner, Port Clinton; Don-
ald A. Miller, Warren; Donald I. Minnig, Akron;
Sylvester C. Missal, Cleveland; Leon F. Moldav-
sky, Akron;
James W. Norris, Columbus; William A. Nosik,
Cleveland; Stephen W. Ondash, Youngstown;
Charles M. Oxley, Dayton; George A. Palmer,
Akron; Richard Patton, Columbus; Alexander K.
Phillips, Youngstown; John A. Renner, Youngs-
town; Ernest E. Rhoads, Cincinnati; Barnet R.
Sakler, Cincinnati; Franklin L. Shively, Jr.,
Dayton; Alcines Clair Siddall, Oberlin; Eugene J.
Stanton, Elyria; Martin R. Sutler, Cleveland;
Donald A. Urban, Zanesville; George Van
Buren, Akron; Richard E. Vance, Columbus;
Elmer J. Wenaas, Youngstown; Daniel S. Wert-
heimer, Fairport Harbor; Edward Woliver, Cin-
cinnati; William P. Yahraus, Canton; Walter E.
Yingling, Lima; Howard H. Yoakem, Columbus;
Glenn W. Zeiders, Canton.
for June, 1950
573
Committee Activities
• • •
Reviews of Questions Considered and Action Taken by Committees on
Education, Public Relations, and Industrial Health Held Recently
MEETINGS of the Committee on Educa-
tion, Committee on Public Relations and
Economics, and Committee on Industrial
Health and Workmen’s Compensation were held
recently at the Columbus Office.
The business transacted by these committees
was reported to The Council at its meetings on
April 22-23. The committee reports were ap-
proved by The Council. (See Proceedings of
The Council, page 569.)
Following are abstracts of the important
matters considered by these committees and the
actions taken on them.
COMMITTEE ON EDUCATION
A meeting of the Committee on Education
was held in the Columbus office on Sunday,
April 2, following a joint meeting with the
Committee on Rural Health.
The principle business transacted was to re-
view the report of the Ohio study of child
health services conducted by the Ohio group
of the American Academy of Pediatrics. Dr.
E. V. Turner, who directed the Ohio study ex-
plained various sections of the report.
It was agreed that Dr. Turner would prepare
a memorandum regarding the recommendations
contained in the pediatrics survey report, sug-
gesting follow-up action, and that this memor-
andum would be used by the committee as the
basis for a committee report to be submitted
to The Council at a later date. Dr. Wilzbach
and Dr. Rardin were designated to work with
Dr. Turner in the preparation of this memoran-
dum. It was agreed that the committee would
meet again when this memorandum is com-
pleted, and at such time the following would
be invited to sit in on the conference: Dr. Hoyer,
Dr. Kramer, a representative of the Ohio Depart-
ment of Health, a representative of the pedia-
tricians and a representative of the Ohio Hospi-
tal Association.
A report from Dr. Jordan, who was unable
to be present because of illness, on a meeting
which he attended as a representative of the
Ohio State Medical Association in Chicago in
February at which the postgraduate activities
of various state medical associations were dis-
cussed, was read and discussed by the com-
mittee. It was the sense of the committee
that there are now too many meetings and
that it would not be feasible for the State
Association at this time to set up district
postgraduate meetings. They felt it would be
more practical for the State Association to
organize teams of speakers on various subjects,
perhaps in cooperation with the State Depart-
ment of Health, and make such teams available
for county medical society meetings or local
one-day seminars under the auspices of county
medical societies. The possibilities of working
out something along this line were left pending
for further consideration.
Dr. Rardin suggested that the State Associa-
tion, under the sponsorship of the committee,
consider preparing pamphlets which might be
offered to physicians at cost, for mailing out
with statements and other communications going
from physicians to patients. Dr. Rardin left
with the committee a list of subjects which are
now being broadcast over Station WOSU, Ohio
State University, as part of the series “Pro-
mote Your Health,” and he suggested that per-
haps some of these subjects might be worked
up into brief pamphlet form.
COMMITTEE ON PUBLIC RELATIONS
A meeting of the Committee on Public Rela-
tions and Economics was held in the State
Headquarters office, Sunday, April 16, follow-
ing a joint meeting with the Committee on
Industrial Health and Workmen’s Compensation,
at which joint meeting the question of compul-
sory temporary disability insurance was con-
sidered and action taken. (See Proceedings of
The Council, page 569.)
Correspondence regarding certain problems
which have arisen in connection with the fur-
nishing of medical care to those on relief was
considered.
After analyzing the questions raised in the
correspondence and hearing reports on similar
situations which have arisen in other counties,
the committee adopted the following statement
of policy to be presented to The Council for
consideration and action. (Note: Received Coun-
cil approval.)
“In some counties in Ohio, an agreement
has been entered into by the local relief
agency and a hospital providing for an
all-inclusive per diem rate to be paid to the
hospital for the care of persons eligible to
receive hospital and medical care as a part
of poor relief.
“Under the terms of this agreement, the
hospital contracts to furnish for the all-
inclusive rate, not only hospital services
but medical services, the medical services
574
The Ohio State Medical Journal
to be furnished free by members of the
medical staff of the hospital.
“The opinion of the Ohio State Medical
Association on this matter has been re-
quested.
“The Council recognizes the right of phy-
sicians to give their services without charge
if they care to do so. In fact, physicians
always have done so.
“However, The Council is of the opinion
that the situation under consideration in-
volves unlawful and unethical acts, namely:
“1. A hospital which agrees to furnish
medical services under the terms of a con-
tract which provides that the hospital shall
be paid for all services, hospital and medical
services, received by patients admitted to
the hospital, is engaged in the corporate
practice of medicine which is illegal in
Ohio
“2. A physician supplying medical serv-
ices in a hospital under such an agreement
is guilty of violating the Principles of Medi-
cal Ethics of the American Medical Asso-
ciation, even though he may have consented
to furnish professional services without
charge.
“Therefore, The Council recommends that
members of a medical staff of a hospital
who may wish to enter into an agreement
for furnishing professional services, with or
without charge, deal directly with the pa-
tients receiving such services or with the
welfare or relief agency assuming liability
for the care of such patients.”
Also, the committee expressed the opinion
that whenever and wherever possible, relief
clients should be permitted to secure medical
and hospital services from physicians and hos-
pitals of their own choice in the county in which
such relief clients reside. This is not possible
when a relief agency contracts for services with
physicians and hospitals in adjoining or nearby
counties.
The committee then considered a question
referred to it by The Council recommending that
the committee consider the feasibility of, as well
as the need for, legislation which would make it
easier for Ohio’s three medical schools to se-
cure unwanted dogs for scientific experimental
purposes.
Communications from the three medical schools
were read and discussed. It was the sense of
the committee that there seemed to be some
difference of opinion among the three medical
schools as to the need for such legislation.
Therefore, the committee tabled the question
temporarily and instructed the Executive Secre-
tary to advise the deans of the three medical
schools that the State Association would re-
consider the question, providing the medical
schools would come to some agreement as to the
need for such legislation and would offer definite
suggestions on the provisions of such a proposal.
The motion also expressed the cooperation and
support of the Association on a state-wide edu-
cational program, regardless of any action which
might ultimately be taken on the matter of
legislation.
The question of multiple screening tests,
which are being done in some areas by the
public health departments, was considered. A
request from a county medical society, asking
for the policy of the State Association, was
discussed. The committee felt that it could
take no action on this question at this time due
to lack of adequate information. The Executive
Secretary was instructed to endeavor to get
additional information on this question.
Dr. Kramer suggested that the Columbus office
poll the county medical societies to secure re-
ports on what is being done locally on the
matter of night calls, providing adequate medi-
cal services for emergencies, the establishment
of a grievance committee, and such other mat-
ters which would be considered a part of the
over-all public relations program.
Dr. Kramer also stated that he felt the
distribution of literature would be more effective
if each physician made it a point to give out
literature from his own desk before dismissing
the patient, rather than simply making liter-
ature available in his waiting room.
Mr. Saville, director of public relations/ and
the Executive Secretary analyzed the public
relations activities of the A. M. A. and the
State Association. Also, they provided in-
formation to the committee on the activities of
individual physicians in the pre-primary and pre-
election campaigns now going on in Ohio.
COMMITTEE ON INDUSTRIAL HEALTH
A meeting of the Committee on Industrial
Health and Workmen’s Compensation was held
Sunday morning, April 16, 1950, following a
joint session with the Committee on Public
Relations and Medical Economics.
Following a thorough discussion of a
number of suggestions from members for re-
vision of certain items in the State Industrial
Commission fee schedule, the committee, on
motion duly made, seconded and carried, agreed
as follows:
1. The assistant’s fee of $10 is adequate
in most cases.
2. The minimum fee for X-ray re-
examination of fingers and toes should be
raised to $5.
3. The fee schedule for such neurosurgi-
cal procedures as cervical laminectomy,
multiple laminectomies and a pneumo-
encephalogram is adequate.
4. The Commission should retain its
present regulation of requiring authoriza-
tion for physical therapy after the first
ten treatments.
5. The fee for rib fractures is adequate.
6. The schedule of fees for dermatologi-
for June, 1950
575
cal services is in line with fees for other
medical services.
7. The period of after-care covered by
the flat fee in reconstructive surgical pro-
cedures should be reduced from six months
to three months.
The above recommendations were approved
by The Council on April 23.
The committee discussed the participation
of the 0. S. M. A. in the annual Ohio State
Safety Conference, held in Cleveland last Sep-
tember, at which the committee provided the
program for the Medical Section. It was re-
ported that while the program was good, the
attendance was small. Also, it was pointed
out that it is difficult to present a program of
equal interest to industrial physicians and
laymen. It was recommended that if the Asso-
ciation is invited to participate in the Ohio State
Safety Conference this year, participation should
be limited to providing a medical speaker on a
topic of general interest for one of the general
sessions.
New Directory Shows One Doctor for
Every 750 Persons in U. S.
The United States at the beginning of 1950
had one doctor for every 750 persons. This is
the best showing for any nation in the world,
with the exception of Palestine where a tem-
porarily high ratio exists because of an influx
of refugee doctors.
Next to the United States, the largest supply
of doctors in relation to population exists in
Great Britain where, based on latest available
official figures, there was one doctor for 870
persons. Other countries in order are: Iceland,
890; Denmark, 950; Canada and New Zealand,
970. Other nations range from 1,110 persons
per doctor to 25,000 persons per doctor, a situa-
tion which exists in China.
The ratio for this country was revealed by
Dr. George F. Lull, Chicago, secretary and
general manager of the American Medical As-
sociation. It was based on an estimated na-
tional population of 151,000,000 and 201,278
doctors whose names will be contained in the
eighteenth edition of the American Medical
Directory, to be issued about June 1.
“This is the largest physician population in
the history of the country,” Dr. Lull said. “The
previous directory, published in 1942, showed
180,496 names for the United States. The in-
crease is due principally to the graduation of
new doctors by medical schools.
“The directory will contain 47,399 names for
the first time. These additions were partially
offset by 26,617 deletions for deaths or other
causes.
“In 1930, there was an estimated 154,500 doc-
tors for a population of 122,775,000, or one doc-
tor for every 795 persons.
“Since then, the amount of medical service a
physician can render has increased markedly be-
cause of technological improvements and in-
creases in auxiliary personnel.”
Dr. Lull predicted a further increase in phy-
sician population as a result of an expansion in
medical school enrollment.
“On the basis of the new schools that are
being organized and the expansion of existing
schools that is now under way, the freshman
class in the medical schools of the United States
will shortly exceed 7,000 students, an all-time
high,” he pointed out. “The average size of the
freshman class in the 10 years preceding the war
was 6,016.”
The new directory will contain 2,913 pages, or
112 more than the previous record volume issued
in 1942. It will list the names, year of birth,
medical school and year of graduation, specialty,
if any, and addresses of physicians in Canada
and the United States dependencies, as well as
of those in the United States.
The total listing will be 219,678 physicians.
The 1942 directory contained 201,272 names,
including 4,209 doctors in the Philippines. The
Philippines are no longer a dependency of the
United States and have been dropped from the
new directory.
Army Seeks Civilian Doctors for
Japan, Guam and Okinawa
The Department of the Army is seeking phy-
sicians to serve in a civilian capacity in Japan,
Guam and Okinawa.
The following information was furnished re-
garding these assignments as to location, title
of position and gross salary: Japan, medical
officer (general), $6,400; Guam, medical officer
(general), $8,000; Guam, medical officer (gen-
eral), $9,500; Okinawa, medical officer (public
health), $8,000; Okinawa, medical officer (public
health), $9,500; Okinawa, medical officer (roent-
genology), $8,000; Okinawa, medical officer
(pediatrics), $9,500.
Licensed doctors up to 57 years of age are
being sought. The minimum tour of duty in
Guam or Okinawa is one year; in Japan, two
years. Dependents are permitted and living
quarters are provided free except on Guam where
a small rental charge is made. American
schools for children through the high school level
are provided.
Further information may be obtained through
the Department of the Army, Civilian Personnel
Division, 1660 E. Hyde Park Blvd., Chicago 15, 111.
TO BE A GOOD CITIZEN, YOU MUST
BE REGISTERED TO VOTE
576
The Ohio State Medical Journal
Hospital Training Facilities . . .
F orty-five Ohio Institutions Approved for Intern Programs
And 56 for Residencies, A. M. A. Council Report Indicates
THE number of internships offered in hos-
pitals approved by the Council on Medical
Education and Hospitals of the A. M. A.
has increased by 246 during the past year, in
spite of a decrease in the number of approved
hospitals. This trend toward greater demand
is a significant factor in considering the per-
centage of shortage of interns, the Council report
points out. The full report is in the April 15
issue of The Journal of the A. M. A.
The report further points out that in 1946
the number of hospitals which the Council had
approved was almost exactly the same as ap-
proved this year (as of April 1, 1950) 798 in
1946 and 799 in 1950. None the less, the same
number of hospitals this year offered 1,372 more
internships than were availabe four years ago.
Internships are offered in all but four of the
states — a total of 9,370. The five leading states
in number of internships offered are: New
York, 1,464; California, 897; Pennsylvania, 837;
Illinois, 702 ; and Ohio, 495. In addition to
those available in the United States, there are
24 in the Canal Zone, 47 in Hawaii and 29 in
Puerto Rico.
For the past two years, the percentage of
internships which were vacant remained about
constant, 20.5 per cent in 1948 and 19.7 per cent
in 1949. This year the number of position
wacancies has increased to 24.9 per cent of the
total number offered. The number of vacancies
Teported by approved hospitals increased from
1,779 in 1949 to 2,340 in 1950. Two factors
influence this increase measurably — the number
of openings increased and more hospitals gave
detailed information on their vacancies.
While hospitals in 11 states reported fewer
vacancies than last year, 33 states and the Dis-
trict of Columbia reported an increase in the
number of internships vacant. Some of the
statistics furnished in the Council’s report are
based on information furnished by 96 per cent
of the 799 hospitals approved while others are
based on the total number. This accounts for
slight variation in figures.
While Ohio is in fifth place in number of
hospitals approved for internship training and
in number of openings, her percentage of
vacancies was highest of any of the larger
states. In fact, only ten states, all with less
than ten hospitals, had higher percentages of
vacancies. The comparative table gives the
following figures for Ohio: Number of hospitals
approved last year, 44; number approved this
year, 45; number of internships offered last
year, 478; number this year, 495; number of
vacancies last year, 128; number this year, 208;
percentage of vacancies last year, 26.7; per-
centage of vacancies this year, 42.0.
TYPES OF INTERNSHIPS
Three types of internships are approved by
the Council on Medical Education and Hospitals
— rotating, mixed and straight. The Council
considers that the rotating internship is most
likely to provide the best basic training for
the graduate, whether he intends later to enter
general practice or to take further training in
a specialty. It provides for supervised experi-
ence in the major clinical divisions of internal
medicine, surgery, obstetrics and pediatrics, to-
gether with training in anesthesiology, roent-
genology and pathology. The mixed internship
offers training in two or more, but not all, of the
major divisions. A straight internship is limited
to supervised experience in a single major clini-
cal division, including its related subspecialties.
Approval in this category is extended in internal
medicine, surgery, pediatrics, obstetrics and
pathology.
LENGTH OF INTERNSHIPS
A significant factor in the present shortage
of interns has been the decrease in the number
of 18-month and two-year internships available,
with a consequent increase in the annual demand
for interns by hospitals which formerly offered
appointments only on alternate years.
Only three Ohio hospitals offer 24-month in-
ternships. They are Mount Sinai Hospital,
Cleveland; University Hospitals, Cleveland; and
Ohio State University Hospital, Columbus. All
the others offer 12-month internships.
RESIDENCY TRAINING
The Council on Medical Education and Hos-
pitals now extends official approval for residency
training in concurrence with the following 17
boards: The American Boards of Anesthesiology,
Dermatology and Syphilology, Internal Medi-
cine, Neurological Surgery, Obstetrics and Gyne-
cology, Orthopedic Surgery, Otolaryngology,
Pathology, Pediatrics, Physical Medicine, Plastic
Surgery, Proctology, Psychiatry and Neurology,
Radiology, Surgery, Urology, and the Board of
Thoracic Surgery.
Residencies in the medical subspecialties of
allergy, cardiovascular, gastrointestinal and pul-
monary diseases are presently approved in con-
currence with the subspecialty board concerned.
for June, 1950
577
The Council also lists approved services in con-
tagious diseases, general practice, malignant dis-
eases and occupational medicine. A preliminary-
list of residencies in preventive medicine and
public health is being prepared for publication
in the 1951 Internship and Residency Number of
The Journal of the A. M. A.
The report shows that there are 4,292 residency
training programs being conducted in 1,079
hospitals approved by the Council. Of the
18,669 positions available, as of September 1,
1949, six per cent were reported vacant. In
some of the specialties the percentage of
vacancies ran much higher. They include phy-
sical medicine, with 33 per cent vacancies; pul-
monary diseases, 21 per cent; psychiatry, 20 per
cent; and anesthesiology, 15 per cent.
OHIO RESIDENCIES
Fifty-six non-Federal and three Federal hos-
pitals in Ohio were approved for residency
training. Following is the number of residency
programs offered in non-Federal hospitals in
Ohio: Anesthesiology 12; cardiovascular disease
1; contagious diseases 1; dermatology and
syphilology 4; general practice 1; internal medi-
cine 32; neurological surgery 5; neurology 2;
obstetrics and gynecology 27; ophthalmology 9;
orthopedic surgery 15; otolaryngology 6; path-
ology 25; pediatrics 5; physical medicine 1; proc-
tology 1; psychiatry 9; pulmonary diseases 10;
radiology 19; surgery 34; thoracic surgery 1,
urology 7.
Following is a summary of residencies, assist-
ant residencies, and fellowships offered in Ohio
hospitals:
Children’s Hospital, Akron — Orthopedic sur-
gery 2; pediatrics 5; surgery 1.
City Hospital, Akron — Internal medicine 4;
obstetrics and gynecology 5; orthopedic surgery
5; pathology 3; radiology 2; surgery 9.
Peoples Hospital, Akron — Internal medicine 5;
obstetrics and gynecology 5; pathology 1; radi-
ology 1; surgery 10.
St. Thomas Hospital, Akron — Internal medi-
cine 1; obstetrics and gynecology 3; surgery 3.
Aultman Hospital, Canton — Internal medicine
4; obstetrics and gynecology 5; pathology 2;
radiology; surgery 6.
Mercy Hospital, Canton — Anesthesiology 1; in-
ternal medicine 3; obstetrics and gynecology 3;
radiology 1; surgery 9.
CINCINNATI
Bethesda Hospital, Cincinnati — Obstetrics and
gynecology 4; pathology 2.
Children’s Hospital, Cincinnati — Orthopedic
surgery 1; pediatrics 16.
Christ Hospital, Cincinnati — Anesthesiology ;
internal medicine 4; neurological surgery 1;
pathology 1; psychiatry 1; surgery 7.
Cincinnati General Hospital — Dermatology and
syphilology 9; internal medicine 29; neurological
surgery 2; neurology 1; obstetrics 6; ophthal-
mology 3; orthopedic surgery 5; otolaryngology
2; pathology 6; pediatrics 16; psychiatry 22;
radiology 8; surgery 17; urology.
Deaconess Hospital, Cincinnati — Internal medi-
cine 2.
Good Samaritan Hospital, Cincinnati — General
practice; internal medicine 7; pathology 1; sur-
gery 10.
Jewish Hospital, Cincinnati — Internal medicine
8; orthopedic surgery 1; pathology 1; radiology
1; surgery 8.
Dunham Hospital, Cincinnati — Pulmonary dis-
eases 3.
St. Mary’s Hospital, Cincinnati — Surgery 3.
CLEVELAND
City Hospital, Cleveland — Contagious diseases
4; dermatology and syphilology 3; internal medi-
cine 18; obstetrics 4; gynecology 2; ophthal-
mology 2; otolaryngology 2; pathology 6; pul-
monary diseases 2; radiology 6; surgery 18;
thoracic surgery 2; urology 2.
Cleveland Clinic Foundation Hospital — Anes-
thesiology 6; dermatology and syphilology 5; in-
ternal medicine 25; neurological surgery 6;
neurology 4; ophthalmology 3; orthopedic sur-
gery 7; otolaryngology 4; pathology 11; physical
medicine 1; psychiatry; radiology 9; surgery
13; urology 5.
Cleveland State Receiving Hospital — Psychi-
atry 1.
Cleveland State Hospital — Psychiatry 1.
Fairview Park Hospital, Cleveland — Internal
medicine 2; obstetrics 2.
Lutheran Hospital, Cleveland — Internal medi-
cine; obstetrics 2; radiology 1; surgery 8.
Mt. Sinai Hospital, Cleveland — Anesthesiology
2; internal medicine 2; obstetrics and gynecology
2; orthopedic surgery 1; pathology 2; radiology
2; surgery 4.
St. Alexis Hospital, Cleveland — Internal medi-
cine 2; radiology 1; surgery 6.
St. Ann’s Maternity Hospital, Cleveland — Ob-
stetrics 4.
St. John’s Hospital, Cleveland — Internal medi-
cine 4; obstetrics and gynecology 4; radiology 1;
surgery 6.
St. Luke’s Hospital, Cleveland — Anesthesiology
2; internal medicine 5; obstetrics and gynecology
4; ophthalmology 1; orthopedic surgery 2;
otolaryngology 2; pathology 2; radiology 3;
surgery 4.
Sunny Acres, Cuyahoga County Tuberculosis
Hospital, Cleveland — Pulmonary diseases 6.
St. Vincent Charity Hospital, Cleveland — In-
ternal medicine 4; pathology 1; radiology 2;
surgery 10.
University Hospitals, Cleveland — Dermatology
and syphilology 3; internal medicine 23; ob-
stetrics and gynecology 12; ophthalmology 3;
orthopedic surgery 2; otolaryngology 3; path-
578
The Ohio State Medical Journal
OHIO HOSPITALS APPROVED FOR INTERN TRAINING, WITH NUMBER OF INTERNSHIPS AVAILABLE AND
OTHER PERTINENT DATA
Control
Capacity
Total Patients
Admitted
Type of Internship
Internships
Affiliated Service
Outpatient Service
Autopsy Percentage
Stipend
City Hospital, Akron
NPA
418
14,858
R
15
(213)
Req
42
30
Peoples Hospital, Akron
NPA
210
9.981
R
6
(171)
Req
51
50
St. Thomas Hospital, Akron
Church
205
11,034
R
6
No
Req
45
75
Aultman Hospital, Canton
NPA
301
10,363
R
10
No
Req
65
50
Mercy Hospital, Canton
Church
235
10,662
R
8
No
Req
36
75
Bethesda Hospital, Cincinnati
Church
218
8,690
R
8
(172)
Req
45
75
Christ Hospital, Cincinnati
Church
372
11,260
R
16
(172)
Req
43
50
Cincinnati General Hospital
City
850
15,449
R-S
48
(267)
Req
54
Deaconess Hospital, Cincinnati
Church
168
5,112
R
5
(173)
Req
26
100
Good Samaritan Hospital, Cincinnati
Church
556
16,783
R
18
No
Req
48
60
Jewish Hospital, Cincinnati
NPA
264
12,763
R
10
(232)
None
65
50
St. Mary’s Hospital, Cincinnati
Church
200
5,001
R
5
No
Req
31
75
City Hospital, Cleveland
City
1,044
11,457
R
24
No
Req
41
40
Evangelical Deaconess Hospital, Cleveland
Church
140
6,615
R
3
No
None
18
75
Fairview Park Hospital, Cleveland
Church
150
9,102
R
6
Req
37
75
Glenville Hospital, Cleveland
NPA
120
4,474
M
4
No
Req
32
75
Lutheran Hospital, Cleveland
Church
133
5,181
R
8
No
None
43
50
Mount Sinai Hospital, Cleveland
NPA
251
11,441
R-S
22
(233)
Req
51
50
St. Alexis Hospital, Cleveland
Church
234
10,282
R
€
No
Req
33
50
St. John’s Hospital, Cleveland
Church
230
8,942
R
8
No
None
46
50
St. Luke’s Hospital, Cleveland
Church
362
14,622
R
20
No
Req
42
30
St. Vincent’s Charity Hospital, Cleveland
Church
296
7,729
R
14
(214)
Req
32
50
University Hospitals, Cleveland
NPA
797
22,380
S
20
No
Req
58
—
Doctors Hospital, Cleveland Heights
NPA
165
6,635
R
12
Req
44
100
Grant Hospital, Columbus
NPA
290
10,628
R
8
No
None
34
—
Mount Carmel Hospital, Columbus
Church
282
10,789
R
8
(174)
None
41
50
Ohio State University Hospital, Columbus
State
279
8,847
R-S
23
(175)
Req
78
9
White Cross Hospital, Columbus
Church
350
11,302
R
10
No
None
46
50
Miami Valley Hospital, Dayton
NPA
451
15,435
R
12
No
Req
45
50
St. Elizabeth Hospital, Dayton
Church
835
12,527
R
7
No
Req
39
125
Huron Road Hospital, E. Cleveland
NPA
284
10,642
R
15
No
Req
40
50
Mercy Hospital, Hamilton
Church
300
8,769
R
6
No
Req
35
100
Lakewood Hospital, Lakewood
City
129
5,942
R
4
No
Req
43
75
Lima Memorial Hospital, Lima
NPA
239
6,359
R
6
No
None
22
100
St. Rita’s Hospital, Lima
Church
300
11,372
R
8
No
Req
36
100
Springfield City Hospital, Springfield
City
266
10,915
R
7
No
Req
46
100
Flower Hospital, Toledo
Church
170
5,643
R
5
(149)
None
30
150
Maumee Valley Hospital, Toledo
County
292
4,011
R
8
No
Req
52
75
Mercy Hospital, Toledo
Church
284
12,191
R
10
No
Req
45
100
Riverside Hospital, Toledo
NPA
154
5,604
R
4 .
31
100
St. Vincent’s Hospital, Toledo
Church
310
10,990
R
10
No
Req
38
100
Toledo Hospital, Toledo
NPA
266
9,495
R
10
No
Req
57
75
St. Elizabeth’s Hospital, Youngstown
Church
330
12,862
R
10
No
Req
40
100
Youngstown Hospital, Youngstown
NPA
627
20,250
R
15
No
Req
55
25
In the above table, the following abbreviations
are used :
NPA—
nonprofit
association ; R-
—rotating
internship.
which
is defined as one which provides supervised experience in internal medicine, surgery, pediatrics, obstetrics and their
related subspecialties, together with experience in laboratory and radiologic diagnosis ; S — straight internship, which is
defined as one which provides supervised experence in a single department, although it may include limited opportunity
for work in a related subspecialty ; M — mixed ; Req — Required.
Key numbers under the heading “Affiliated Service” indicate the following affiliations: (149) Children’s Hospital,
Columbus, pediatrics; (171) Children’s Hospital, Akron, pediatrics; (172) Children’s Hospital, Cincinnati, pediatrics;
(173) Cincinnati General Hospital, contagious diseases and pediatrics; (174) Children’s Hospital, Columbus, pediatrics; (175)
Children’s Hospital and St. Francis Hospital, Columbus, pediatrics, medicine, surgery; (213) Children’s Hospital, Akron,
pediatrics; (214) St. Ann’s Hospital, Cleveland, obstetrics; (232) Cincinnati General Hospital, pediatrics; (233) City
Hospital, Lakeside Hospital, Cleveland, tuberculosis, contagious diseases; (267) Chronic Disease Hospital, Cincinnati,
chronic diseases, and Dunham Hospital, tuberculosis.
Internships are for 12 months with the following exceptions: Mount Sinai Hospital, Cleveland; University Hospitals,
Cleveland; and Ohio State University Hospital, Columbus, each 24 months.
for June, 1950
579
ology 7; pediatrics 10; psychiatry 4; radiology
5; surgery 19; urology 1.
Woman’s Hospital, Cleveland — Anesthesiology 1.
Windsor Hospital, Chagrin Falls — Psychiatry 2.
COLUMBUS
Benjamin Franklin Hospital, Columbus — Pul-
monary diseases 6.
Grant Hospital, Columbus — Pathology 1.
Mt. Carmel Hospital, Columbus — Internal medi-
cine 5; obstetrics 3; orthopedic surgery 1;
surgery 2.
Children’s Hospital, Columbus — Orthopedic
surgery 2; pediatrics 11.
Columbus State Hospital, Columbus — Psychia-
try 8.
St. Ann’s Maternity Hospital, Columbus — Ob-
stetrics 2.
St. Francis Hospital, Columbus — Surgery.
Ohio State University Hospital, Columbus —
Anesthesiology 3; internal medicine 15; ob-
stetrics and gynecology 6; ophthalmology 4;
otolaryngology 2; pathology 4; radiology 5;
surgery 20; urology 3.
White Cross Hospital, Columbus — Cardiovascu-
lar diseases 1; internal medicine 2; neurological
surgery 2; obstetrics 3; orthopedic surgery 3;
pathology 2; surgery 3.
OTHER CITIES
Miami Valley Hospital, Dayton — Internal medi-
cine 3; obstetrics 1; pathology 2; radiology 2;
surgery 5.
Huron Road Hospital, East Cleveland — Anes-
thesiology 6; internal medicine 3; pathology 1;
surgery 7; urology.
Elyria Hospital — Orthopedic surgery.
Mercy Hospital, Hamilton — Pathology 1.
Lakewood Hospital, Lakewood — Anesthesi-
ology; internal medicine 1; obstetrics 1; sur-
gery 3.
St. Rita’s Hospital, Lima — Obstetrics 1; path-
ology; surgery 5.
Massillon State Hospital — Psychiatry 3.
Springfield City Hospital — Pathology 1.
Maumee Valley Hospital, Toledo — Anesthesi-
ology 1; internal medicine 4; obstetrics and
gynecology 1; surgery 5.
Mercy Hospital, Toledo — Internal medicine 1;
obstetrics and gynecology 4; pathology 1; sur-
gery 4.
St. Vincent’s Hospital, Toledo — Internal medi-
cine 2; neurological surgery 1; obstetrics and
gynecology 2; orthopedic surgery 2; pathology 1;
radiology 1; surgery 5; urology 2.
Toledo Hospital — Internal medicine 4; ob-
stetrics and gynecology 4; pathology 2; sur-
gery 4.
Harding Sanitarium, Worthington — Psychia-
try 3.
Mahoning Tuberculosis Sanitorium, Youngs-
town— Pulmonary diseases 2.
St. Elizabeth Hospital, Youngstown — Anes-
thesiology 1; internal medicine 2; obstetrics and
gynecology 3; surgery 7.
Youngstown Hospital — Anesthesiology 2; in-
ternal medicine 9; orthopedic surgery 2; path-
ology 3; proctology 1; radiology 3; surgery 12.
FEDERAL HOSPITALS
Veterans Administration Hospital, Brecksville
— Pulmonary diseases 5.
Veterans Administration Hospital, Cleveland —
Internal medicine 27; neurological surgery 1;
neurology 1; ophthalmology 2; orthopedic sur-
gery 7; otolaryngology 2; pathology 4; physical
medicine 2; psychiatry 12; radiology 4; surgery
16; thoracic surgery 2; urology 2.
Veterans Administration Hospital, Dayton —
Anesthesiology 1; internal medicine 27; path-
ology 1; radiology 1; surgery 15; urology 1.
New Members of 0. S. M. A.
Following are the names of new members
of the Ohio State Medical Association, since
March 3, 1950. The list shows the county in
which they are affiliated, city in which they are
practicing, or temporary addresses in cases where
physicians are taking postgraduate work.
ASHTABULA COUNTY
Robert J. Zimmerman,
Conneaut
BELMONT COUNTY
Arthur A. Tesi, YorkviUe
Julius M. Tesi, Yorkville
Winter T. Varner, Flush-
ing
CLARK COUNTY
Patricia V. Adams,
Springfield
CUYAHOGA COUNTY
Charles C. Althoff, Cleve-
land
Paul F. Boyd, Cleveland
Helmut M. Dehn, Berea
Marvin W. Evans, Cleve-
land
James Hare, Parma
Heights
Albert A. Rayle, Jr.
Cleveland
Richard L. Ruggles,
Cleveland
ERIE COUNTY
Joseph P. Ohlmacher,
Sandusky
FULTON COUNTY
Richard W. Deatrick,
Wauseon
GUERNSEY COUNTY
Kenneth J. Frakes,
Quaker City
HAMILTON COUNTY
Margaret J. Abrahamson,
Cincinnati
Robert Harris, Cincinnati
Martin B. Macht, Cincin-
nati
William E. Shaw, Cincin-
nati
Thomas-J. Siegel, Cincin-
nati
Richard J. Weber, Cincin-
nati
JEFFERSON COUNT'S
Laura K. Mesaros, Steu-
benville
Paul Mesaros, Steuben-
ville
LAWRENCE COUNTY
Joseph N. Rose, Ironton
LICKING COUNTY
David T. Williams, Newark
LUCAS COUNTY
James S. Olms, Toledo
Ernst Schmerl, Toledo
Claude A. Tallman,
Sylvania
MAHONING COUNTY
Richard R. Goldcamp,
Youngstown
MONTGOMERY COUNTY
Paul Beare, Dayton
Thomas Jarrold, Dayton
William S. Koller, Dayton
SANDUSKY COUNTY
Robert W. Minick, Gib-
sonburg
John W. Monahan, Fre-
mont
Richard R. Wilson. Fre-
mont
SENECA COUNTY
Emmet T. Sheeran,
Fostoria
SUMMIT COUNTY
Walter H. Brown, Jr.,
Akron
Richard C. Curlis, Akron
William B. Rogers, -Jr.,
Cuyahoga Falls
Leon J. Sacks, Akron
Edward A. Sawan, Akron
Leo J. Szary, Akron
Benjamin B. Wehling,
Barberton
WAYNE COUNTY
Matthew O. Marks,
Wooster
580
The Ohio State Medical Journal
The Public Views the Doctor . . .
Basis for Criticisms Directed at Medical Profession Aired; How the
Individual Physician Can Prevent These and Meet Existing Problems
By ROBERT W. ELWELL, Toledo, Ohio
IT has always been extremely stimulating
to talk with the members of the medical
profession, individually and in groups of
four or five, about some of the problems that
face American Medicine. To attempt to do this at
this meeting may be somewhat different. At least
you will probably have to wait a few minutes
longer than usual for rebuttal. However, I hope
we can discuss a few points in an objective man-
ner and that you will be kind enough to inter-
pret these remarks in the spirit they are given.
I think you will agree that lay persons who
work closely with doctors and hospitals cannot
help but become strong allies, staunch sup-
porters and often zealots in protecting the posi-
tion rightfully deserved by those who engage
in the practice of good ethical medicine. To you
who are here at this meeting, I know that your
life work is not just a business or a way of
making a good living, but truly a profession
whose first concern is service to all those who
need it. Your membership on this staff is testi-
mony to that fact.
Now to turn to the subject at hand and why
this subject. Well, it was thought that perhaps
you might be interested in knowing some of the
reactions that we, your employees at the Aca-
demy, receive from the public. You can appre-
ciate that it is the logical place for people to
go with their medical problems; and these prob-
lems range from selection of medical personnel
to complaints of a most bizarre nature. To im-
pose upon your good nature even more, let us
enlarge the scope of this field to include the con-
tacts that one has in the business and the social
world.
Let us bear in mind that for some years now,
and perhaps for many more, hunting permits
read “open season on doctors.” The people who
are taking the pot shots — and there is a fair-
sized army of them — are probably doing so
for a number of reasons. Here are examples,
just to mention a few: An unfortunate experi-
ence with a doctor or hospital; an expensive
medical experience; inability to secure a doctor
in emergencies (a high percentage of these are
not emergencies, but you can’t convince the fam-
ily of this fact); and the most important factor
of all, the attention that is being focused upon
the profession by Messrs. Truman, Ewing, etc.,
and by some newspapers, magazines and the
radio stations. For instance, that article in the
Mr. Elwell is Executive Secretary of the
Toledo Academy of Medicine. The accom-
panying article is the text of an address
which he made at the annual meeting of
the staff of the Maumee Valley Hospital,
Toledo.
December issue of Harper's, entitled “The Dogged
Retreat of the Doctors” by Milton Mayer, is a
most cynical article which serves only to poison
the minds of persons who accept the writer’s
sarcastic remarks as fact without further in-
vestigations.
SOME COMMENTS
Briefly, let us consider some of the unfavor-
able comments that come our way:
High Fees: That is probably the most fre-
quently mentioned gripe about the profession
in general conversation, but interestingly enough
when specific complaints are lodged, this is not
the basis in the proportion you would expect.
It is rather small. However, it takes only a
few doctors charging exorbitant fees to brand
the whole profession with the dollar sign.
It has been my personal experience in talking
with people from the hills to the river banks,
that many, many times they unconsciously use
the high fee as a point on which to vent their
dissatisfaction that actually arises from another
source.
For example, a businessman complained of
what he thought was a high fee for a so-called
minor operation on his child. After full dis-
cussion, it was very apparent that he was well
able to pay the fee and that he had desired the
services of a specialist. The child came through
the operation and convalesced quickly. He and
his wife were grateful for the skill of this
doctor in operating on their child, but in the
final analysis, the specific complaint was that
when the operation was completed, a nurse an-
nounced to the anxious parents that the child
had come through the operation all right. The
parents wanted this assurance from the doctor,
not the nurse. The father never did meet the
doctor.
This illustrates a point which is too often over-
looked by the physician. A few words and a
friendly handshake in situations of this kind
will do a great deal to break down resentment
for June, 1950
581
of the profession and take it out of the assembly
line production class.
DOUBLE-DIP
There is another type of complaint where the
physician knowing the patient is covered by
surgical insurance will increase his fee and reap
the benefits from that added protection. Allow
me to recite just one of several cases that
have come to our attention. A patient was
referred to a surgeon for an appendectomy. The
surgeon, knowing that the patient was insured
with the doctor’s own plan, Ohio Medical Indem-
nity, rendered a bill for $200. When questioned
by another doctor why this fee was larger than
his usual charge his explanation was that the
patient would receive $100 from the insurance
plan and it would mean that the patient would
have to pay out only $100 of his own money.
If this reasoning is to be considered valid
then one wonders just how to answer a query
from the public like this . . . “Why should we
follow the advice of the medical profession and
buy prepayment insurance only to find ourselves
still paying out of our pockets about the same for
medical services, plus the insurance premiums?”
Here again is that very small percentage which
gives the public another opportunity to condemn
the doctors over bridge tables, telephones, at
the shop and in the office.
EMERGENCY CALLS
The public expresses itself on another point
more frequently than we like to hear. The
alleged refusal to make house calls has been
a problem all over the country for the past
few years. This has made for bad public rel-
ations and needlessly so, in many cases. There
is no reason for any person in this community
not being able to secure the services of a
doctor on ^a bona fide call. The difficulty has
been in getting to the right source.
Most lay people will accept the fact that all
doctors cannot make calls at all times and that
some doctors do not feel best qualified to go on
calls. Instead of a flat refusal to make a call,
the patient or relative in most cases would
accept a reasonable explanation and appreciate
assistance in locating an alternate doctor. That
assistance, which many of you give by calling
an alternate or having the Academy send a doc-
tor, would take the poison from the barbs that
are thrown our way.
Another factor in this picture that has many
ramifications is the much-repeated complaint
by the patient that “I pay my good money, get
a few minutes of the doctor’s time, a hurried
exit and no information.” We, no doubt, can
thank most of the magazines for giving the
public a second-rate medical education. Be this
good or bad, there has been a change brought
about whereby many patients of today want to
know about their illnesses. I don’t mean to infer
that it would be good practice to go into full
details. Perhaps a few words properly chosen
by the doctor to fit the situation would counter-
act such expressions as “I wonder if the doctor
knows what is wrong with me”; “How long will
he keep me coming”; “I’m not so dumb that I
couldn’t understand a few things”; “The doctor is
too busy making money to spend any time with
me”; “Medicine is sure a good racket these days.”
We can’t stop all of these remarks but a small
amount of “lip service” would be the most potent
factor in building greater confidence on the part
of the patients.
UNNECESSARY CRITICISM
It has been a surprise to us at the Academy
to have a goodly number of patients tell us
that Doctor “B” says that Doctor “A” did a
poor job or that the work never should have
been done at all; or the wrong treatment was
prescribed. It is interesting to note that in
most of these cases discredit in the patients’
eyes not only falls upon Doctor “A” but also
upon Doctor “B” for they feel he is attempting
to be superior or inflating his ego. Although
he may be very sincere in his statements the
patients again misinterpret the doctor’s words.
It would appear that from the many reactions
we have had in this regard that a derogatory
reference about a colleague’s work helps no one
and hurts everyone.
ITEMIZED STATEMENTS
We have wondered how common is the prac-
tice of rendering statements to the patient
with just a total figure placed after the standard
clause, “For Professional Services Rendered.”
To itemize services on a statement, particularly
when there is a large bill, may be conducive to bet-
ter understanding on the part of the recipient.
This situation was brought to our attention by
a man who called one day to ask if a charge
of $50 for supposedly two office calls was not
exorbitant. If further explanation were not
forthcoming this could be presented to the pub-
lic in just that light and you can imagine
the conversations that would follow.
The true picture was this: His wife had been
having intestinal distress. The family doctor,
and he had been their doctor for many years,
made a rather complete examination on the first
office visit and admitted the patient to the
hospital the following day. A work-up was done
under the direction of the family doctor over a
period of days. A surgeon was called in and
he removed the gallbladder as indicated. The
important point which the complaining party,
being unfamiliar with medical practice, over-
looked is: The family physician did all of the
preoperative and postoperative work; the sur-
geon did only the surgical procedure for which
he charged $100. It should be mentioned that
582
The Ohio State Medical Journal
due to some complications more than the usual
amount of postoperative care was needed. It was
pointed out to the husband that if the surgeon
had the case from the beginning his regular fee
would have been $150.00. There actually was
no more outlay of money because of two doctors
being on the case. This family did not under-
stand for what the charges were and upon
explanation were more than satisfied.
There is a sequel to this story. It was reported
to us that when he first asked the doctor about
the statement for $50, he was told curtly that
his wife had come through the operation very
nicely and that was the important thing. Failure
to explain the charge did not hurt the family
pocketbook, but it caused concern that the doc-
tor had been sharp with them.
In the final analysis the important thing was
that the relationship between doctor and family
should not be clouded by misunderstanding. We
received a call at a later date from this party
expressing appreciation that they had re-
established their former relationship with the
family doctor.
Being a member of a profession certainly
limits one in the manner in which he can
handle people. It is apparent that people do
expect the doctor to be very professional at all
times. When a complaint is lodged with a
doctor and he should step out of character in
handling the situation, he is immediately
chastised as being very unprofessional. We
certainly do not envy any doctor the task of
handling unreasonable patients, but they are the
ones who do the most talking and convincingly
so sometimes.
ABILITY TO PAY
Let us refer back to a previous point for a
moment, that of high fees. Many persons have
called the Academy stating that they are un-
able to pay their doctor bills. In these situations
we are discussing now, it is not a case of the
fee being unreasonable but rather too many
medical bills for the paying ability of the family.
Most of these people appreciate the service
rendered and would like to be able to pay
the doctor or doctors. In any case where we
or the Collection Bureau or Central Hospital
Bureau have talked with the doctors there has
been a most cooperative attitude and many bills
have been stricken off the records.
It seems regrettable that information regard-
ing a family’s financial status is not available
beforehand. In most cases, physicians want to
take into consideration this factor and it is only
through lack of knowledge that later adjustments
have to be made. Here again the profession is
often labeled unfairly when there is a definite
willingness to do a charitable deed.
Some cities such as Columbus have set up
bureaus in their Academy which for a small
membership fee maintain and furnish this type
of service.
OFFICE PERSONNEL
For sometime the Ohio State Medical Associa-
tion has been aware of what they thought was
a weak link in the relationship between the
doctor’s office and the public and so they de-
veloped the booklet entitled “A Date With the
Doctor.” If any of you are not familiar with
it, it can be said that it serves as a guide for
the secretary, nurse or receptionist, in better
handling of your patients. That this is needed
can be borne out by remarks such as “When
I get past that battle-axe in the front office
the doc treats me swell”; or “It’s a wonder that
doctor has anybody come back a second time
with that sourpuss at the front desk.” Now
of course people do come back because they
want to see the doctor, not the nurse. Never-
theless, this contact is identified with the doctor
and certainly breeds no extra goodwill for the
profession.
Because of the doctor’s educational background
with years of special training, the public ex-
pects him to contribute of his time and efforts
in affairs of the community, particularly in those
fields where he can better serve than the non-
medical citizen. Generally it has not been easy
to get doctors to accept this responsibility. In
our community we are fortunate in having quite
a few doctors who have given freely of their
time to numerous activities. This number should
be increased so as to lighten the load on the
present wheel horses and further expand the
realm of your influence.
COMMUNITY PROJECTS
Very briefly, I want to touch upon a point that
has brought much discredit upon the profession
from a public relations standpoint. This has to
do with the Community Chest Campaign. In
order to save the doctors’ time, pledge cards were
mailed rather than have volunteers make the con-
tact. Two-thirds of the doctors returned their
cards and the over-all increase in the amount ol
pledges in this group was 10 per cent. This
was highly commendable, but not what people
talked about. The other one-third did not return
their cards, and solicitors, who were strictly
volunteers, waited hours in waiting rooms only
to be told curtly that the doctor was too busy
to talk with them. When they were able to
contact the doctor their reception was very cool
and in some cases the volunteers were chastised
for asking for a pledge. This even happened
in front of patients. The record shows that
this one-third group pledged very little. It
wasn’t how little they pledged that was the
topic of conversation at the Chest banquet, it was
the attitude of some doctors toward a Com-
munity endeavor.
Now to some of you these remarks so far
for June, 1950
583
are just repetitious of that to which you have al-
ready given considerable thought; to others it
may seem incredible that the public is critical of
the medical profession. Those who have made the
effort to feel the pulse of public opinion are
alarmed.
As George Saville, director of Public Relations
for our State Office, said about a year ago, and I
quote, '‘We who are laymen working for you in the
State Office and local societies, have it brought
home to us day after day at the luncheon table,
at social gatherings, from secretaries of other
organizations and in legislative halls. We are
belabored with irritating incidents and unhappy
experiences, usually culminating in the state-
ment: ‘If we get socialized medicine, the doctors
will have brought it on themselves.’ ” Mr.
Saville went on to point out how unfair that
statement is, but at the same time emphasized
how important the individual doctor is in this
public relations picture.
We have discussed rather specific complaints
at this meeting and in most cases they are not
difficult of solution. I know that you doctors
solve even more of these problems in your
everyday practice than those who are working
for you in state and local offices.
DOES THE PUBLIC KNOW?
Let us pose a question or two at this point.
Does the public really know that it can take
its grievances to the medical profession of this
county and receive consideration ? Does the
public have any conception of the extent to
which this is being carried on by the individual
doctors and medical organization?
When one knows that this is being done it is
disconcerting to hear frequent remarks that the
individual with a grievance against the medical
profession has no recourse. The profession be-
lieves in an open door policy and welcomes the
opportunity to correct abuses, make adjustments
and particularly, correct misunderstandings that
may arise.
There is strong evidence to support this claim
such as the action taken by several states in
setting up formal machinery for this purpose
and just recently, a resolution adopted by the
House of Delegates of the A. M. A. at the last
session in Washington, commending those state
associations who have established grievance
committees and urging all constituent associa-
tions to adopt comparable programs.
It has been gratifying to witness the exten-
sive and favorable editorial response in the
states and communities where such programs
have been adopted. Actually the machinery
exists in your own society for handling these
matters, but it is not generally known and
so as a result many believe our door is locked
when in reality that door is a swinging door.
Even in view of apparent favorable publicity,
there are some things to be said against ad-
vertising the fact that you have established a
grievance procedure. It may be an admission
that the profession cannot correct its faults in-
ternally. Personally, I dislike the word griev-
ance and that dates back to former experience
in personnel work. In one plant we did not allow
the word grievance to be used because we felt
it prejudiced the parties before we entered
into discussion. We talked in terms of adjust-
ments.
WHAT ONE SOCIETY DID
For further insight into this problem I would urge
every member to read an article in the January
Ohio State Medical Journal, entitled “Fees and
Public Relations.” This article outlines one
approach that the San Diego County Medical
Society has taken to solve the delicate problems
arising between doctors and patients with refer-
ence to fees.
They advocate: (1) Discussion of Fees prior
to rendering a proposed service; (2) publication
(to physicians only) of average fee schedules to
serve as a guide for those physicians who seri-
ously attempt to make proper charges; (3)
thoughtful explanation of the patient’s problem;
(4) education of physicians to the importance
of the problem and pressure if necessary, to
bring into line the few who continue to injure
the standing of the whole profession by charging
excessive fees. They feel a Complaint Bureau
is unnecessary and undesirable if the basic prin-
ciples just outlined are carefully followed by all.
If our public relations problem was just one
of specific complaints I think all that would
be necessary would be for the doctors to re-
assure themselves that they are carrying on the
practice of medicine according to the Code of
Ethics and let the Professional Relations Com-
mittee handle those members who do not.
But we must realize that the problem is not
that elementary. Let us be frank and realize
that the widespread antagonism and ill feeling
against the medical profession in general is of
major consequence. It is an intangible kind of
thing which is difficult to put your finger on,
much less try to eradicate.
THE WHY OF FEELINGS
Let me give you a typical example — and the
end result could be duplicated in a majority of
cases. While engaged in conversation with a
lay acquaintance some time ago, he interrupted
to ask me who a certain party was across the
room. It happened to be a doctor whom he did
not know and that started things rolling in
another direction. Now this person, a college
graduate, an intelligent person and owner of a
profitable business, expressed quite strongly this
attitude I have just mentioned. Upon further
questioning he spoke freely of his family doctor
with the highest praise and confidence. As for the
584
The Ohio State Medical Journal
cause of his feeling about the profession as a
whole, he could give no reason and was somewhat
nonplussed to realize he had such deep feelings on
the subject and yet could not explain why.
This conversation served to arouse sufficient
curiosity on my part to try to find out in
subsequent off-the-record interviews some of the
causes for this feeling. In an attempt to sum-
marize these conversations it would appear that
the financial success that the doctors have en-
joyed for some time now is cause for the public
to feel that the doctors have become a privileged
group. The public retaliates with coldness to the
profession as evidenced by remarks that were
made about the impersonal attitude of doctors
toward their patients. The superior attitude of
doctors not only in their professional work but
also in other contacts was a cause given by
others.
The fact that the doctors living in some of
the nicer sections of our community, having
nice cars and good standards of living are
only a small percentage of the citizens of these
sections, does not temper the feeling of people.
If you make a better than average living as a
contractor, salesman, owner or executive of a
business or even a lawyer, people think little
about it. Being in a profession that services
people when they are ill seems to have some
adverse influence on the attitudes of many of
our critics.
For example, if a merchant sells a thousand
dollars worth of furniture to a family they are
not critical of the profit he makes, but if a
doctor is called upon to administer to a sick
member of that same family they may resent
his financial success; not taking into considera-
tion the investment the doctor makes, the re-
sponsibility of life and death, the long hours,
interrupted nights, loss of time with his family
and many other unpleasant phases that go to
make up the practice of medicine as you know it.
Perhaps psychologically many people let
emotions govern their logic and as a result still
correlate on a general basis sickness with poverty.
When people buy material things the salesman
convinces them they have bought a good product
and something they need or will want. Medical
care certainly holds or should hold priority on
most people’s list of needs. Have the doctors
done a good job of selling their patients on the
value of their services ? What is more important
to any family than good medical care?
HUMANITY FIRST
I would like to pass on one remark that was
made in the above interviews by a person who
is unalterably opposed to socialism in any form
and is actively fighting to stem the tide toward
a totalitarian state. In speaking of the doctors
he said, “I believe that every man should have
the right to work and strive for his niche in this
world be it large or small, but he should maintain
the greatest degree of humility.”
This has been a rambling kind of talk, not said
very eloquently as many of you could have done,
but said with the sincerity of one raised in a pro-
fessional man’s home. That is a heritage for
which I will always be thankful because when one
speaks critically of the medical or dental profes-
sion, that is criticism of those I admire the most.
In conclusion may I add . . . we have many
problems facing us today but the most important
issue the people of our country must decide
is whether they want a controlled state or a
liberal democracy. That medicine has been made
the battleground may be a good thing. There
is no doubt in my mind that if every doctor ap-
preciates his responsibility in this struggle the
verdict will be for freedom.
As Bill Vaughn, editorial writer for the
Kansas City Star, so aptly put it in talking
to the doctors in his city, “And yet, many a
man who would never think of selling out the
warm, friendly human being who is the doctor
we all know and love, frankly doesn’t care
whether the efficient machine in the white coat
is socialized or not . . . because he feels the
machine doesn’t give a damn about him.”
Lorain County Doing Something
About Public Relations
Recent public relations activities of the Lorain
County Medical Society include: sponsorship of
a Blue Cross Individual Enrollment Campaign;
forum on socialized medicine at meeting of the
Elyria American Legion Post 12, with Dr. I.
M. Hinnant, Cleveland, presenting the viewpoint
of the medical profession; talks on socialized
medicine at meetings of the Republican Women’s
Club of Elyria by Dr. Raymond L. Shilling,
Democratic Women’s Club of Elyria by Dr. S. D.
Nielsen, president of the Lorain County Medical
Society; publication of an article by Dr. Nielsen
in the Elyria Chronicle Telegram on ‘How to
Get Hold of a Doctor in a Serious Emergency.”
Dr. Theodore Berg, Elyria, is chairman of the
public relations committee of the Lorain County
Medical Society.
Dr. Lawrence Peters, assistant professor in
the Pharmacology Department, Western Reserve
University School of Medicine, has been awarded
a $25,000 grant by the Markle Foundation of
New York City. The grant, payable during the
next five years, is one of 48 announced to date
under which $1,200,000 has been set aside to
keep young doctors on teaching and research
staffs of medical schools.
IF YOU’RE NOT REGISTERED TO VOTE.
VISIT YOUR ELECTION BOARD
for June, 1950
585
Cincinnati Acts on Rebates . . .
Academy Works Out Plan “That Will Be Effective in Dealing With
Problem”; Authorizes Disciplinary Action in Cases of Violation
A PLAN of procedure to deal effectively with
the problem of “rebates” and “kick-backs,”
involving* disciplinary action against physi-
cians found guilty of such practices has been
worked out by the Council of the Cincinnati
Academy of Medicine, with the assistance of the
Cincinnati Better Business Bureau, and is now
in operation.
Details of the plan are outlined in a letter
which has been sent to each member of the
Academy by Dr. J. Stewart Mathews, the presi-
dent, reading as follows:
Much unfavorable publicity has been given
to our profession in recent years in the daily
press and special articles that appeared in
The Reader’s Digest and the Sunday news
supplement known as The American
Weekly. These articles accuse some phy-
sicians of accepting monetary rebates or
“kick-backs” from retail dispensers.
We believe that only a small minority have
been guilty of this practice but there have
been enough violations to create considerable
resentment against the profession which
warrants forceful action to abolish this evil.
The Council of the Academy of Medicine
has been at work for a number of months,
with the help of a special committee, in co-
operation with the Cincinnati Better Business
Bureau, in working out a plan of procedure
that will be effective in dealing with this
problem. The purpose of this letter is to
acquaint all members of the Academy with
Council’s final conclusions in this matter
and to make plain just what can and will be
done about it.
Each member of the Academy of Medicine
signs an agreement on his initial application
that he will “support the Constitution and
By-Laws” of the Academy. Council now
proposes to interpret this signed agreement
as meaning exactly what it says. Your at-
tention is therefore called to Article V,
Section 7 of the Academy By-Laws, part of
which reads that “Council shall be charged
with the duty of hearing evidence of conduct
unbecoming to a member of the Medical Pro-
fession; violation of the Principles of Ethics
of the American Medical Association, or the
rules of the Academy of Medicine . . .”
Your attention is further called to Article
VI, Section 4 of the Principles of Ethics of
the A. M. A., which reads as follows:
“When a patient is referred by one phy-
sician to another for consultation or for
treatment, whether the physician in
charge accompanies the patient or not,
it is unethical to GIVE or RECEIVE
a commission by whatever term it may
be called or under any guise or pretext
whatsoever.”
Council has adopted a resolution which puts
the following rule into effect:
“The principle involved in Article VI,
Section 4 of the Principles of Ethics of
the A. M. A. shall be extended to include
the statement that it is also UNETHI-
CAL for a physician to accept from any
lay person, firm or corporation supplying
goods or services to the physician or his
patient, a rebate, credit, gratuity, pay-
ment of money, material or any other
special consideration whatsoever in con-
nection with any transaction not known
to the ultimate consumer.”
Council has also approved a Standard for
Dispensing Practice for lay individuals and
firms supplying optical goods or services,
appliances, trusses, mechanical equipment,
laboratory services, etc., same to be sent by
the Better Business Bureau to all such firms
known to be in these types of businesses and
asking for a signed agreement to obey the
rule of giving no rebates, gifts, credits, etc.,
of any kind to a physician. A copy of this
form is enclosed.
The final step taken by Council is that of
authorizing the Better Business Bureau to
watch for violations of these rules to make
the program effective and of agreeing that
when a violation is reported, Council will
make a thorough investigation and if the
violation is proved, the guilty member will be
promptly dealt with as provided for in the
Academy By-Laws, Article V, Section 7 (F),
which authorizes Council to expel from mem-
bership any member guilty of conduct un-
becoming to a member of the medical pro-
fession.
Council wishes to stress the fact that this
program of cooperation with the Better Busi-
ness Bureau has been entered into for the
purpose of protecting the best interests of
the public and the good name of our profes-
sion. It is expected that members of the
Academy will live up to their promises of
practicing ethical medicine and abide by the
rules of good conduct properly becoming to
members of the profession. It is imperative
that we enforce the high moral standards
we have imposed on ourselves to justify
the confidence and goodwill of the public.
These resolutions became effective as of the
date of this letter. Council has also au-
thorized the Cincinnati Better Business Bu-
reau to use this letter in its dealings with
business firms.
Following are the standards for dispensing
practice which the Cincinnati Better Business
Bureau will circulate among individuals and firms
supplying merchandise or services on order of a
physician, to which such individuals and firms
will be asked to subscribe.
CODE FOR MERCHANTS
Being conscious of the degree of our respon-
sibility for the health and welfare of the users
586
The Ohio State Medical Journal
of our merchandise or services and to the mem-
bers of the medical profession whose orders we
fill, and, as members of the business community,
we the undersigned hereby adopt the following
standards of practice and pledge ourselves to
abide by the terms thereof in all our relations
with each other, with the public generally and
with the members of the medical profession en-
gaged in treating human ailments and prescrib-
ing therefor.
Further we agree to cooperate fully with the
Cincinnati Better Business Bureau in establish-
ing these standards, thereby maintaining public
confidence in our goods and services.
DEFINITIONS
Merchandise or services: For purposes of this
agreement “Merchandise or Services” shall in-
clude lenses, frames, mountings or any part
thereof supplied for the human eye and based
upon prescriptions together with any services
supplied in connection therewith; appliances,
trusses, hearing aids, mechanical equipment,
laboratory services, or any other kind of product
based on prescriptions or orders received from a
physician to be used by a patient.
Retail Transaction: For purposes of this agree-
ment any transaction in which the undersigned
provides any of the service to or in any way deals
directly with the ultimate consumer, shall be
considered a retail transaction.
Wholesale Transaction: For purposes of this
agreement any transaction in which the under-
signed does not provide any of the service to or
deal in any way directly with the ultimate con-
sumer shall be considered a wholesale transaction.
STANDARDS
I
We pledge that we will neither offer nor give
any rebates, credits, gratuities, payments of
money, materials or any special considerations
whatsoever in connection with any retail transac-
tions. It is further agreed that all retail transac-
tions will be charged and billed directly to the
ultimate consumer.
II
We agree to file in writing with the Cincinnati
Better Business Bureau all our current price
lists for merchandise in our special field and the
servicing thereof and further agree that any
deviations from these lists will also be filed in
writing prior to their effective dates.
hi
We agree to maintain adequate written rec-
ords of all transactions, both retail and whole-
sale and to make such records and all supporting
data available to representatives of the Cin-
cinnati Better Business Bureau at any time
during business hours. Such records shall in-
clude at least, in every transaction, the name of
the doctor issuing the prescription or order, the
prescription, the name and address of the per-
son to whom issued, the date received or delivered
and an itemization of the merchandise sold and
services rendered and the prices charged for each.
IV
Each such retail transaction shall be evidenced
by a receipt issued by us to the ultimate con-
sumer at the time of the transaction. On re-
quest, a detailed receipt shall be given which
shall show our name and address as the seller,
the name and address of the purchaser, the date,
the services rendered and the items sold together
with the prices charged for each such service
and item. A duplicate of such receipt shall be
retained in our permanent files.
v
We agree to display conspicuously in our
waiting or fitting room a suitable plaque or state-
ment outlining this pledge and our adherence to
it. Such a plaque or statement shall be issued
by and shall remain the property of the Cincin-
nati Better Business Bureau and shall be sur-
rendered to it upon request.
VI
It is further agreed that the signer may termi-
nate this agreement at any time after thirty (30)
days written notice:
Accepted this day of 1950.
Firm
By
Wide Scale Study of Incomes of
Physicians Is Under Way
The first full-scale survey of physicians’
incomes in nine years is under way.
The study is being made jointly by the Bureau
of Medical Economic Research of the American
Medical Association and the Office of Business
Economics of the United States Department of
Commerce. The survey will cover 125,000 doctors,
or about 62.5 per cent of the nation’s total of
201,278.
“There is evidence that the national averages
in some surveys have been too high because
physicians who do not have bookkeepers to fill
out questionnaires do not reply in sufficient
numbers,” says an editorial in the April 8
Journal of the A. M. A.
“Some of the previous surveys have given
biased results. For example, those with small
practices have not been represented properly.
Accurate postwar data on physicians’ incomes are
needed to permit more accurate estimates of how
much the American people pay to physicians.”
Selection of the names will be from the punch
card files of the Bureau of Medical Economic
Research by a formula which eliminates any par-
tiality. To every other name will be sent a
questionnaire requesting income information for
1949.
Of the other approximately 100,000 physicians
every fourth name will be chosen. To 10,000
of these will go the same type of questionnaire.
The other 15,000 will receive a long form sheet,
requesting information on income for the years
1945 through 1949. All are to be returned un-
signed in franked envelopes.
ARE YOU AND MEMBERS OF YOUR
FAMILY REGISTERED TO VOTE?
for June, 1950
587
Prescription Refill Problem . . .
Druggists Discuss Legal and Professional Issues Confronting Them;
Court Ruling or Legislative Action Might Change Entire Picture
«rmHE question is probably the hottest
legal and professional issue confronting
pharmacy/’ decries the Ohio State Phar-
maceutical Association, in a bulletin issued to its
members. In order to clarify thinking on this
important matter the bulletin issued to its mem-
bers a compilation of factual information which
should be of equal interest to Ohio physicians.
A recent statement that the refilling of all pre-
scriptions are governed by regulation of the Fed-
eral Food and Drug Administration is not cor-
rect, the bulletin states, adding that “there has
been no ruling or regulations on the subject to
the best of our knowledge.” Contrary to an-
other report, “the Federal law has not been
amended to specifically prohibit refills.”
The position of the Federal Food and Drug
Administration on refills is simply based upon
an opinion and its interpretation of the Federal
Act and its application to unauthorized refilling
of prescriptions under existing law, the article
points out.
PHYSICIAN’S WILL
The Federal Drug Administration believes that
the following definition of a prescription is one
which expresses the concensus of medical opin-
ion, according to the understanding of the Asso-
ciation: “A prescription is a written expression
of a physician’s will and purpose that the pa-
tient be furnished with a specific quantity of a
drug for use as the physician directs.”
A recent check of current prescription files
indicated that a good percentage of prescriptions
did not contain either the name or address of
the patient and a very large number did not
authorize a refill “It is apparent,” the bulletin
continues, “that too many physicians are not fa-
miliar with the responsibility of the pharmacist
under State and Federal laws and the problems
which confront the pharmacist in the handling of
drugs or prescriptions.”
In order to overcome the unreasonable de-
mands of some customers, certain pharmacies are
posting signs as follows: “Please don’t ask us
to violate Federal and State laws by dispensing
without a prescription, sulfa drugs, barbital, thy-
roid, penicillin or other restricted items. These
statutes are set up for the protection of the pub-
lic health — your health. This pharmacy com-
TO BE A GOOD CITIZEN, YOU MUST
BE REGISTERED TO VOTE
plies with such laws and the direct orders of your
family physician.”
SUMMARY
The bulletin summarizes the question with the
following statements:
(1) The refilling of any prescription without
specific authorization from the practitioner, is
an over-the-counter transaction and, as such,
must meet certain labeling requirements, indi-
cates the F. D. A.
(2) Over-the-counter sale of an R legend drug
without any directions is illegal based upon the
U. S. Supreme Court decision in the Sullivan
case.
(3) Over-the-counter sale of an R legend drug
with directions supplied by the pharmacist is
illegal according to the F. D. A. and the issue is
expected to be tested in the courts.
(4) Unauthorized refill of an R legend drug —
also considered illegal by the F. D. A. — is illegal
after the prescription has expired.
(5) Unauthorized refill of an over-the-counter
drug, the F. D. A. indicates, is legal as an over-
the-counter sale, provided it is accompanied by
adequate directions. If it is in the manufac-
turer’s package, he is responsible for the label-
ing; if repackaged by the pharmacist, he is re-
sponsible for labeling.
ONE-THIRD REFILLS
A recent report shows that new prescriptions
comprise 65.2 per cent of the prescription busi-
ness, with 17.1 per cent non-refillable. Of the
remaining 34.8 per cent representing refills, it
was found that 74.1 per cent were refilled within
one year; that 11.8 per cent were refilled within
two years, and that the refills after two years
were negligible.
Dr. Robert M. Zollinger, chairman of the
department of surgery, Ohio State University
College of Medicine, Columbus, spoke on “In-
dications for Surgery in Gallbladder Disease,”
at the annual meeting of the Illinois State Medi-
cal Society, held at Springfield, 111., May 23-25.
American Cancer Society grants at Western
Reserve University now amount to $125,335.
Recent awards include one to Dr. Sidney Katz
for research in tissue growth, and one to Dr.
A. S. Weisberger for research in the leukemia
diseases. Other studies include research in ab-
normalities in urine and the use of isotope tracers.
588
The Ohio State Medical Journal
In Our Opinion:
NARCOTIC “DON’TS”
FOR THE PHYSICIAN
Recently, the Hennepin County Medical So-
ciety Bulletin (Minneapolis) issued a set of
narcotic “don’ts” for the physician. Being un-
able to do a better job ourselves, we have taken
the liberty of lifting them and passing them
on to Ohio physicians, with the admonition that
they read them carefully and comply with them:
Don’t leave prescription pads around.
Addicts want them for effecting narcotic
forgeries.
Don’t write a narcotic prescription in lead
pencil.
Avoid writing any R in pencil, many are
changed to call for morphine.
Don’t write for narcotics this way:
Morphine HT V2 #X or
Morphine HT y2 #10.
Several X’s or zeros can be added to raise
the amount. Use brackets or spelling.
Don’t carry a large stock of narcotics in your
bag.
Addicts are on the lookout for these in
doctors' offices and cars.
Don't store your office supply where patients
can get it.
Avoid storage near sink or urinal. The
patient may ask for use of these.
Don’t fall for a good story from a stranger
claiming ailment that usually requires morphine.
The addict can produce bloody sputum,
simulate bad coughs or other symptoms.
Make your own diagnosis.
Don’t give a narcotic R to another without
seeing the patient.
Addicts have posed as nurses to get doc-
tors to prescribe narcotics.
Don’t write large quantities of narcotics un-
less unavoidable.
Diversion to addicts is a profitable busi-
ness, as much as $1 for % gr. M. S,
Don’t prescribe narcotics on the story that
another M. D. had been doing it.
Consult that physician or the hospital rec-
ords whenever possible.
Comments on Current Economic and Social
Questions and Professional Problems ;
Suggestions Regarding Organized Activities
Don’t leave R’s signed in blank at the office.
Signed blanks are bad practice and many
have been stolen by addicts.
Don’t treat an ambulatory case of addiction.
Addicts must be under proper control.
Addicts go to several M. D.’s at a time.
Notify the local Internal Revenue Depart-
ment.
Don’t dispense any narcotic without keeping
a record of it.
Bedside and office administration are per-
mitted without record.
Don’t buy your office narcotic needs on R
blank in name of patient.
The law requires you to use an official
order form.
Don’t resent a pharmacist’s call for informa-
tion about a R you may have written.
The pharmacist is held responsible for
filling forgeries. Please cooperate.
HAVE YOU COOLED YOUR
HEELS IN COURT?
What’s your experience in answering court
subpoenas? One of the editorial writers for the
Columbus Academy of Medicine Bulletin tells
about one of his in the following “get it off
your chest” fashion:
“The birds are singing merrily, and all’s
right with the world. You arrive at the office
full of zest for a well-planned productive day.
There, on your desk lies—
“A subpoena. It calls for your appearance in
court right now, at 9:00 a. m.
“An anguished yelp brings your secretary.
You learn that it was left at 5:00 p. m. the
evening before with the janitor. You get rec-
ords in haste, and set out for the court house,
shirt-tail aflutter.
“After peeking through the courtroom door
window for a bit you gather some courage, figure
out which lawyer called you, and motion him
out into the hall.
“ ‘Oh, so sorry, doctor! Didn’t anyone tell
you? We are impanelling the jury now. You
don’t need to come till we ’phone — that will
probably be Wednesday or Thursday.’
“So you go back to the office to sit on records
and tenterhooks till about Friday. Finally a
discrete call to the lawyer’s office discloses that
the case was settled out of court three days
before!
“The above is not just piled-up bad luck.
As most readers can testify, it is about the
way many lawyers do business. The neophyte
perhaps may picture himself as a central actor
in the courtroom drama, but after a while it be-
for June, 19)0
589
comes a damnable bore. Perhaps even the
lawyer who subpoenaed you has not acquainted
himself with your story, so he fumbles about,
while all parties concerned apparently conspire
to keep you from fulfilling your oath to tell the
whole truth.
“The average person may not be subpoenaed
twice in a lifetime, and such a contribution to
citizenship is fair. But the doctor seems to
stand in the runway and may be called almost
monthly, usually on damage cases which are in
the private, not public interest. In view of this
it is highly presumptuous of the legal profession
to assume that on short notice their rights are
superior to those of our patients and ourselves;
and that the most casual connection with a case
gives them the right by subpoena to take our
property, in the form of expert testimony, with-
out personal or monetary consideration.
“It would seem to be a good spot for ap-
propriate committees of Bar and Academy to
work out a fairer plan.”
Doubtless, the same story could be told, and
supported by facts, in almost any county. That
being the case, it is suggested that the recom-
mendation of the closing paragraph be followed
by each county medical society. In other words,
have your society go into a huddle with your
local bar association. The effort might conserve
your time and keep your blood pressure at a
minimum.
MAKING FRIENDS WITH THE PRESS
IS GOOD PUBLIC RELATIONS
From reports received, officers of many county
medical societies are doing a good job in pub-
lic relations and are not neglecting that all-
important nucleus at the center of the public re-
lations field — the men and women of the news-
papers and radio stations.
There is a tendency on the part of many per-
sons in organization offices to wait until they
have a story to publish or a broadcast to arrange
before they attempt to approach the people who
make these affairs go day after day.
Many society officers go out of their way to
invite members of the press merely to sit in on
a dinner meeting or other special affair. This
gesture enables doctors and members of the press
to get acquainted and at the same time to ex-
change some good ideas on what constitutes good
public relations. Response by members of the
press invariably has been favorable when this
was done.
And while you’re inviting the press, don’t stick
to the publisher of the newspaper or the pro-
prietor of the radio station. The reporters and
desk men are the ones who actually write the
stories and see that they get into the paper.
A society might use the installation of officers
an occasion to invite these men of the fourth
estate. This will give the reporters an oppor-
tunity to get acquainted with the new officers
with whom they will deal. Many other special
occasions lend themselves to more or less in-
formal get-togethers.
TOO MANY RIDING THE WAGON;
TOO FEW PUSHING
One of the reasons why Socialism (or Com-
munism) impoverishes a nation is that the pro-
cess of socializing draws a large proportion of
the people out of productive pursuits into par-
asitic careers on government jobs, an editorial in
the Cleveland Plain Dealer asserts.
Some government obviously is necessary, the
editorial points out, but as government begins
to regulate the workaday lives of individuals,
it grows and grows and grows.
“A benign government (our own) decides that
shoes should be pegged at a given price to pro-
tect the honest workingman. A big staff of em-
ployees is necessary to see that the line is held.
“The next week the government finds that
shoe prices cannot be pegged unless raw leather
is put under price control, and this requires a
brand new army of employees.
“Then nails, machinery, rents, and all the
things which together determine the price of
shoes must be similarly controlled. And then
the same process must be applied to the factors
which control the prices of nails, machinery,
and so on.
“Everyone who lived through the government
controls of the war years saw this happen on a
broad scale.”
The editorial continues by pointing out that
in England one in nine persons is on the govern-
ment payrolls, supported by the other eight
(and that eight, we might add, includes house-
wives, children and others who are not wage
earners). The editorial concludes with the ob-
servation that if the British Labor party’s
scheme continues, the ratio of government work-
ers to producing workers will be half and half.
PHYSICIANS, HOSPITALS PLAY PARTS
IN DECREASED MATERNAL HAZARDS
An indication of how mutual cooperation be-
tween physicians and hospitals works for the
good of the public is emphasized in the almost
miraculous decrease in hazards of pregnancy
and childbirth during the past two decades.
That the physician has played the leading role
in this decrease has been demonstrated numerous
times. That the hospitals are doing their part
is shown by a close relationship in various re-
gions between maternal mortality and the num-
ber of confinements within hospitals.
The Metropolitan Life Insurance Company
points out that the maternal mortality rate of
20 years ago was seven per 1,000 live births,
one of the highest in the civilized world at the
time. The rate was down to 1.3 per 1,000 by
1947, and currently is estimated to be about one
per 1,000,
Dr. Louis I. Dublin, chief statistician for
590
The Ohio State Medical Journal
Metropolitan, calls attention to the fact that
rural mortality is higher than urban and ex-
presses the belief that recent legislation should
have the result of increasing the number of hos-
pitals and health centers available to people in
the more sparsely populated sections. With
that thought in mind, he predicts a very bright
future in maternal care.
MR. GREEN SPEAKS —
BUT HASTILY
The Associated Press has quoted Mr. William
Green, president of the American Federation of
Labor, as telling a London audience that he would
“rather have the United States as a welfare
state than a Wall Street state.”
We don’t know exactly what Mr. Green means
by “a Wall Street state.” But, judging from
the latest financial report on conditions in Eng-
land we are somewhat inclined to believe that
Uncle Sam has done better by “Our Nell” than
has John Bull, even with the financial assistance
which the latter has been receiving from the
old man on this side of the pond. Wonder how
many of Mr. Green’s members would like to
trade places with their counterparts in the
British Isles? We haven’t noticed any grand
rush for passages on the Queen Mary.
Mr. Green has every right to battle for im-
proved conditions for his members. On the
other hand, he should be sure that what he
thinks they should have is an improvement over
what they already have and that in asking for
changes he doesn’t destroy the base on which
present benefits rest and on which justifiable
benefits of the future will have to rest — in brief,
a sound economy.
CLAUSES IN RADIUM CONTRACTS MAY
ENTAIL LEGAL ENTANGLEMENTS
In a monthly news letter, the American College
of Radiology calls attention to an undesirable
clause which is contained in the standard
agreement of lease for radium between a sup-
ply house and contracting physicians. The clause
reads as follows:
“Nothing herein contained shall be construed
as an express or implied warranty that the
radium leased is an effective therapeutic agent,
nor any warranty as to the mechanical strength
of the containers described in Paragraph 1. The
Lessor shall not be liable to the Lessee, its
agents, patients, employees, guests, or any other
person for any injury or damage directly or
indirectly arising out of or resulting from ex-
posure to or contact with said radium, in any
manner or from any cause whatsoever, and the
Lessee agrees to keep and save the Lessor
harmless from any and all suits or claims for
such damage or injury.”
The article calls attention to the fact that
this clause constitutes a contractual agreement
on the part of the physician to assume liability
of a third party. The radiologist’s professional
liability insurance policy sponsored by the Ameri-
can College of Radiology specifically excludes
liability for claims arising by reason of the
contractual liability of the insured to ethers
than his patients.
The article continues to point out that in
effect this means that a malpractice claim
against a physician leasing radium under a
contract containing this clause could not be
defended on the basis of defective radium, or
a defective container, because the physician had
agreed to assume liability for such defects.
In the particular instance cited, an agreement
was worked out to the satisfaction of the sup-
ply house and the indemnity company. The
article, however, concludes with a caution that
physicians would do well to examine their
leasing agreements and their insurance con-
tracts to determine whether they have protective
coverage.
Possibly the same caution would apply in
regard to any other therapeutic or diagnostic
agents or equipment for which the physician
is under contract.
NOT WHAT YOU HAVE,
BUT WHAT YOU SHARE
A newspaperman, assuming editorship of a
small town newspaper, wrote: “During my stay
in this town, whether it be for a year or for a
lifetime, I shall endeavor to improve my com-
munity by at least one per cent.”
Not much improvement, someone may say on
first thought. But think what it would mean
to the community if each doctor, each lawyer,
each businessman and so on, would undertake
to improve his community only one per cent.
Unfortunately there is not that much com-
petition in community philanthropy. The many
doctors who have resolved to make their com-
munities better places in which to live find
unlimited opportunities to work at it. Although
the practice of medicine undoubtedly is number
one as a time consuming profession, many
doctors find relaxation by participating in various
community projects.
BLESSED ARE THE POOR FOR THEY
SHALL INHERIT THE DEBT
Many well-meaning persons in the lower in-
come brackets are praising the so-called share-
the-wealth programs, subsidies to farmers, and
the like. What these same people don’t seem to
appreciate is that many of our social security
benefits are coming, not from any share-the-
wealth schemes, but from an ever-mounting debt
which some day the poor as well as the well-
to-do must settle or pass on to their children.
for June, 1950
591
• * ®
Collection Agencies
Unfortunate Experiences Furnish Warnings That Doctors Should Deal
Only With Ethical Organizations, Preferably Those Operated Locally
THE purpose of this article is twofold — to
offer a few helpful suggestions to physi-
cians who may wish to turn over delinquent
accounts to a collection agency, especially to
those doctors who may be new in practice, and
to advise doctors to choose carefully before mak-
ing an agreement with an agency. Why? Be-
cause many doctors, by not being forewarned
and by dealing unadvisedly, have subjected
themselves and their patients to humiliation and
outright fraud.
TYPICAL CASE
“It seems I have been taken for another ride
with one of these collection agencies,” reads the
opening sentence of one letter from an Ohio
doctor on file in the Headquarters Office.
“The agent gave me to understand,” the letter
continues, and then relates how “sleepers” in the
contract worked to the exact opposite of what
the slick salesman had stated.
This doctor goes on to say that he turned over
a large number of accounts to the agency with
the understanding that it would charge him $3
minimum only on the cases accepted for liquida-
tion. Instead, the agent skimmed off the cream
of the accounts for collection, but charged the
doctor the $3 minimum on accounts not collected.
Then it charged him 30 per cent of the amount
which had been collected.
It was the doctor’s understanding that he
was to receive 70 per cent of the amount col-
lected, while the agency would get 30 per cent.
As it worked out — with the agency charging for
accounts not collected — the doctor received ap-
proximately 30 per cent while the agency got
the lion’s share.
This is only one of many similar cases.
READ THE CONTRACT
Few doctors are trained in law, and few of
them are in position to spot deceptive “sleepers”
in unethical contracts. Experience shows that
many doctors rely on the interpretation of the
contract by the salesman. The saying that “a
verbal agreement isn’t worth the paper it is
written on” holds true in this case, especially
if the doctor signs a printed contract. One
contract even had this statement hidden in the
proverbial small type: “It is further understood
and agreed that no oral representations made
by your agents shall be binding upon you.”
HIDDEN CLAUSES
Based on past experience, here are some of the
tricks in some contracts that may seem to the
untrained as merely legal terminology, but which
may gyp the doctor out of his hard-earned fees
and give him a reputation in the community
that he may never live down:
1. Granting full authority to the company to
settle, collect, adjust and act as attorney-in-fact
for the physician in handling accounts, thus
giving the company power to take court action
and perform special services, at extra cost
to the physician. Some agencies routinely file
suit on all accounts, thus subjecting the doctor
to extra cost.
2. Charging a larger fee for accounts collected
in installments than for those collected in full,
thus encouraging installment collections and
stretching out the procedure endlessly.
3. A docket fee on each account regardless
of whether any collections are made. The doc-
tor has no definite way of knowing what ac-
counts the agency attempts to collect.
4. Assignment of authority to the company
to endorse for deposit and collection commercial
papers received from all doctors.
5. Provision that payments made direct to the
physician shall be remitted by him to the com-
pany and commission charged thereon.
6. Provision that commission be paid on basis
of all accounts submitted for collection, and not
on the amount the company is able to collect.
The word “aggregate” is tricky in this respect.
7. Repeat or follow-up contracts. Some
agencies make a “trial offer.” They offer to
collect a dozen or so accounts and present a
legitimate contract for the doctor to sign. Then
after collecting these accounts at a nominal fee,
the agent presents a renewal contract which he
represents as “substantially the same” as the
original. The tricks may be in the second
contract.
8. Agreement that remittance will be made
to the doctor only after full settlement has been
made by the agency. The agency may collect 90
per cent of all accounts and never get around
to collecting the remainder.
9. Provision that commission will be paid
even if the doctor withdraws the account from
the agency.
Unscrupulous collection agencies can do the
doctor untold harm in the community, especially
those which resort to “gangster” methods of
collecting accounts. Some threaten and harry
debtors until they pay up in self-defense. Some
collectors make a practice of “falling into con-
592
The Ohio State Medical Journal
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DRAMAMINE* — for the Prevention and
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RESEARCH IN THE
SERVICE OF
MEDICINE
SEARLE
for June, 1950
593
versation” with the debtor’s neighbors or fellow
employees to humiliate him into paying.
HOW TO PROCEED
Here are some suggestions to the doctor who
feels that he wishes to turn over long overdue
accounts to a collection agency:
Deal with a local agency — at least one that
is known locally. Almost every town of any
size has an ethical agency, or a neighboring
town has one which operates in the area.
Use your local county medical society if it
has such an agency or has an agreement with
a local agency. Many societies do operate
bureaus of medical economics. Others have
agreements with agencies operated by the local
chamber of commerce or retail merchants’
association.
If you wish to deal with a commercial agency,
check it carefully. Read any contract carefully
before you sign it. Usually a few calls to other
doctors, attorneys or business leaders in the
community will give you the information you
need. A few days spent in checking may save
many a headache.
Investigate carefully before dealing with a
commercial agency with a national hookup. Some
of them are not reliable.
Agree to payment of a fee only on the basis
of amount actually collected.
Licensed Through Endorsement by
State Medical Board
The State Medical Board has issued licenses
to practice medicine and surgery in Ohio to
the following physicians through endorsement of
their licenses to practice in other states:
January 17 — Jack William Barrett, Youngs-
town, St. Louis Univ.; Homer Clarence Brown,
Hamler, Univ. of Mich.; Robert Stewart Dar-
row, Columbus, U. of Oklahoma.; Robert Joseph
Duffner, Cincinnati, Indiana U.; Pascal Friscia,
Columbus, Royal U. of Bologna (Italy); Roy
Charles Hairston, Dayton, Meharry Med. Coll.;
Victor Simon Hirsch, Cleveland, U. of Penna.;
James Stewart Kaufman, Cleveland, Temple U.
James Patrick Keane, Cleveland, St. Louis U.;
John Alfred Knapp, Columbus, Yale U.; John
Stanley Kozy, Toledo, U. of Chicago; Hubert
Frank Loyke, Cleveland, St. Louis U.; Wilva
Marjory Mcllmoyle, Cleveland, U. of Toronto:
Wilson Gault Newell, Lebanon, Northwestern
U.; Carl Joseph Nicosia, Bowerston, U. of
Buffalo; Joseph Norris Rose, Ironton, U. of
Arkansas; Leon Schiffman, Cleveland, Friedrich
Wilhelm U.
Max Schiller, Cleveland, U. of London (St.
Bartholomew’s); Harriett Simmons Taylor,
Cleveland, Coll, of Med. Evangelists; Robert
Max Taylor, Cleveland, Coll, of Med. Evangelists;
Albert Annis Rayle, Jr., Cleveland, Emery U.;
Harry William Clatworthy, Jr., Columbus, Har-
vard U.; Paul James Fuzy, Jr., Youngstown,
Harvard U.; Robert Francis Schultz, Kenton, U.
of Mich.; Isidor Smith, Cleveland, U. of Toronto;
Harry C. Jelstrom, Bethel, New York U.
April 4 — Thomas Dent Allison, Lima, Harvard
U.; Kenneth D. Arn, Dayton, U. of Mich.; Clyde
E. Asbury, Jr., Springfield, Northwestern U.;
John W. Bengtson, Cleveland, U. of Rochester;
Eleanor Smith Bozeman, Akron, Meharry Med.
Coll.; Wilfred Boswald Bozeman, Jr., Akron.
Meharry Med. Coll.; William C. Caccamise, Cleve-
land, U. of Rochester; Phillip Cohn, Toledo,
U. of Iowa; Ernest Ford Crider, Toledo, U. of
Louisville; Arthur M. Dalton, Toledo, Duke U.;
Conrad DeBold, Dayton, Washington U.
Frank J. Dzurik, Cleveland, St. Louis U.;
Franklin Earnest, III, Toledo, Jefferson; Arthur
Martin Edwards, Cleveland, La. State U.;
Thomas D. Ef station, Tiffin, Georgetown U.;
Charles Dudley Evans, Jr., Hudson, George
Washington U.; Emmeleine E. Ferguson, Upper
Sandusky, U. of Louisville; Robert Ross Fisher,
Youngstown, Boston U.; Max D. Garber, Mans-
field, Indiana U.; Abran E. Handy, Jr., Cleveland,
Med. Coll, of Va.; Earl A. Hathaway, Dayton,
U. of Chicago; James Fraser Jackson, East
Liverpool, U. of Pittsburgh.
John R. Levitas, Columbus, Northwestern U.;
Alexander Ling, Cleveland, Washington U.; Al-
bert Ward McCally, Jr., Dayton, Columbia U.;
Arthur E. McElfresh, Columbus, Cornell U.;
James A. McGlew, Marion, St. Louis U.; Robert
A. McLemore, Springfield, Jefferson Med. Coll.;
Lester B. Mallette, Akron, Northwestern U.;
Jack M. Martt, Cincinnati, Washington U.; Mary
Alice Miller, Columbus, Loyola U.; Richard W.
Mills, Jr., Marion, Northwestern U.; Salvador
L. Mora, Toledo, U. of Berlin; George R. Nichol-
son, Akron, Syracuse U.
Arthur J. Patek, Jr., Cleveland, Harvard U.;
Clarence J. Podore, Cincinnati, U. of Illinois;
Raymond C. Pogge, Cincinnati, Northwestern
U.; Frank Princi, Cincinnati, U. of Colorado;
Wayne S. Ramsey, Greenville, Harvard U.; Mur-
ray Reswick, Cleveland, U. of Paris; Vernon
Rowland, Cleveland, Harvard U.; Charles C.
Royer, Columbus, Harvard U.; Curtis E. Sauer,
Van Wert, St. Louis U.; James W. Sayre, Cin-
cinnati, Cornell U.; Otis Blaine Schreuder, Le-
banon, U. of Oregon; Joseph Schultz, Cleveland,
St. Louis U.; Helen C. Sharp, Cincinnati, U. of
Kansas; Seymour Simerman, Dayton, Long
Island Coll.
Edna H. Sobel, Cincinnati, Boston U.; Joseph
II. Stagaman, Cincinnati, St. Louis U.; Leon
Stein, Cincinnati, U. of Louisville; Edward
Joseph Steiner, Cincinnati, U. of Illinois; John
P. Storaasli, Cleveland, U. of Minn;. Jan Schwarz,
Cincinnati; German U. of Prague; Walter W.
Donahue, Dayton, U. of Louisville; Heinz Eisen-
berg, Columbus, U. of Berlin; Robert S. Heidt,
Cincinnati, U. of Louisville; Walter G. Zerbe,
Cincinnati, Temple U.
594
The Ohio State Medical Journal
new and different salt substitute
. . . tastes like salt
looks like salt
sprinkles like salt
CO-SALT tastes so much like table salt that low so-
dium diet patients can actually enjoy their food again.
With CO-SALT in place of sodium chloride, they will
cooperate more fully in following your diet... will
be better nourished . . .and intake of edema-causing
sodium will be held to a minimum.
CO-SALT CONTAINS NO LITHIUM ... is not bitter,
metallic, or disagreeable in taste. It is the only salt
substitute that contains choline.
Professional Samples
Upon Request
Available:
2 oz. shaker
top package
8 oz. economy
package
CO-SALT — for use at the table or in cooking— will
be a joy to low-sodium diet patients.
INGREDIENTS: Choline, potassium chloride, ammo-
nium chloride and tri-calcium phosphate.
Accepted for advertising in
the Journal of the American
Medical Association.
4
Casimir Funk Laboratories, Inc.
affiliate of U. S. VITAMIN CORPORATION
250 E. 43rd St. • New York 17, N. Y.
for June, 1950
595
Do You Know?
• • •
Western Reserve University and Case Institute
of Technology agreed recently to extend the
Western Reserve Health Service to cover Case
students. The Health Service treats all am-
bulatory patients and pays for examinations,
tests and consultations except dental care and
eye refractions.
❖ ❖ ❖
Dr. Burr Noland Carter, Cincinnati, was
elected treasurer of the American Surgical Asso-
ciation at the annual meeting of the organiza-
tion in Colorado Springs, Colo., in April.
:}: 5ji
Dr. William G. Myers, Columbus, is taking
the leading role in a series of programs over
Station WOSU, built around the general subject,
“Some Medical Aspects of Atomic Explosion.”
The 10-weeks series began on Monday, April 3,
at 7:15 P. M.
>;c *
Dr. Thomas Hale Ham, assistant professor at
the Harvard Medical School, was named recently
to supervise a change of teaching techniques at
Western Reserve University School of Medicine,
according to a report in the public press. Dr.
Joseph T. Wearn, dean of the School, hopes to
break down the wall between preclinical and
clinical training so that students may receive
clinical training earlier in their course.
^ ^
Dr. Frank C. Sutton, administrator of the
Miami Valley Hospital, Dayton, was named
president-elect of the Ohio Hospital Association
at its annual meeting in Columbus. Dr. Russell
B. Crawford, Lakewood, superintendent of the
Lakewood Hospital, assumed office as president
at the annual meeting.
❖ ❖ ❖
The Board of Trustees of the Ohio State Uni-
versity College of Medicine has increased the
quota of freshmen medical students from 88 to
150, effective next fall.
* * *
Dr. 0. P, Kimball, Cleveland, is making a
survey of nutritional needs and goiter condi-
tions in Latin America, under the auspices
of the World Health Organization, He will
present his observations at a meeting of WHO
in Rio de Janeiro in June.
?{C
The American Trudeau Society has named Dr,
John IL Skavlem, Cincinnati, president-elect,
if: s}: sjc
“The Acute Effects of Air Pollution on Human
Health with Special Reference to the Donora, Pa.,
Episode,” was the topic discussed by Dr. Wm.
F. Ashe, Gallipolis, at the recent U. S, Technical
Conference on Air Pollution in Washington, D. C.
Dr. Ashe was special medical consultant to the
American Steel and Wire Co., following the
Donora disaster in October, 1948.
5*S %
Dr. Walter J. Zeiter, Cleveland, has been
named to fill the unexpired term of the late Dr.
John S. Coulter of the Council on Physical
Medicine and Rehabilitation of the American
Medical Association.
;-c %
Dr. E. J. McCormick, Toledo, a member of the
A. M. A. Board of Trustees, was one of the
United States representatives to the May meeting
of the World Health Organization in Geneva,
Switzerland.
jfc
Dr. Fred W. Dixon, Cleveland, was one of the
guest speakers at a joint meeting of the West
Virginia Academy of Ophthalmology and Oto-
laryngology and the Virginia Society of Ophthal-
mology and Otolaryngology, May 7-9, at White
Sulphur Springs, W. Va. His subject was: “Dis-
eases and Treatment of the Hard and Soft
Palate.”
%
Dr. Carl A. Wilzbach, of Cincinnati, is one of
five persons elected to Honorary Life Member-
ship this year by the American Social Hygiene
Association. He was cited for the award at a
luncheon meeting of the Cincinnati Social Hy-
giene Society on February 3.
^ H*
Dr. E. Scott Hill related experiences and ob-
servations on the system of medical practice in
Great Britain based on a recent trip to that
country before the Canton Academy of Medi-
cine, Dr. Hill reported that on a two-weeks’
visit he talked with persons in all walks of life
as well as to physicians. While the average
person approves the plan on the mistaken belief
that he is getting something for nothing, persons
on the professional level are strongly opposed,
he said.
❖ ^ ❖
The Committee on Medical Motion Pictures
of the American Medical Association has com-
pleted a second revised edition of the booklet
Reviews of Medical Motion Pictures. The
booklet reviews and evaluates 225 films which
are available to the medical profession. Copies
are available for 25 cents from: Order Depart-
ment, A, M. A., 535 N, Dearborn St., Chicago 10.
ifc
“Role of Antibiotics and Nutrition in the
Treatment of Infection” was the topic discussed
by Dr. William A, Altemeier, Cincinnati, at the
Western Michigan Clinic Day, May 18, at Grand
Rapids, Mich.
596
The Ohio State Medical Journal
Made in Wisconsin
from Grade A Milk
THE physician who prescribes Baker’s Modified
Milk simplifies infant feeding problems for
himself as well as mothers. Mothers and doctors both
find their experience with Baker’s pleasant — and
time-saving, because Baker’s is so readily prepared
for infant feeding — equal parts of Baker’s and water,
previously boiled. No change in formula is required
as baby grows older — just an increase in the quantity
of each feeding.
Today, more and more doctors are getting highly
satisfactory results for most of their infant feeding
cases by prescribing Baker’s Modified Milk. Doctors
who prescribe Baker’s will tell you they favor Baker’s
because of its wide application. With Baker’s, most
babies require fewer feeding adjustments from birth
to the end of the bottle feeding period.
You are invited to write for complete informa -
tion about this highly nutritious food for infants •
*fOICAL
FOODS AND
THE BAKER
Main Office: Cleveland, Ohio
Plant: East Troy, Wisconsin
LABOR ATORIES INC.
Division Offices: San Francisco, Los Angeles,
Dallas, Denver, Seattle and Greensboro, N. C.
for June, 1950
597
Ohio Medical Indemnity ...
Doctors’ Plan Sponsored by the Association Liberalizes Contracts;
Now Has More Than 740,000 Persons Covered; Officers Are Reelected
OHIO Medical Indemnity, Inc., the Blue
Shield Plan sponsored by the Ohio State
Medical Association, has again liberalized
its contract, according to a recent announce-
ment made by Mr. Charles H. Coghlan, Execu-
tive Vice-President.
A survey conducted by Ohio Medical in the
last quarter of 1949 pointed out the necessity
for these increases and information acquired
in the survey served as a guide in amending
the contract.
Previously, the Plan had a semiannual limit
of $150 for operations due to the same illness,
such as cancer and skin grafting. This limit
has now been raised to $200.
In addition, a number of individual items
in the schedule of indemnities were increased,
the amount of the increase ranging from five
dollars to fifty dollars. Some of the major
surgical items previously paid at $150 and
now being paid at $200 are as follows: gastrec-
tomy, nephrectomy, abdominal perineal resec-
tion and craniotomy.
In addition, the following items in the surgi-
cal schedule were increased; radical breast am-
putation, removal of breast tumor, submucous
resection with nasal septum, transurethral pros-
tatectomy, dilatation and curettage, and cysto-
scopic examinations.
New items added to the schedule were: lamin-
ectomy, perineorrhaphy, anterior colporrhaphy
and three new procedures involving multiple
rectal surgery.
NEW COVERAGE CONTRACT
At the same time, Ohio Medical announced
the introduction of a new contract to its sub-
scribers. The new coverage, available at a
slightly higher rate, will cover in addition to
surgery and obstetrics, medical (non surgical)
services for hospitalized cases. The monthly
rate for the new contract is 75 cents for the
single person and $2.30 for the family. Bene-
fits are based on per diem basis for the number
of days the patient is hospitalized up to a limit
of 30 days per year per member. The indemnity
schedule provides $5.00 per day for the first
two days of each admission and $3.00 per day
for the next 28 days.
The Board of Directors in authorizing the re-
lease of this new contract pointed out that the
contract follows the basic principle established
in the surgical contract in that it is relatively
free from exclusions. Since pre-existing illnesses
are covered, it was recommended that the con-
tract be limited to group enrollment until some
experience figures have been accumulated.
DIRECTORS, OFFICERS ELECTED
The annual meeting of the corporation was
held in Columbus on April 19, 1950, and the
Board of Directors was elected for the coming
year, by the Ohio State Medical Association,
sponsor of Ohio Medical. The Board of Di-
rectors is as follows: Dr. L. Howard Schriver,
Dr. Robert C. Rothenberg, Dr. R. K. Finley,
Dr. Carll S. Mundy, Dr. Edgar P. McNamee,
Dr. Wm. M. Skipp, Dr. C. C. Sherburne, Dr.
Robert T. Allison, Jr., Dr. J. Craig Bowman, Dr.
Carl A. Lincke, Dr. John Marshall, Dr. H. M.
Clodfelter, Dr. A. A. Brindley, Mr. Harold W.
Slabaugh, Mr. James E. Stuart, Mr. H. J.
Winkeljohn, Mr. D. A. Endres, Mr. E. C. Pohl-
man, Mr. Clair E. Fultz, Mr. Waldo M. Bowman
and Mr. Walter Allman.
Officers reelected at the annual meeting are
as follows: Dr. L. Howard Schriver, President;
Dr. Carll S. Mundy, First Vice-President; Mr.
Charles H. Coghlan, Executive Vice-President;
Mr. Charles S. Nelson, Secretary-Treasurer; and
Mr. Frank W. Van Holte, Assistant Treasurer.
Enrollment in Ohio Medical as of March 31,
1950, was 740,113, an increase of over 50 per
cent since January 1, 1949. This means that
the Ohio Doctors’ Plan covers a number of
persons equal to the combined populations of
Cincinnati (488,000) and Dayton (252,000). Over
8,000 Ohio firms and businesses are now co-
operating with Ohio Medical in making the Plan
available to their employees and their families.
Ohio ranks fifth in size in the nationwide
Blue Shield organization covering over 15 mil-
lion Americans.
Dr. L. Howard Schriver, President of Ohio
Medical, was also reelected President of the
National Blue Shield organization at their re-
cent national conference.
The American Society for the Study of
Sterility will hold its sixth annual meeting
in the Sir Francis Drake Hotel, San Francisco,
Calif., June 24 and 25. Further information
may be had by writing Dr. Walter W. Williams,
secretary-treasurer, 20 Magnolia Terrace, Spring-
field, Mass.
TO BE A GOOD CITIZEN, YOU MUST
BE REGISTERED TO VOTE
598
The Ohio State Medical Journal
Resistant
Bacterial Infections
AU R EOMVC I N
Aureomycin is now widely used for the treat-
ment of infections that have proven resistant to
other chemotherapeutic agents, or combinations
of such agents. Aureomycin does not commonly
provoke resistance in bacteria, and its ability to
penetrate cell membranes and diffuse through
the body fluids assures the presence of the
therapeutic material everywhere it is needed.
HYDROCHLORIDE LEDERLE
bite fever, acute amebiasis, bacterial and virus-
like infections of the eye, bacteroides septicemia,
boutonneuse fever, acute brucellosis, gonorrhea
resistant to penicillin, Gram-positive infections
(including those caused by streptococci, staph-
ylococci, and pneumococci), Gram-negative
infections (including those caused by the coli-
aerogenes group), granuloma inguinale, H. in-
fluenzae infections, lymphogranuloma venereum,
peritonitis, primary atypical pneumonia, psit-
tacosis (parrot fever), O fever, rickettsialpox,
Rocky Mountain spotted fever, subacute bac-
terial endocarditis resistant to penicillin, tula-
remia and typhus.
LEDERLE LABORATORIES DIVISION
AMERICAN
COMPANY
30 Rockefeller Plaza, New York 20, New York
Aureomycin has been found effective for the
control of the following infections : African tick-
Capsules: Bottles of 25, 50 mg. each capsule. Bottles of 16,250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper; solution prepared by adding 5 cc. of distilled water.
for June, 1950
599
Narcotic License Must Be Renewed
By July 1 to Avoid Penalty
On or before July 1 every physician registered
under the Harrison Narcotic Act, must, unless
he is in military service, reregister with the
Collector of Internal Revenue of the district in
which he maintains an office, and pay the Federal
Narcotic Tax of $1.00. Initial application may
be made at any time, but existing permits must
be renewed on or before July 1, annually.
PENALTIES
Failure to reregister within the time allowed
by law adds a penalty to the annual tax, and
in addition makes the physician liable to a fine
not exceeding $2,000 or to imprisonment for not
more than five years or both. In recent years
the Commissioner of Internal Revenue has given
some tardy registrants the choice between pay-
ing sums by way of compromise in lieu of the
penalties for their offenses, or as an alterna-
tive, accepting criminal prosecution, with result-
ant publicity and liability to fines and pos-
sible imprisonment. Strict adherence to the
law will obviate the necessity for such ac-
tion and protect the physician from needless
embarrassment.
FORMS MAILED
Copies of the forms for reregistration are
scheduled to be mailed about June 1 by the
District Collectors of Internal Revenue to each
Ohio physician already registered, with brief
instructions of the procedure to be followed.
Application for reregistration must be made
on Form 678, signed by the physician applying
and either acknowledged by two 'qualified wit-
nesses or sworn to by a Notary Public or an
official of the Internal Revenue Department. The
physician must note on his application the num-
ber of his license to practice medicine in Ohio.
The registration number assigned by the Depart-
ment of Internal Revenue is retained from year
to year. Remittance accompanying the applica-
tion may be in the form of cash, a postal money
order, or certified check. Personal checks not cer-
tified will be returned to the sender.
INVENTORY NECESSARY
An inventory of the narcotic drugs on hand in
the physician’s office must accompany the appli-
cation, on Form 713. The regulations require
that this inventory must be sworn to by a Notary
Public or an official of the Internal Revenue De-
partment regardless of the quantity of drugs
on hand.
Inventories may be taken at any time after
the receipt of the application forms each year,
and may be filed as soon as completed. They
must be filed by July 1.
Physicians who administer, dispense, or pre-
scribe cannabis, must obtain a special permit
under the Marihuana Tax Act, and reregister
annually on or before July 1, with the Collector
of Internal Revenue of his district, and pay a
tax of $1.00 in addition to the regular registra-
tion fee.
MUST APPLY AFTER MILITARY SERVICE
A physician in the armed forces need not re-
register. If such a physician should receive an
application form for reregistration he should
return it to the office of the Collector of In-
ternal Revenue from which it was sent, together
with a statement that he is in the armed forces,
that he does not have in his possession any
narcotics, and requesting that the registration
number previously assigned to him be reserved.
Upon his return to civilian practice, a physi-
cian who has been in military service must im-
mediately apply for registration. He will be as-
signed his former registration number.
New Law Liberalizes Provisions for
Veterans’ Home Loans
World War II veterans will find home loan
benefits greatly enhanced by provisions con-
tained in the Housing Act of 1950, recently
signed by the President. Regulations and pro-
cedures to put the new provisions into effect
are being drafted by Veterans Administration.
In the meantime, V. A. announced a number
of changes that the new law brings about.
The following are high lights of these changes.
The amount of V. A.’s guaranty on an eligible
veteran’s home loan is increased to 60 per cent
of the loan, up to a maximum guarantee of
$7,500. Previously the guarantee was 50 per
cent, up to $4,000. Thus under the new law
the 60 per cent ratio will apply on mortgages
up to $12,500, with the guarantee remaining
at $7,500 for loans over $12,500.
Gratuity payment for credit on the veteran’s
loan remains at four per cent of the first
$4,000 of guarantee used.
Unremarried widows of veterans who died
in service, or from service-connected causes
after discharge, are made eligible.
Combination F. H. A.-veterans’ loans will be
eliminated some time in the future. According
to V. A., these loans are more costly and less
advantageous to the borrower than the straight
veterans’ loan.
The maximum period of time over which
home loans may be made repayable is extended
from 25 years to 30 years.
The Federal National Mortgage Association,
a government agency, is given $250,000,000 in
additional authority for the purchase of veter-
ans’ and F. H. A. loans made by private lend-
ing agencies. This must be used for current
purchases only, and is not subject to earmark-
ing in the form of commitments for future
purchases.
Entitlement to a guaranteed loan remains avail-
able until July 25, 1957.
600
The Ohio State Medical Journal
PROVIDES PROTECTION WITHOUT IRRITATION
Evidence obtained by direct-color photog-
raphy shows that the cervix remains
occluded for as long as ten hours after an
application of “RAMSES”* Vaginal Jelly.
“RAMSES” Vaginal Jelly immobilizes
sperm in the fastest time recognized under
the authoritative Brown and Gamble
method of measuring the spermatocidal
power of vaginal jellies or creams. This has
been established by repeated tests for
spermatocidal activity conducted by an
accredited independent laboratory.
Clinical observation of patients receiving
daily applications of “RAMSES” Vaginal
Jelly for three-week periods reveals no evi-
dence of irritation or other untoward effect.
“RAMSES” Vaginal Jelly is acceptable to
even the most fastidious patient because
it provides efficient protection without
leakage or ^excessive lubrication. It is avail-
able at all pharmacies in regular and large
tubes; the regular tube is also available in
a package containing a measured appli-
cator.
active ingredients : DodecaethyleneglycolMono-
laurate 5%, Boric Acid 1%, Alcohol 5%.
qualify first since 1883
*Tho word "RAMSES” it a rogitforod trodomark of Jotim Schmid. Inc.
for June, 1950
601
• • •
Reserve Officers
With Twenty Years of Service, Members of Military Components May
Become Eligible for Substantial Retirement Pay at Age of Sixty
RECORDS in the Headquarters Office of the
Ohio State Medical Association show that
at one time during the war more than 3,100
Ohio doctors were in active military service.
This figure does not include the many doctors who
saw service prior or subsequent to that time,
nor those who have come into the Association
since. The following article, therefore, will be
of interest to physicians of this State, particu-
larly those who are now in reserve components
or who may wish to continue their services to the
military establishment. It is reprinted from The
Journal of the A. M. A.
* ❖ ❖
Some members of the reserve components of
the Armed Services are not familiar with the
retirement benefits to which they are entitled by
law. Public Law 810 of the Eightieth Congress
states that any reserve officer or enlisted man
who has performed satisfactory Federal service
for an aggregate of twenty years, the last eight
of which have been as a member of a reserve
component, is eligible for retirement pay on
reaching the age of 60. The amount of such
pay is proportionate to the highest rank satis-
factorily held and to the relative number of years
of active and inactive service.
SERVICES DEFINED
The term “Federal Service” as used includes
all active Federal service in the United States
Army, Air Force, federally recognized National
Guard prior to 1933, Navy, Marine Corps, Coast
Guard and all service in their reserve components
other than active Federal service performed
prior to July 1, 1949, except for service in the
inactive National Guard or Air National Guard,
in a nonfederally recognized status in the
National Guard or Air National Guard or in an
inactive reserve section of the Officers’ Reserve
Corps or an inactive officers’ section of the Air
Force Reserve.
The term “active Federal service” includes all
periods of annual training duty, all prescribed
periods of attendance at service schools and any
period of active duty under orders of competent
Federal authority. In other words, each year
of satisfactory service prior to July 1, 1949, is
considered to be a year of satisfactory Federal
service without any retroactive requirement as
to the duties which must have been performed,
provided that this service was not performed in
certain inactive components which are specifically
excluded.
This law states that no one who was a member
of a reserve component on or before Aug. 15,
1945, shall be eligible for retirement benefits
under its provisions unless he has performed
active Federal service during any portion of
either of the two periods April 6, 1917, to
Nov. 11, 1918, and Sept. 9, 1940, to Dec. 31, 1946.
Subsequent to July 1, 1949, however, a year
of satisfactory Federal service as a member
of a reserve component while not on active duty
consists of any year during which a minimum
of fifty points has been credited on the follow-
ing basis: (1) Fifteen points, automatically
granted for membership in the active reserve;
(2) one point for each day of active Federal
service during that year; (3) one point for each
drill, meeting, instruction period and performance
of physical examinations and for each day of
training duty, with or without pay, and (4)
various point credits for the successful completion
of correspondence courses.
PERCENTAGE BASIS
The retirement pay granted under this law
equals the sum derived by multiplying 2.5 per
cent of the base and longevity pay which the
recipient would receive if he were serving on
active duty, at the time he is granted such
pay, in the highest temporary or permanent
grade which he held satisfactorily during his
entire period of service, by a certain factor.
This factor consists of the number of years
and any fraction thereof (on the basis of 360
days per year) composing the sum of the fol-
lowing: (1) All periods of active Federal serv-
ice; (2) fifty days for each year of Federal
service, other than active Federal service, per-
formed as a member of a reserve component prior
to July 1, 1949, and (3) one day for each of
the fifty points required for each year of satis-
factory service performed subsequent to July 1,
1949. Not more than sixty days may actually
be credited, on this basis, per year.
Anyone who has not attained the age of 60
but is eligible in all other respects to receive
retirement pay under the provisions of this law
may be transferred to an inactive status.
EXAMPLE
Suppose that a physician served as a reserve
officer for the ten-year period ending Jan. 1, 1940.
He will thus have accumulated 10 times 50, or
500 “days” during this time. Called to active
duty on Jan. 1, 1940, he served five years, until
Jan. 1, 1946, at which time he was released
602
The Ohio State Medical Journal
ipllil
Therapy
TED • PHIL AD E L P H 1 A 3
WYETH 1NCOR
PURODIGIN is available in three strengths: Tablets of 0.1 mg.,
0.15 mg., and 0.2 mg. This facilitates closer adjustment of main-
tenance dosage to the patient’s requirements . . . minimizes need
to “stagger” larger and smaller doses or to prescribe irregular
intervals between doses.
For reliable, efficient cardiotherapy, specify PURODIGIN-
pure crystalline digitoxin, Wyeth.
for June, 1950
603
from active duty with the rank of colonel or
its equivalent and 5 times 360, or 1,800 additional
days. Remaining in his reserve component, he
accumulates 314 times 50, or 175 additional days
during the three and one-half year period be-
tween Jan. 1, 1946, and July 1, 1949.
He now has eighteen and one-half years of
satisfactory Federal service and needs only one
and one-half more years of service to qualify
for the retirement benefits under Public Law 810.
To do this he must be credited with the fifty
points a year required, since July 1, 1949, for a
year of satisfactory Federal service. Should he
do this by remaining active in the reserve pro-
gram, he will receive an additional 75 (114
times 50) days, giving him a total of 2,550 days
of service over this twenty-year period of Federal
service.
At the age of sixty he will be entitled to re-
ceive 2.5 per cent of $612.75, the base pay of a
colonel with twenty years of service, times 7.1
(2,550 divided by 360), or $108.77 monthly, for
the remainder of his life. Should he not be
credited with the necessary fifty points by July
1, 1950, however, and since he may conceivably
be discharged for disability during the extra
year that would then be required for him to earn
these fifty points, he may have forfeited the
equivalent of an annuity for which he has already
almost completed payment.
WHY FORFEIT ACCUMULATION?
Some younger men, unknowingly, may also
be forfeiting a sum already paid by them for a
similar annuity. Suppose a physician has served
for one year in a reserve component and then
for three years of active duty during the war,
after which he has let his commission lapse.
He is credited with four years of Federal
service, and, because of his youth, still has avail-
able to him the necessary time in which to serve
the sixteen additional years required of him.
He is probably still young enough, despite the
three to four-year period that he has been in-
active, to serve the required sixteen years and
revert to an inactive status before the age of 60.
Since he may retire with the rank of colonel
or its equivalent, he will, even though he has
not served on active duty a single day during
this time, be entitled to $88.86 monthly for the
remainder of his life. Should he elect to serve
for additional periods of active duty the amount
to which he would be entitled would, of course,
be greater.
A new medical detachment assigned to the
Ohio National Guard, 182nd Antiaircraft Batta-
lion, was activated recently in Dayton. Lt. Rob-
ert L. Sutton, M. C., Veterans Administration
physician, is in command. Other personnel in-
clude a dental officer and 11 enlisted men.
Doctors’ Orchestra of Akron
Completes 24th Season
The 40-piece Doctors’ Orchestra of Akron
recently completed its 24th season with its
142nd concert.
Concerts were given for the Summer Home
for the Aged, Children’s Home, Children’s Hos-
pital, Akron City Hospital; benefit concerts for
the Children’s Hospital of Barberton, Our Lady
of the Elms School, St. Thomas Hospital.
Director of the orchestra is Dr. A. S. Mc-
Cormick and Dr. Arthur Dobkin is concert-
master. They with Dr. R. E. Pinkerton and
Dr. C. P. Neff constitute the executive committee.
During its 24 years the orchestra has played
for 25 hospitals, medical and dental and nursing
organizations in Akron, Barberton, Canton, Co-
lumbus, Chargin Falls, Monroe Falls, Clinton,
Congress Lake, Uniontown, Springfield Lake
and Wadsworth. Benefit concerts were given for
the City Hospital of Akron, Citizens Hospital
of Barberton and Municipal Hospital of
Wadsworth.
The 25th season will open in October when re-
hearsals are resumed.
Opinion of Attorney General
Following is the syllabus of Opinion 1607,
given recently by Attorney General Herbert S.
Duffy:
“Aid for the aged does not constitute poor
relief, as that term is defined in Section 3391-1
et seq., General Code, as enacted by Amended
Substitute House Bill No. 277 of the 98th Gen-
eral Assembly.”
Cancer Film Available
A new film entitled “Breast Cancer: The
Problem of Early Diagnosis” produced jointly
by the American Cancer Society and the Na-
tional Cancer Institute of the U. S. Public
Health Service, is available for use at county
medical society meetings and other scientific
sessions. It is the second in a diagnostic series
of six films on cancer. Inquiries should be
directed to the Ohio Division of the American
Cancer Society, local cancer societies or the
Ohio Department of Health.
Medical Illustrators
The directory issue of Graphics, official pub-
lication of the Association of Medical Illustra-
tors, contains the name, address, training,
professional experience and reference to major
published work of each member. Other informa-
tion pertaining to the profession is included.
The journal, to be issued June 1, will be
available to those who require medical illustra-
tion service and will be sent free of charge
upon request to the editor, Miss Helen Lorraine,
5212 Sylvan Rd., Richmond 25, Va.
604
The Ohio State Medical Journal
r 'Stick-to -it-iveness
is
fine—
for
everyone
else . . .
"but take me— I just can’t stick to my diet.
1 can’t resist desserts. Oh, dear, this diet is getting me down!”
If she thinks it's getting her down what's it doing to physicians who have
to listen to such explanations every day? This is especially true for the doc-
tor who hasn't prescribed Efroxine Hydrochloride.
Efroxine makes it easier for most patients to reduce by depressing the appetite
and elevating the mood. Efroxine offers a number of advantages over other
sympathomimetic amines.
...It has a more rapid and longer-lasting effect with smaller dosage.
... It has little pressor effect in the recommended dosage range. This advan-
tage is particularly valuable in the treatment of obesity.
...It is more likely to produce cerebral stimulation with relatively few side
effects.
Efroxine Hydrochloride Tablets and Elixir
Maltbie Brand of Methamphetamine Hydrochloride
Maltbie Laboratories, Inc.
Newark 1, New Jersey
for June, 1950
605
Buckeye News Notes . . .
Akron — Dr. David J. Roberts addressed a group
at the First Universalist Church on the theme,
“The Threat of Socialization of Medicine and
Business.”
Bellevue — Dr. Forest R. Yohe spoke on the
subject of “Socialized Medicine” before the
Bellevue Chamber of Commerce.
Bluff ton — “What You Should Know About
Compulsory Health Insurance” was the topic
of a discussion by Dr. Boyd W. Travis before
the Bluffton Parent-Teacher Association.
Bowling Green — Dr. David A. Tucker, Jr.,
University of Cincinnati College of Medicine,
spoke on the subject, “The Physician in Histori-
cal Retrospect,” before the Bowling Green Chap-
ter of Alpha Epsilon Delta.
Cadiz — Dr. D. L. Tippett spoke on the subject
of “Socialized Medicine” before a meeting of the
local American Legion Post.
Canton — Dr. Helen S. Brogden addressed the
Canton Division of the Minute Women in Ohio
in the School of Nursing, Mercy Hospital, on
the subject of “Socialized Medicine.”
Chardon — Dr. W. P. Edmunds, formerly of
Cleveland, is the new Geauga County health com-
missioner. He succeeds Dr. W. C. Corey, of
Chardon, part-time health officer for 25 years.
'Cincinnati — Dr. Frank R. Dutra discussed
“Medicine in the Investigation of Crime” at
a meeting of the Cincinnati Dental Society.
Cincinnati — Dr. William L. Roach spoke on the
subject, “Modern Trends in Psychiatry” at a
meeting of the Alumnae Association of the
Deaconess Hospital School of Nursing.
Cincinnati — Dr. Esther Marting Fabing spoke
before the Women’s Auxiliary of the Cincinnati
Lions Club.
Cincinnati — Dr. J. Stewart Mathews, president
of the Academy of Medicine of Cincinnati, in-
troduced Dr. Donald A. Covalt, Institute of
Physical Medicine and Rehabilitation, University
of New York-Bellevue Hospital Medical Center,
at the annual meeting of the Craft Shop of the
Handicapped, in April. Approximately 300 women
attended the meeting.
Cincinnati — Dr. Earl R. Bush has been ap-
pointed medical director of the Western &
Southern Life Insurance Co. He formerly was
associate medical director.
Cincinnati — Dr. Stanley E. Dorst, dean of the
University of Cincinnati College of Medicine,
spoke at the University of Cincinnati Day
banquet.
Cincinnati — Dr. Joseph Lindner spoke before
the Gate Club.
Cincinnati — Dr. Charles Goosmann spoke before
a meeting of the Lions Club on the importance
of early diagnosis and treatment of cancer.
Cleveland — Dr. Robert M. Stecher, one of the
founders of the Cleveland Health Museum, was
elected its president to succeed the late Dr.
Lester Taylor.
Cleveland — Dr. Alan R. Moritz, Western Re-
serve University School of Medicine, addressed
members and guests of the Women’s City Club,
advocating more adequate means of dealing with
sex offenders.
Cleveland — Dr. Claude S. Beck addressed a
meeting sponsored by the Junior League on the
subject, “What Surgery Can Do for Heart
Disease.”
Columbia — Dr. Marion G. Fisher, Oberlin, dis-
cussed public health before a meeting of the
Acme Grange.
Columbus — Dr. Robert E. S. Young discussed
proposed Federal compulsory health insurance
before the Northern Columbus Kiwanis Club.
Columbus — Dr. John E. Martin presented the
medical profession’s viewpoint in a forum on the
subject, “Socialized Medicine or Federal Health
Insurance” at the East Broad Street Church
of Christ.
Columbus — Dr. Robert C. Kirk presented the
medical profession’s viewpoint on national com-
pulsory health insurance proposals in a panel
discussion at a meeting sponsored by the War
Veterans Republican Club.
Columbus — Dr. Miner W. Seymour discussed
“Compulsory Health Insurance Qr Government
Controlled Medicine,” at a meeting of the Busi-
ness and Professional Women’s Club of Columbus.
Dayton — Dr. Samuel N. Maimon spoke on
“Gastrointestinal Allergy” at a meeting of the
Ohio Valley Allergy Society.
Dover — Dr. C. S. Palmer, Massillon, was main
speaker at the Chamber of Commerce civic
award banquet. His topic was “Aggressive
Citizenship — Safeguard of Freedom.”
Elyria — The physician’s viewpoint on “Social-
ized Medicine” was discussed by Dr. Raymond L.
Shilling at the March meeting of the Elyria
Republican Women’s Club. Part of his discus-
sion was based on observations on a recent trip
to Great Britain.
Elyria — Dr. I. M. Hinnant, Cleveland, explained
the medical profession’s stand on “Socialized
Medicine” in a panel discussion before the local
American Legion post.
Findlay — Dr. John H. Marshall spoke before
the Findlay Kiwanis Club on the subject of
dangers of atomic bombs. Dr. Marshall recently
606
The Ohio State Medical Journal
Doctor . . .
Here are two great Spot Tests that simplify urinalysis
GALATEST
ACETONE TEST
The simplest, fastest urine sugar
test known.
(DENCO)
For the rapid detection of Acetone in urine or in
blood plasma.
A LITTLE POWDER
A LITTLE URINE
COLOR REACTION IMMEDIATELY
Galatest and Acetone Test (Denco) . . . Spot Tests that require no
special laboratory equipment, liquid reagents, or external sources of
heat. One or two drops of the specimen to be tested are dropped upon
a little of the powder and a color reaction occurs immediately if acetone
or reducing sugar is present. False positive reactions do not occur.
Because of the simple technique required, error resulting from faulty
procedure is eliminated. Both tests are ideally suited for office use,
laboratory, bedside, and "mass-testing.” Millions of individual tests for
urine sugar were carried out in Armed Forces induction and separation
centers, and in Diabetes Detection Drives.
The speed, accuracy and economy of Galatest and Acetone Test (Denco)
have been well established. Diabetics are easily taught the simple
technique. Acetone Test (Denco) may also be used for the detection
of blood plasma acetone.
Write for descriptive literature
THE DENVER CHEMICAL MFG. CO., INC.
163 Varick Street, New York 13, N.Y.
BIBLIOGRAPHY
Joslin, E. P., et al: Treatment of
Diabetes Mellitus —
8 Ed., Phila., Lea & Febiger,
1946— P. 241, 247.
Lowsley, O. S. & Kirwin, T. J. :
Clinical "Urology —
Vol. 1, 2 Ed., Balt., Williams &
Wilkins, 1944— P. 31.
Duncan, G. G. :
Diseases of Metabolism —
2 Ed.. Phila., W. B. Saunders &
Co., 1947— P. 735, 736, 737.
Stanley, Phyllis: The American Jour-
nal of Medical Technology —
VoL 6, No. 6, Nov., 1940 and
VoL 9, No. 1, Jan., 1943.
Have You an Article in this Issue?
The Stoneman Press will still have the type standing on the June
Ohio State Medical Journal until the 7 Oth of the month and will
furnish reprints of your article at the following prices:
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for June, 1950
607
attended a conference in Washington at which
military and medical phases of the A-bombs
were discussed.
Hillsboro — Dr. A. M. Brenner addressed the
Rotary Club on the subject of “Atomic Weapons
and Medicine.”
Hudson — Dr. C. E. Kinney, Cleveland, spoke
before the Episcopal Men’s Club on the subject,
“A Doctor Looks at Europe With Some Ob-
servations on Socialized Medicine.”
Huron — Dr. Carl E. Swanbeck spoke before
the Rotary Club, relating experiences and ob-
servations on a recent trip to Panama and the
Canal Zone.
Mansfield — Dr. Harry Wain, Richland County
health commissioner, addressed members of the
Hedges P.-T. A., centering his talk around two
moving pictures on human reproduction and hu-
man growth.
Marion — Dr. Daniel M. Murphy was named a
director of the local Lions Club. Dr. Frederick
T. Merchant spoke before the Lions Club on the
subject, “Socialized Medicine.”
Marion — Dr. Frederick W. Rea was guest
speaker at a meeting of the Silver Street
P.-T. A., where he explained importance of the
pre-school clinic.
Mentor — Dr. I. M. Hinnant, Cleveland, spoke
on “Socialized Medicine” at a meeting of the
Mentor Woman’s Club.
Mentor — Dr. L. Warren Payne, Willoughby, de-
scribed work at the Painesville Cancer Clinic at
a meeting of the Mentor Child Study Club.
Nelson ville — Dr. J. L. Webb and Dr. W. H.
Hyde have been appointed to serve as joint
chiefs of staff of the new Mount St. Mary
Hospital.
Painesville — Dr. J. M. York has been ap-
pointed full-time medical director of the Dia-
mond Alkali Company’s Painesville plant. He
formerly held the same position on a part-time
basis.
Plain City — Dr. Robert A. Vogel, commissioner
of the Madison-Union-Delaware Health District,
spoke before the local Lions Club.
Portsmouth — Dr. Harry A. Schirrman was
commended by the U. S. Weather Bureau for his
nearly 47 years as official U. S. weather ob-
server at Portsmouth, and was the subject of a
feature article in the Portsmouth Times.
Racine — Dr. John Philson was the subject of
a human interest article in the Pomeroy Sentinel
on his 53rd anniversary in the medical profession.
Sandusky— Dr. N. Berneta Block is the new
Sandusky-Erie County health commissioner.
Sandusky — Dr. Ross M. Knoble spoke before
the local Kiwanis Club on the subject, “So-
cialized Medicine.”
Veterans Administration
Veterans Administration announced organiza-
tional changes in its Physical Medicine Rehabil-
itation Service placing greater medical emphasis
on the rehabilitation aspects of the service.
Specifically, the V. A. said, the former Educa-
tional Therapy and Manual Arts Therapy sec-
tions in hospitals and centers have been placed
under the administrative and professional super-
vision of the Chief of the Occupational Therapy
Section.
Dr. Paul B. Magnuson, Chief Medical Director
of the V. A., declared the move will “increase
the efficacy of these rehabilitative therapies by
providing administrative and professional super-
vision by a person (occupational therapist) with
a background of clinical training.”
The professional supervision by the Chief of
Occupational Therapy will make available to
the physician additional important information
essential for the over-all treatment of the pa-
tient.
This realignment, V. A. officials pointed out,
does not alter the professional direction and re-
sponsibility of the physician in charge of Phy-
sical Medicine Rehabilitation at the hospital.
Physical Therapy and Corrective Therapy sec-
tions continue reporting directly to the physician.
Manual Arts and Educational therapists will
continue to utilize their professional techniques
as heretofore for those patients whose illnesses
require those particular types of therapy.
% H* %
Bids are scheduled to be received in June
for the 500-bed Veterans Administration Hos-
pital to be built in the Wade Park-E. 105th
Street area of Cleveland. Officials expect the
hospital to be ready for occupancy in the early
part of 1952. Cost will be approximately
$5,000,000.
The new hospital will be restricted to medical
and surgical cases, according to reports in the
public press, and will replace Crile Veterans
Hospital in that respect.
It is also planned that a new 1,000-bed neuro-
psychiatric hospital will be built on the present
site of Crile Veterans Hospital shortly after
the other hospital is completed.
The joint Veterans Commission of Cuyahoga
County has recommended simultaneous construc-
tion of the two hospitals to avert any patient
pinch during the interim period.
*
Twenty-six new Veterans Administration hos-
pitals and 6 major additions to existing V. A.
hospitals are scheduled for completion during
calendar year 1950, F. H. Dryden, V. A. assist-
ant administrator for Construction, Supply and
Real Estate, announced.
608
The Ohio State Medical Journal
THE NEW YORK POLYCLINIC
MEDICAL SCHOOL AND HOSPITAL
(Organized 1881)
THE PIONEER POST-GRADUATE MEDICAL INSTITUTION IN AMERICA
DERMATOLOGY AND SYPHILOLOGY
A three year coarse, beginning in October, fulfilling all
the requirements of the American Board of Dermat-
ology and Syphilology.
SYMPOSIUM FOR SPECIALISTS
A full time course of five days’ duration. . A review of
recent advances in Dermatology and Syphilology, con-
sisting of lectures and demonstrations; discussion of
the rarer dermatoses with lantern slide illustrations.
eye, ear, nose, and throat
A combined full time course covering an academic year
(9 months). It consists of attendance at clinics, witness-
ing operations, lectures, demonstration of cases and
cadaver demonstrations; operative eye, ear, nose and
throat on the cadaver; head and neck dissection
(cadaver); clinical and cadaver demonstrations in bron-
choscopy, laryngeal surgery and surgery for facial
palsy; refraction; radiology; pathology; bacteriology;
embryology; physiology; neuro-anatomy; anesthesia;
physical medicine; allergy; examination of patients pre-
operatively and follow-up post-operatively in the wards
and clinics. Also refresher courses (3 months).
SYMPOSIUM ON DERMATOPATHOLOGY
A full time course of five days’ duration comprised of
didactic lectures, microprojection of illustrative mate-
rial and study of microscopic slides under supervision.
SYMPOSIUM for GENERAL PRACTITIONERS
A full time course of five days’ duration. A review of
recent advances in the diagnosis and treatment of the
more common disorders of the skin, including syphilis,
comprising lectures, lantern slide demonstrations, presen-
tation of cases and histopathological material.
For the GENERAL PRACTITIONER
Intensive full time instruction in those subjects which
are of particular interest to the physician in general
practice, consisting of clinics, lectures and demonstra-
tions in the following departments — medicine, pedia-
trics, cardiology, arthritis, chest diseases, gastroen-
terology, diabetes, allergy, dermatology, neurology,
minor surgery, clinical gynecology, proctology, peri-
pheral vascular diseases, fractures, urology, otolaryn-
gology, pathology, radiology. The class is expected to
attend departmental and general conferences.
For Information Address
345 WEST 50th STREET MEDICAL EXECUTIVE OFFICER NEW YORK CITY 19
INGLESIDE FARM INGLESIDE HOME
Hospitals for Nervous and Mental Disorders
VIEW AT INGLESIDE FARM
THE FARM - Chardon, Ohio
Telephone Chardon 355
Medical Director, Neil T. McDermott, M.D.
THE HOME - 8821 Euclid Ave.
Cleveland, Ohio Cedar 5416
Mabel A. Woodruff, Director
Facilities for
Chronics and Convalescents
jor June, 1950
609
In Memoriam
• • •
William Frederick Bay, M. D., Bradenton, Fla.;
Ohio Medical University, Columbus, 1894; aged
76; died March 28; former member of the Ohio
State Medical Association through 1929. Dr.
Bay formerly practiced at Clyde.
Henry Clay Burson, M. D., Seattle, Wash;
Toledo Medical College, 1896; aged 81; died
March 1. Dr. Burson practiced in Toledo and
vicinity many years ago.
Ernest Fleetwood Cox, M. D., Columbus; Ohio
Medical University, Columbus, 1906; aged 73;
died March 8; former member of the Ohio State
Medical Association and the American Medical
Association through 1947. Dr. Cox practiced his
profession in Columbus for approximately 44
years, and for a number of years was physician
for the City of Columbus. He was a member of
the Second Baptist Church and the Masonic
Lodge and was a trustee of the Godman Guild.
Surviving are his widow, a daughter, two sisters
and two brothers.
Carl Floyd Hartmann, M. D., Wauseon; Rush
Medical College, Chicago, 1909; aged 66; died
April 18; member of the Ohio State Medical
Association and the American Medical Associa-
tion through 1947. Dr. Hartmann practiced
medicine in Fulton County for almost 40 years.
He served for four years as county coroner and
for 29 years as county health commisisoner. A
veteran of World War I, he was active in the
local American Legion Post, and was active in
several Masonic orders. Surviving are his
widow, a daughter, a son and two sisters.
Lewis P. Jackson, M. D., Columbus; Starling
Medical College, Columbus, 1898; aged 82; died
February 5; former member of the Ohio State
Medical Association and the American Medical
Association. Dr. Jackson had retired from
practice many years ago.
Frank Theodore Kopf stein, M. D., Cleveland;
University of Wooster Medical Department,
Cleveland, 1896; aged 83; died May 7; former
member of the Ohio State Medical Association
and the American Medical Association through
1946. Dr. Kopfstein had practiced medicine in
Cleveland for 54 years and was among Cleveland
doctors approved to receive the 50-Year Pin
and Certificate of the Ohio State Medical Asso-
ciation. He was a member of the Episcopal
Church and several Masonic orders. Three
brothers and two sisters survive.
James Morris Lantz, M. D., Lancaster; Ohio
State University College of Medicine, 1908;
aged 68; died April 30; former member of the
Ohio State Medical Association and the Ameri-
can Medical Association through 1947; Dr.
Lantz had practiced his profession in Lancaster
from 1908 until his retirement about five years
ago. He was a veteran of World War I. Sur-
viving are his widow and a son.
Harvey E. Massey, M. D., Sharon, Pa.; Starling
Medical College, 1911; aged 65; died March 11 in
Florida; former member of the Ohio State Medi-
cal Association and the American Medical Asso-
ciation. Dr. Massey practiced at Marshallville
before moving to Pennsylvania many years ago.
Irwin William Mayberry, M. D., Dobbston;
University of Cincinnati College of Medicine,
1911; aged 63; died April 21. Dr. Mayberry
formerly practiced in Huntington, W. Va., and
moved to Dobbston in 1930. Surviving are a son
and a brother.
Ray A. Nixon, M. D., Eau Claire, Wise.; Ohio
State University College of Medicine, 1911; aged
62; died April 25 at Fondulac, Wise. Dr. Nixon
formerly practiced in Stratton and Toronto
(Ohio) before moving to Wisconsin about 30
years ago. Surviving are his widow, a daughter,
two brothers and three sisters.
William Ravine, M. D., Cincinnati; Medical Col-
lege of Cincinnati, 1909; aged 66; died April 11;
member of the Ohio State Medical Association
and a Fellow of the American Medical Associa-
tion; diplomate of the American Board of Psy-
chiatry and Neurology; member of the American
Psychiatric Association. Dr. Ravine had served
all of his professional career in Cincinnati with
the exception of the time he served in the
Medical Corps during World War I and time
spent in study abroad. He was consultant to
the Department of Psychiatry at Jewish Hos-
pital and served the Court of Domestic Relations
as psychiatrist. Other activities included mem-
bership in Wise Center Temple, B’nai B’rith Club
and the Optimist Club. His widow survives.
William Rigelhaupt, M. D., Cleveland; Western
Reserve University School of Medicine, 1911;
aged 68; died April 9; former member of the
Ohio State Medical Association and a Fellow
of the American Medical Association through
1947. Dr. Rigelhaupt was on the active staff
of Lutheran Hospital. His widow survives.
Anton Benjamin Spurney, M. D., Cleveland;
University of Wooster Medical Department,
Cleveland, 1902; aged 71; died May 1; former
member of the Ohio State Medical Association
and a Fellow of the American Medical Associa-
tion through 1945; member of the American
College of Surgeons. Dr. Spurney had prac-
ticed his profession in Cleveland for approxi-
mately 48 years. During World War I he
served in the Medical Corps. He was active
in the development of Polyclinic Hospital and
610
The Ohio State Medical Journal
When
Tempted
by Forbidden Foods
So she weakens — she goes on an ice cream bender.
Will she return to the prescribed course of calorie-counting, or will this
be the turning point when many physicians prescribe Desoxyn
Hydrochloride? There’s good reason for prescribing Desoxyn — a little
goes a long way. Small daily doses decrease the craving for food,
increase the energy output and impart a feeling of well-being
which encourages dietary adherence.
Smaller dosage is possible because weight for weight Desoxyn is more
potent than other sympathomimetic amines. One 2.5-mg. tablet
before breakfast and another about an hour before lunch is usually
sufficient. A third tablet may be taken in midafternoon if necessary,
and if it does not cause insomnia. Investigators have shown, too,
that Desoxyn has a faster action, longer effect and relatively few
side-effects. With judicious use Desoxyn is safe, simple and effective.
Why not give it a trial? On it may lean the continued p p
cooperation of a sweet-famished obese patient. v^UUO'LL
TABLETS
2.5 mg. and 5 mg.
ELIXIR
20 mg. per fluidounce
(2.5 mg. per fluidrachm)
AMPOULES
20 mg. per cc.
PRESCRIBE
DESOXYN
®
Hydrochloride
( Methamphetamine Hydrochloride, Abbott)
jor June, 1950
611
had been a member of its staff since it was
organized. Surviving are his widow and a son.
Orville Jackson Walker, M. D., Youngstown;
University of Pittsburgh School of Medicine,
1915; aged 61; died April 27; member of the
Ohio State Medical Association and a Fellow
of the American Medical Association; vice-
president of the Mahoning County Medical So-
ciety in 1940 and president in 1941; delegate to
the Ohio State Medical Association, 1936-39;
diplomate of the American Board of Otolaryng-
ology; member of the American Academy of
Ophthalmology and Otolaryngology; member of
the Association for Research in Ophthalmology.
Following completion of service during World
War I, Dr. Walker began his practice in Youngs-
town. In addition to his medical career, he was
active in numerous civic and fraternal activities;
was a member of the Presbyterian Church, the
Elks Club, the Youngstown Club, the Masonic
Lodge, the Southside Merchants and Civic As-
sociation and Phi Rho Sigma. Surviving are his
widow, two sons and two brothers.
John Peterson Young, M. D., Empire; Balti-
more Medical College, 1894; aged 90; died April
8; former member of the Ohio State Medical
Association and the American Medical Associa-
tion through 1940. Dr. Young had practiced his
profession in Jefferson County for more than
50 years. Recently he was honored by being
presented the 50- Year Pin and Certificate of
the Ohio State Medical Association. He was
Jefferson County Health Commissioner from
1919 until 1940 when he retired from active
practice. Other activities include memberships
in the Methodist Church, the Masonic Lodge and
the Knights of Pythias. Surviving are two
sons, one of whom is Dr. John W. Young of
Empire and Steubenville, and a sister.
Dr. Shaffer To Direct Workshop
In School Health
The third annual School Health Education
Workshop will be held on the Ohio State Univer-
sity campus, Columbus, for three weeks begin-
ning on June 20. The workshop is designed for
school physicians and nurses, school administra-
tors and others interested in school health.
Special emphasis will be given to these con-
siderations: health needs of school-age children;
recognition of physically handicapped children;
teacher-nurse-physician cooperation; understand-
ing the worries of children; use of resources in
teaching health; community participation in
health activities of the school.
Further information may be obtained from:
Dr. Thomas E. Shaffer, Workshop Director,
Room 8, The University School, Ohio State Uni-
versity, Columbus 10, Ohio.
Four Members Are Reappointed On
Hospital Advisory Council
Dr. John D. Porterfield, director of the Ohio
Department of Health, announced reappoint-
ment for four-year terms of four members of
the Hospital Advisory Council, whose terms had
expired.
Those reappointed, all of whom have served
since organization of the Advisory Council, are:
Dr. George A. Woodhouse, Pleasant Hill; Mr..
Charles S. Nelson, Columbus, Executive Secre-
tary of the Ohio State Medical Association; Mr.
W. L. Benfer, Superintendent of Toledo Hospital;
and Mr. Artee Fleming, Akron attorney.
The Council acts in an advisory capacity to the
Office of Hospital Facilities of the Ohio De-
partment of Health which administers Federal
grants-in-aid toward hospital construction under
the Hill-Burton Law.
Dr. Porterfield is ex officio chairman of the
Council. Judge John H. Lamneck, director of
Public Welfare, is an ex officio member, and
Anthony J. Borowski, Dr. P. H., administrator of
the Office of Hospital Facilities, is its secretary.
Other members are: Dr. M. F. Steele, super-
intendent of Christ Hospital, Cincinnati; Mr.
Robert M. Porter, administrator of Children’s
Hospital, Columbus; Mr. Guy J. Clark, execu-
tive secretary of the Cleveland Hospital Council;
Monsignor Robert A. Maher, director of the
department of health and hospitals for the
Catholic diocese of Toledo ; Mr. Charles F.
Owsley, Youngstown architect; Miss Nell Robin-
son, superintendent of East Liverpool Hospital;
Mrs. Frances Hoffman, Columbus Metropolitan
Health Council; Mr. Harry W. Culbreth, Ohio
Farm Bureau; Mr. Joseph W. Fichter, master of
the Ohio State Grange; Dr. J. F. Bateman, di-
rector of the Columbus State Hospital; Dr. Ralph
L. Rutledge, Alliance; and Dr. Joseph B. Stock-
len, comptroller of Tuberculosis for Cuyahoga
County.
Fort Steuben Academy
The Fort Steuben Academy of Medicine had
as guest speaker at its April 11 meeting, Dr.
Henry L. Bockus, University of Pennsylvania
Graduate School of Medicine, who spoke on
“Recent Advances in Treatment in the Field
of Gastroenterology.”
Dr. Joseph DeLor, Ohio State University Col-
lege of Medicine, Columbus, opened discussion
on the presentation. Dr. Carl A. Lincke, Car-
rollton, President of the Ohio State Medical
Association, acted as chairman of the dis-
cussion.
Members of the Academy heard a talk by
Dr. Thomas Francis, Jr., of the University of
Michigan School of Public Health, on “The
Control of Acute Respiratory Diseases,” on
March 14.
612
The Ohio State Medical Journal
Ohio Supreme Court Rules Out
Medical Texts in Evidence
The Ohio Supreme Court early in April held
that medical books or treatises, even though
properly identified and authenticated and shown
to be recognized as standard authorities on the
subjects to which they relate, are not admissible
in evidence to prove the truth of the statements
therein contained.
The ruling was made in the case of Hallworth
v. Republic Steel Corporation. Hallworth suf-
fered an injury while working for the appel-
lant when a piece of metal struck him on the
back of the neck, and possibly back of head,
and died 20 days later of a cerebral hemorrhage.
The widow filed a claim for death benefits
under the Workmen’s Compensation Act, against
the defendant, a self-insurer. The claim was
disallowed by the Industrial Commission on
original hearing and on rehearing.
An appeal was filed in the Common Pleas
Court. The case was tried before a jury which
returned a verdict for the plaintiff, the widow.
The trial court granted motion for a new trial
on the ground that the verdict was not sustained
by sufficient evidence. The jury again returned
a verdict for the plaintiff. The Common Pleas
Court overruled defendant’s motion for judg-
ment and rendered judgment for the plaintiff
on the verdict.
Defendant appealed to the Court of Appeals
which affirmed the judgment of the Common
Pleas Court.
In testimony before the jury in Common Pleas
Court, the defendant’s physician witness was
cross-examined by plaintiff’s counsel reading
portions from the medical text. In regard to
this examination, the Supreme Court opinion
stated: “No objection was made by defendant
to this cross-examination (of the witness), so
that the question, as to whether such cross-
examination was or was not proper, is not
directly before the court in this case.”
At the conclusion of the cross-examination,
the Common Pleas Court accepted the text in
evidence. This the Supreme Court found
erroneous. The opinion in part read: “. . .Ad-
mission in evidence of such a book or treatise
or any part thereof would, in effect, admit into
evidence the testimony of the author of the
book without affording to opposing counsel any
opportunity to cross-examine him. Furthermore,
the court would, in effect, be allowing the author
to testify without having required him to take
the usual oath required of a witness.”
Dr. and Mrs. George Crile, Jr., Cleveland,
presented their new all-color film, “The Under-
seas World,” in the Masonic Auditorium, as
part of “Round the World Adventure Series.”
DRINK
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You trust
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for June, 1950
613
Activities of County
First District
(COUNCILOR: D. W. HEUSINKVELD, M. D.,
CINCINNATI)
ADAMS
At a luncheon meeting of the Adams County-
Medical Society on April 20, Dr. Elmer P. R.
Maurer, Cincinnati, discussed “Carcinoma of the
Lung.” A business meeting preceded the lunch-
eon and scientific program.
CLINTON
Dr. Anson L. Brown, Columbus, was guest
■speaker at the April 4 meeting of the Clinton
County Medical Society. His discussion was
based on a film shown to the group, “Papani-
colaou Technique for Early Diagnosis of Cancer.”
HAMILTON
Dr. Hilde Bruch, College of Physicians and
Surgeons, Columbia University, spoke during
a joint program of the Academy of Medicine
of Cincinnati and the Nutrition Council of the
Public Health Federation on April 4, on the
subject, “The Psychology of Obesity.” Her
paper was discussed by Drs. Maurice Levine,
Cecil Striker, Richard Wolf and Kurt Tschiassny.
“Factors in the Control of Bleeding” was the
topic of a discussion by Walter H. Seegers,
Ph. D., Wayne University College of Medicine,
at the April 18 meeting of the Academy.
At the May 2 meeting, Dr. William F. Mengert,
Southwestern Medical College, Dallas, Tex.,
spoke on the subject, “Management of Men-
.strual Irregularities.”
Second District
(COUNCILOR: M. D. PRUGH, M. D., DAYTON)
CLARK
Dr. C. W. Hullinger, Springfield, spoke on
“Postural Backache” at the March 20 meeting
of the Clark County Medical Society in the
Ker-Deen Inn. On April 6 the regular business
meeting of the Society was held in the same
place.
Dr. Morton S. Bryer, Johns Hopkins Univer-
sity School of Medicine, Baltimore, spoke on
the subject, “The Clinical Use of the Newer
Antibiotics,” at the April 24 meeting of the
Society.
DARKE
“The Fenestration Operation for Deafness”
was discussed by Dr. Robert E. Boswell, Day-
ton, at the April 18 meeting of the Darke
County Medical Society in Greenville.
GREENE
The Greene County Medical Society and three
other neighboring county medical societies spon-
sored a symposium and scientific meeting at the
Societies . . .
Fels Research Institute in Yellow Springs on
April 19. Other sponsors of the meeting were
the Clinton, Fayette and Highland County Medi-
cal Societies.
Speakers and subjects discussed included the
following:
Dr. F. C. Ottati, Indianapolis, Ind., of the
Eli Lilly & Co., “Newer Concepts of Antibiotics.”
Dr. Nathan R. Abrams, University of Cin-
cinnati College of Medicine, “Medical Aspects
of Arthritis.”
Dr. Robert Perlman, University of Cincin-
nati College of Medicine, “Management of
Chronic Arthritis.”
Dr. Richard Patton, Ohio State University
College of Medicine, Columbus, “Diagnosis of
Acute Abdomen.”
Speaker of the evening session was Hon.
Paul M. Herbert, former lieutenant governor of
Ohio and former state commander of the Ameri-
can Legion, Department of Ohio.
The Greene County Medical Society is now
publishing a printed bulletin. Editors are Dr.
R. W. Barry and Dr. R. D. Hendrickson, presi-
dent and secretary, respectively, of the Society.
Mr. Frank C. Bateman, of Springfield, has been
appointed executive secretary of the Society
and is managing editor and business manager
of the publication.
MONTGOMERY
Dr. Stanley E. Dorst, dean of the University
of Cincinnati College of Medicine, was guest
speaker at the May 12 meeting of the Mont-
gomery County Medical Society at the Engin-
eer’s Club in Dayton. His discussion on the
subject, “Medical Training in Great Britain
Under the Program of Nationalized Health,”
was based on a recent visit in England which
he made as a member of an A. M. A. committee
to study health and medical services in that
country.
Third District
(COUNCILOR: J. CRAIG BOWMAN, M.D.,
UPPER SANDUSKY)
SENECA
Dr. Bert Seligman, Toledo, was speaker at
the regular meeting of the Seneca County Medi-
cal Society on April 17 in Tiffin. His discussion
was based on the differential diagnosis of
lymphedema.
Fourth District
(COUNCILOR: CARLL S. MUNDY, M. D., TOLEDO)
LUCAS
The scientific program of the Academy of Medi-
cine of Toledo and Lucas County for April in-
cluded the following features:
Section on Pathology, Experimental Medicine
614
The Ohio State Medical Journal
and Bacteriology, April 7 — “Acute Dilation of
the Stomach,” Dr. A. E. Rhoden; “Necrotizing
Papillitis,” Dr. M. F. Vidoli.
Postgraduate Program, April 14 — “The Pres-
ent Status of Anti-Coagulant Therapy,” Dr.
G. DeTakats, Chicago; “Paroxysmal Ventricular
Tachycardia, Its Importance, Diagnosis and
Management,” Dr. G. K. Fenn, Chicago.
General Practice Section, April 18 — “Office
Urology,” Dr. A. S. Avery, Toledo.
Medical Section, — “Electrophoretic Changes in
Hemoglobin in Various Types of Anemia,” Dr.
G. Watson James, Richmond, Va.
The annual meeting of the Toledo Medical
Library Association was held with a banquet at
the Hillcrest Hotel on April 28. Dr. H. F.
Howe was program chairman.
WOOD
The Wood County Medical Society held its
regular dinner meeting at the Midway Rest-
aurant, Perrysburg, on April 20. Dr. Raymond
N. Whitehead presided.
This was a joint meeting with the Fourth
District Chapter of the American Academy of
General Practice.
Dr. Herman Mannhardt, President of the Acad-
emy, gave a short talk on the aims and work
of that organization and introduced Dr. Way-
land B. Recker, of Liepsic, past-president, who
gave a short report on the St. Louis meeting
and plans for the future. He said the Academy
was growing very rapidly. The new magazine
GP was shown and excited interest among
those present.
Dr. George H. Lemon, of the Lucas County
Chapter, talked on the Intern situation and in-
troduced a resolution making for better distri-
bution of Interns among University and non-
university connected hospitals. The resolution
was passed unanimously.
The paper of the evening was given by Dr.
George Booth, Toledo, on “The Sciatic Syn-
drome; Its Diagnosis and Treatment.” His talk
was well illustrated with slides. The cause of
the characteristic symptoms w*as discussed to-
gether with treatment.
This was an informative paper based largely
on Dr. Booth’s wide experience in neurosurgery.
A rising vote of thanks was tendered Dr. Booth.
Fifth District
(COUNCILOR: FRED W. DIXON, M. D„ CLEVELAND)
ASHTABULA
The Ashtabula County Medical Society met at
Chapman’s Diner at Geneva on April 11. Dr.
C. T. Risley, Conneaut, president, was in charge.
The former secretary, Dr. John B. Hall, of
Geneva, read the minutes of the last meeting in
the absence of the secretary.
The speaker of the evening was Dr. Arthur
F. Young, Cleveland, whose subject was “Cor-
order your
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615
onary Heart Disease." He discussed new
methods of artery injections using radiopaque
material to study postmortem specimens. He
also discussed Sellensinger’s group, maintain-
ing that all coronary artery disease falls in
these patterns. He maintained that 40 per cent
appeared to be balanced, 40 per cent organized
in the right artery and 20 per cent in the left
artery. The speaker said that it is thought
that the coronary pattern may follow the heredity
pattern and that anemia may cause early cor-
onary anastomosis. The speaker expressed
definite value in anticoagulants. It was thought,
he said, that Vitamin E had proven of little
value in coronary heart disease.
CUYAHOGA
Miss Anna Freud, of London, England, daugh-
ter of Sigmund Freud, was guest speaker at
the April 26 meeting of the Cleveland Academy
of Medicine where she spoke on the psychological
aspects of caring for children in hospitals. She
was introduced by Dr. Douglas D. Bond, of the
psychiatry department, Western Reserve Uni-
versity School of Medicine.
LAKE
Members of the Lake County Medical Society
were guests on April 5 of the Industrial Rayon
Corporation, at a dinner at the Painesville
plant. Dr. John Rausch Kolb, Cleveland, was
guest speaker on the topic, ‘‘Industrial Derma-
toses." Dr. C. B. Elliott, Painesville, was re-
sponsible for program arrangements.
Sixth District
(COUNCILOR: PAUL A. DAVIS, M. D., AKRON)
COLUMBIANA
Fifty-year Pins and Certificates of the Ohio
State Medical Association were presented to
three members of the Columbiana County Medi-
cal Society at the April 18 meeting. Dr.
Paul A. Davis, Akron, Councilor of the Sixth
District, made the presentations.
Those who received the awards are Dr. H. J.
Pelley, Hanoverton; Dr. W. A. McCommon, East
Palestine; and Dr. A. B. Hobson, Salem.
Although Doctors McCommon and Hobson
were unable to attend because of poor health,
Dr. Pelley, still active and practicing at the
age of 86, was present to receive the certificate
and pin. Dr. Pelley stated that he is still “on
call 24 hours a day, seven days a week, and
intend to be as long as I am able." He re-
ceived his M. D. degree from Western Pennsyl-
vania Medical College, now the University of
Pittsburgh Medical College, in 1892, and took
his postgraduate training in the New York
Polyclinic Hospital in 1901. He is an honorary
staff member of the Salem Central Clinic Hos-
pital. He is the only practicing physician in
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mann-Jones Company, Cleveland — The Crocker-Fels Com-
pany, Cincinnati — The Rupp & Bowman Company, Toledo —
Lyons Physicians Supply Company, Youngstown.
616
The Ohio State Medical Journal
A
Hanoverton and the surrounding rural area,
the Society secretary reported, because as Dr.
Pelley stated, “the people still need me.”
The scientific portion of the meeting was high
lighted by an illustrated lecture on the “Present
Management of Hypertensive Diseases,” pre-
sented by Dr. Robert Taylor, of Cleveland.
PORTAGE
The heart revascularization operation de-
veloped by Dr. Claude S. Beck, of Cleveland,
with the assistance of Dr. David S. Leighninger,
was described by Dr. Leighninger at the April
13 meeting of the Portage County Medical So-
ciety in Ravenna.
SUMMIT
“The Challenge of Longevity” was the topic
of a talk by Dr. Edward J. Stieglitz, Washing-
ton, D. C., at the May 2 meeting of the Summit
County Medical Society in Akron.
Seventh District
(COUNCILOR: R. J. FOSTER, M. D., NEW
PHILADELPHIA)
BELMONT
“The Use of Digitalis in Heart Failure,” was
the title of a film which was the basis of the
scientific program of the Belmont County Medi-
cal Society on April 13 in the Martins Ferry
Hospital. The program was presented by the
hospital staff with Dr. H. H. Murphy, Society
President, in charge.
Dr. Charles D. Hershey, of the Wheeling Clinic,
spoke on “Peripheral Vascular Disorders” at the
May 11 meeting of the Belmont County Medical
Society at the Belmont Hills Country Club.
Members of the Auxiliary were guests.
TUSCARAWAS
Dr. Phillip T. Doughten was accepted as a
new member in the Tuscarawas County Medical
Society at the April meeting. He is a graduate
of Western Reserve University School of Medi-
cine and served in the Air Forces as a captain
from Sept., 1947, to 1949. He will practice
Trom his office in New Philadelphia.
The secretary reported that Dr. John C.
Blinn, who was severely injured in an auto ac-
cident February 13, was removed late in April
Trom Union Hospital to his home in New
Philadelphia.
Eighth District
(COUNCILOR: CHESTER P. SWETT, M. D., LANCASTER)
MUSKINGUM
Dr. Kenneth H. Abbott and Dr. James R. Gay,
both of Columbus, spoke on “Trauma of Head
and Cervical Spine” at the April 5 meeting of
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the Muskingum County Academy of Medicine in
Zanesville.
PERRY
Six Perry County physicians have been hon-
ored, one of them posthumously by being
awarded the 50-Year Pin and Certificate of the
Ohio State Medical Association. Dr. Chester
P. Swett, Lancaster, Councilor of the Eighth
District of the Association, made the presenta-
tions. Those so honored by being presented the
awards personally are Dr. James Miller, Corn-
ing; Dr. Harry W. Shaw, New Lexington; Dr.
John F. Switzer, New Straits ville; Dr. Marcus
0. Smith, New Straitsville, and Dr. Frank R.
Clemson, Thornville. Dr. Swett presented the
award to the widow and son of Dr. John G.
McDougal, late of New Lexington.
Ninth District
(COUNCILOR: J. PAUL McAFEE, M. D.,
PORTSMOUTH)
LAWRENCE
Nearly a hundred persons, including doctors,
their wives and guests attended the Ninth Dis-
trict Conference held in Ironton on April 27.
The Lawrence County Medical Society was host
to the district conference.
A team of three physicians invited by the
Cancer Committee of the Ohio State Medical As-
sociation presented the scientific program on the
subject, “Cancer of the Uterus.” Dr. Hans G.
Schlumberger presented the subject from the
standpoint of the pathologist; Dr. Joseph L.
Morton spoke on radiological aspects; and Dr.
Charles H. Hendricks gave the surgical aspects.
The presentation was in the form of a panel
discussion.
The Woman’s Auxiliary to the Lawrence
County Medical Society with Mrs. G. Newton
Spears as president served tea for the ladies
in the Elks parlors. Dr. Ralph F. Massie con-
ducted the doctors on a tour of the new addi-
tion to the Lawrence County General Hospital.
Dinner was served at the Episcopal Church parish
house.
Following the dinner, Dr. Daniel J. Webster,
Ironton, was presented the 50-Year Pin and
Certificate of the Ohio State Medical Association
by Dr. J. P. McAfee, Portsmouth, Ninth District
Councilor.
Mr. George H. Saville, Columbus, public rela-
tions director for the Ohio State Medical Asso-
ciation, spoke on the subject, “Present Status
of Medical Public Relations.”
PIKE
Officers of the Pike County Medical Society for
the year are Dr. C. L. Critchfield, Waverly,
president; and Dr. Albert M. Shrader, Waverly,
secretary. Dr. Critchfield was secretary for the
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The Ohio State Medical Journal
preceding year and succeeds Dr. Charles A.
Clifton, of Piketon, as president.
SCIOTO
Guest speaker at the April 10 meeting of the
Hempstead Academy of Medicine was Dr. Rob-
ert J. Tapke, Cincinnati, whose topic was “Car-
cinoma of the Colon.” A buffet lunch was served
at the Nurses’ Recreation Hall of General
Hospital.
At the May 8 meeting of the Academy, Dr.
Norman 0. Rothermich, Ohio State University
College of Medicine, Columbus, discussed the
subject, “Further Treatment of Diabetes.”
Tenth District
-(COUNCILOR: H. M. CLODFELTER, M.D., COLUMBUS)
PICKAWAY
Pickaway County Medical Society honored three
physicians, one posthumously, for a half cen-
tury or more of practice by awarding them
50-Year Pins and Certificates of the Ohio State
Medical Association. The dinner meeting was
held on April 20.
Those so honored are Dr. George R. Gardner,
Ashville; Dr. A. W. ^Holman, formerly of
Circleville but now of Columbus; and the late
Hr. Dudley V. Courtright whose award was
presented to his. son at the banquet.
Awards were presented by Mr. Charles S.
Nelson, Columbus, Executive Secretary of the
.Association. Dr. Jasper M. Hedges was toast-
master for the occasion. Dr. Lloyd Jonnes spoke
in praise of the honored doctors.
ROSS
Four Ross County physicians were honored,
two of them posthumously, by the Ross County
Medical Society. Dr. William L. Counts and
Dr. 0. P. Tatman, both of Chillicothe, were
presented the 50- Year Pin and Certificate of
the Ohio State Medical Association. The same
awards were presented to the widows of the
date Dr. Charles C. Hatfield, Kingston, and
the late Dr. O. L. Iden, of Chillicothe. Dr.
Ralph W. Holmes, Dr. Loy E. Hoyt and Dr.
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Medical Director
BARCLAY J. MacGREGOR
Registrar
29 Geneva Rd., Wheaton, Illinois (near Chicago)
ffor June, 1950
619
Albert E. Merkle, representing the Ross County
Medical Society, made the presentations.
Eleventh District
(COUNCILOR: JOHN S. HATTERY, M. D„ MANSFIELD)
LORAIN
Dr. Robert W. Heinle, Cleveland, spoke on
“The Anemias” at the April 4 meeting of the
Lorain County Medical Society. Dr. Swen D.
Nielson, president, presided at a business meet-
ing following the scientific program.
The Postgraduate Symposium conducted by
a team from the University of Illinois College
of Medicine, and presented by the Lorain County
Medical Society drew more than 70 doctors to
the Spring Valley Country Club, Elyria, on
April 26.
The guest doctors and their subjects were:
Dr. Max M. Montgomery, “Present Status of
Antibiotic Therapy”; Dr. William Requarth,
“Surgical Therapy of Pancreatic Disease”; Dr.
Louis R. Limarzi, “Present Status of Therapy of
Hematological Diseases”; Dr. Edmund F. Foley,
“Jaundice”; and Dr. Willard 0. Thompson,
“Treatment of Thyrotoxicosis.”
Following dinner, Dr. Thompson again ad-
dressed the group on the subject, “Clinical Ap-
plications of Cortisone and ACTH.” Dr. Nielsen
presided at the meeting.
RICHLAND
Members of the Richland County Medical So-
ciety and the medical staff of the Mansfield Gen-
eral Hospital held a combined meeting at the
hospital on April 27. Dinner was followed by a
business meeting and scientific program.
Speaker on this occasion was Dr. H. Keith
Fischer, Philadelphia, Pa., who spoke by ar-
rangement with the Ohio State Mental Hygiene
Association, on the subject, “Psychiatric Basis
for General Medicine.”
Special Instructional Course On
“Complications Of Anesthesia”
“Complications of Anesthesia” is the subject
of an Instructional Course sponsored by the
Ohio Society of Anesthesiologists. It will be
held at the University Hospital in Columbus on
Saturday, June 24, 1950. A clinical session will
start at 8:00 a. m., and a number of anesthetic
techniques will be demonstrated. This will be fol-
lowed by a luncheon at the Faculty Club. The
afternoon session will begin at 1:30 and will be
devoted to discussions on anesthetic complica-
tions. The physiologic mechanisms and the in-
fluence of drugs, methods and coincidental dis-
ease will be stressed. There is no registration
fee, and all physicians interested in anesthesia
are invited to attend.
W. H. MILLER, M. D.
328 East State Street
COLUMBUS 15, OHIO
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The Ohio State Medical Journal
Woman’s Auxiliary . . .
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
President — Mrs. C. W. Kirkland, 4805 Guernsey Street,
Bellaire
Recording Secretary — Mrs. C. H. Bell, 754 Dickson Parkway,
Mansfield
Treasurer — Mrs. A. Paul Hancuff, 3551 Maxwell Road,
Toledo 13
OHIO DOCTOR’S WIFE HONORED
Mrs. William F. Marting of Ironton — a mem-
ber of the Woman’s Auxiliary to the Lawrence
County Medical Society — was signally honored
this year being named the Ohio Mother for 1950.
In addition to being the wife of a doctor, Mrs.
Marting, seventy-seven years old, is the mother
of three doctors — Dr. Anne D. Alstott of Iron-
ton, Dr. Miriam R. Marting of Ironton, and Dr.
Esther Marting Fabing of Cincinnati. Mrs.
Marting is prominent in club, civic, church, and
community projects. She was given the award
by the Woman’s Forum of Cleveland which spon-
sored the state-wide competition. The judges
who made the selection included three Cleve-
land newspaper editors, a judge of the municipal
court and the general secretary of the Cleveland
Y. M. C. A.
AUGLAIZE
The Auxiliary to the Auglaize County Medi-
cal Society met at the home of Mrs. E. F. Heff-
ner on Wednesday evening, April 19. Mrs. Karl
Kohler spoke on “The School Health Program.”
BUTLER
“Socialization of medicine is the first planned
step to make the United States a socialist na-
tion,” Dr. E. 0. Swartz, president-elect of the
Ohio State Medical Association, told members of
the Butler County Auxiliary at a luncheon meet-
ing on April 25 at the Manchester Hotel. Dr.
Swartz urged the auxiliary members to help
in educating the public to the dangers of the
program.
“The Job We Have to Do” was the theme of
Dr. Swartz’s talk. Annual election of officers
also featured the April meeting at which Mrs.
William Neel of Middletown was chosen presi-
dent-elect. Mrs. Paul Ivans becomes the new
president, succeeding Mrs. W. H. Henry. Other
officers elected included: Mrs. William Jacobs,
vice-president; Mrs. C. J. Chamberlain, corre-
sponding secretary; Mrs. Ralph Leyer, recording
secretary; Mrs. Robert Wilson, treasurer; and
Mrs. Kenneth Smith, director.
Mrs. Neel was chairman of arrangements for
the meeting and was assisted by Mrs. Martin
Decker, Mrs. Thomas Wenzel, Mrs. C. T. Atkin-
son and Mrs. Smith.
DELAWARE
Mrs. A. R. Callander was elected president of
the Delaware County Auxiliary at its luncheon
meeting held on April 25. Mrs. Wray Davies is
president-elect; Mrs. George Parker, vice-
president; Mrs. G. T. Blydenburgh, secretary,
and Mrs. W. W. Livingston, treasurer. Mrs.
Harold W. Davis of Ashley, the outgoing presi-
dent, was hostess at the luncheon.
ERIE
Members of the Woman’s Auxiliary to the
Erie County Medical Society entertained their
husbands with a dinner party at the Plum Brook
Country Club on April 29. Mrs. E. J. Meck-
stroth was chairman of the arrangements com-
mittee.
FRANKLIN
The April meeting of the Woman’s Auxiliary
to the Columbus Academy of Medicine was held
at the home of Mrs. Howard E. Boucher. The
program committee presented a light comedy
“Girls Must Talk,” the cast of which was made
up of auxiliary members. Mrs. Harley Thomas,
harpist, provided the afternoon’s musical program.
Mrs. K. D. Reichelderfer was chairman of
hostesses, with Mrs. Karl P. Klassen and Mrs.
Thomas E. Fox as co-chairmen. They were
assisted by Mrs. Thurman R. Fletcher and Mrs.
Clyde W. Dawson, members of the music
committee.
HAMILTON
The Hamilton County Auxiliary presented Dr.
Esther Marting Fabing as its guest speaker at
the organization’s meeting on April 18 at the
home of Mrs. Paul Hoxworth. Dr. Marting
Fabing’s talk was on “What’s Being Done
About Cancer” and she was introduced by Mrs.
Lloyd Larrick, program chairman.
The meeting’s business agenda included the
annual election of officers. Those elected in-
clude: Mrs. Richard Vilter, president-elect; Mrs.
Robert Kotte, vice-president; Mrs. Herbert
Brinker, recording secretary; Mrs. Walter Engel,
corresponding secretary; Mrs. Warren Strohmen-
ger, treasurer; and Mrs. Paul Woodward, direc-
tor for a two-year term.
At the tea which concluded the afternoon’s pro-
gram, Mrs. V. E. Siler, hospitality chairman,
was assisted by Mrs. Charles A. DeWert, Mrs.
Joseph Goldcamp, Mrs. John Fleming and Mrs.
Harold Humphrey.
HARDIN
The Woman’s Auxiliary to the Hardin County
Medical Society held its March meeting at San
Antonio Hospital. Sister Adelaide of the hospi-
tal staff gave a brief talk and thanked the or-
ganization for the money donated to the hospital
from the Mistletoe Ball. Mrs. Robert Ruffing
gave an interesting talk on “Hat Designing.”
Mrs. Albert Sage, president, conducted the
business session.
LAWRENCE
The Elks Club parlors was the scene of a
tea and meeting on April 27 when the Woman’s
Auxiliary to the Lawrence County Medical So-
for June, 1950
621
ciety entertained the doctors’ wives of the
Ninth District. This meeting was held concur-
rently with that of the doctors attending the
Ninth Medical District Session. The get-together
convened at one o’clock when members and
guests were registered by Mrs. Forest Stewart,
Mrs. Paul Baker and Mrs. Halsey Wheeler.
Mrs. G. N. Spears, Lawrence County presi-
dent, presided at the business meeting and
welcomed the guests. She introduced Mrs. C.
W. Kirkland, state president, who spoke on
state activities and the many accomplishments
of Ohio’s sixty organized counties. Another
speaker on the afternoon’s program was Mrs.
W. E. Gault of Portsmouth who presented an
outstanding book review on “The Elephant Walk.”
Silver candelabra holding yellow tapers graced
the center of the tea table, and Spring flowers in
artistic arrangement added to the decoration.
Mrs. Spears and Mrs. W. F. Marting presided
at the table. Later in the afternoon, many of
the women joined the delegation that went on
tour of the new addition at Lawrence County
General Hospital. The women joined their
husbands for the dinner held at six o’clock at
the Episcopal parish house.
LICKING
Twenty-five members of the Auxiliary to the
Licking County Medical Society assembled on
April 25 at the Moundbuilders Country Club for
a dinner meeting. The program for the evening
featured a book review by Mrs. Norton Suter on
“The Plum Tree” by Mary Ellen Chase.
Mrs. J. Y. Salzman, retiring president, pre-
sented the gavel to the incoming president, Mrs.
Roland Jones, who announced her committee
appointments for the year.
Plans were made for the rummage sale to be
given for the benefit of the hospital on May 13.
LOGAN
The Logan County Auxiliary met on April 25
for its regular monthly meeting at the home of
Mrs. John Maurer. Mrs. F. B. Webster, presi-
dent, presided at the business session. An inter-
esting book review on “The Physician’s Wife”
was given by Mrs. A. J. McCracken as the
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For information and catalog, address the
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The Ohio State Medical Journal
afternoon’s program feature. A social hour with
refreshments followed.
LORAIN
Miss Eleanor Goldstein, case worker with the
Lorain County Guidance Center, was guest
speaker at the March luncheon meeting of the
Lorain County Auxiliary. Mrs. Theodore Berg,
vice-president, presided at the business session
in the absence of the president, Mrs. L. B. Ste-
phan. A nominating committee was named to
present a slate of officers at the May meeting.
Shamrocks, daisies and green tapers formed
the centerpiece for the luncheon table, with
miniature shamrocks at each place.
In her talk on mental hygiene, Miss Goldstein
explained the types of mental illness and how the
state of Ohio cares for its mental patients. She
then traced the development of the Lorain County
Center and stressed the importance of its work.
LUCAS
A benefit luncheon and card party was held by
the Woman’s Auxiliary to the Toledo and
Lucas County Academy of Medicine on April 25
to raise funds for the new Academy building.
Approximately 450 people were present. Many
prizes, good food and a pleasurable social hour
made it more than just a money-making project.
Mrs. Hauzen Hauman and Mrs. Joseph Hertzberg
who head the Fund Raising Committee were in
charge of arrangements.
At the March luncheon meeting of the Auxi-
liary, Dr. E. A. Ockuly, president of the Toledo
Academy of Medicine, gave a stimulating talk on
“Present Trends in Medical Legislation.”
The regular April meeting of the group was
an “Open Tea” on April 18 and featured Rabbi
Leon I. Feuer who spoke on “Peace Through
World Health.”
The two study group programs continue ac-
tive participation, meeting each month.
MAHONING
Dr. R. L. Rutledge, a past-president of the
Ohio State Medical Association, spoke to the
members of the Mahoning County Auxiliary at
its April meeting at the Woman’s City Club
in Youngstown.
MARION
Luncheon was followed by a program and brief
business session when the Woman’s Auxiliary
to the Marion Academy of Medicine held its
March meeting at Hotel Harding. Mrs. Joan
Reams entertained with a musical sketch.
On April 15, the regular monthly luncheon
meeting was in the form of a “guest party”
and featured as its speaker, Miss Carolyn Brad-
ley, a member of the faculty at Ohio State Uni-
versity. Author, painter and lecturer, Miss Brad-
ley showed paintings and costumes and described
countries visited on her recent trip to Central
America. Completing the program was a group
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for June, 1950
623
of musical selections by Mrs. Reams. Mrs. B.
H. Taylor, vice-president, presided.
MEIGS
Mrs. J. J. Davis was hostess at a dinner
meeting of the newly organized Meigs County
Auxiliary in March. For the April meeting the
group entertained with a luncheon held at Little
House, the hostess, Mrs. Selim Blazewicz. Mrs.
E. F. Maag, president, conducted the business
session.
MONTGOMERY
in the hospital dining room. Presiding at the
tea table were Mrs. Gibson and Mrs. C. R. Wood,
district director.
PICKAWAY
Eighty-three girls from Circleville and,
Ashville were guests of the Pickaway County
Auxiliary on a tour of Mt. Carmel Hospital in
Columbus on April 14. The trip, sponsored by
the auxiliary, was offered to those interested in
choosing nursing as a career.
ROSS
The Montgomery County Auxiliary held a
luncheon meeting on April 11 at the Engineers’
Club. Fifty members were present. Installa-
tion of officers was conducted by Mrs. Paul Wood-
ward, state vice-president. A panel discussion
on Socialized Medicine was presented by Mrs.
David W. Heusinkveld, Mrs. Charles Baron
and Mrs. Woodward, guests from the Hamilton
County Auxiliary. Chairman in charge of ar-
rangements for the day was Mrs. S. N. Maimon.
The newly installed officers include: Mrs. Rob-
ert Zipf, president; Mrs. H. M. James, president-
elect; Mrs. E. W. Smith, vice-president; Mrs.
J. J. Shea, recording secretary; Mrs. Irving
Helfert, corresponding secretary; Mrs. R. H. Cap-
lan, treasurer.
OTTAWA
Members of the Woman’s Auxiliary to the
Ottawa County Medical Society were hostesses
on April 19 at a tea at Magruder Hospital at
which forty-five junior and senior girls from
Oak Harbor, Lakeside and Port Clinton high
schools were guests. These girls had previously
indicated an interest in following nursing as a
career.
The girls assembled in the solarium where
they were welcomed by Mrs. W. R. Gibson,
auxiliary president. Then, in groups of ten,
they were taken on a complete tour of the
hospital by Superintendent Rachel Garlich and
Miss Esther Fullwiller, first floor supervisor.
Miss Garlich distributed booklets concerning
nursing as a career, and answered questions. A
social hour followed, with refreshments served
Installation of new officers followed the din-
ner meeting on May 4th of the Ross County
Auxiliary at Allyn’s dining room. Mrs. F.
CHAS. F. BOWEN, M. D.
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The Ohio State Medical Journal
W. Nusbaum, outgoing president, installed the
new officers. They are:
Mrs. Walter E. Kramer, president; Mrs. L. T.
Franklin, vice-president; Mrs. Nicholas Holmes,
secretary; and Mrs. Robert Giesler, treasurer.
Committee chairmen appointed by Mrs. Kramer
include: membership and radio, Mrs. L. T. Frank-
lin; program, Mrs. R. C. Bane; publicity, Mrs.
John Franklin, historian, Mrs. Warde Smith; ways
and means, Mrs. Walter Breth; legislative and
public relations, Mrs. William Garrett; bulletin
and handbook, Mrs. Robert Swank; student
nurses’ loan fund, Mrs. Wood. Mrs. Kramer an-
nounced that the nurses’ loan fund is available
to any Ross County student who needs financial
help for her nurse’s training.
SANDUSKY
Mrs. A. F. Schultz was named new president
of the Sandusky County Auxiliary at its dinner
meeting on March 15. Other officials elected to
office at that meeting included Mrs. Francis A.
Visconti, vice-president; Mrs. Richard Wilson,
secretary and Mrs. C. L. Kuntz, treasurer. Mrs.
Robert Fox, the outgoing president, opened the
meeting and presented the new officers.
On April 19, members of the Auxiliary were
hostesses at a benefit dessert-bridge at the
Nurses’ Home at Memorial Hospital. Those in
charge of arrangements were Mrs. John Mana- I
han, chairman, Mrs. E. C. Swint, Mrs. A. P. New-
man, Mrs. Irvin Koons, Mrs. Richard Wilson,
Mrs. W. J. Martin and Mrs. Carroll Miller. Pro-
ceeds will be used to purchase needed equipment
at the Nurses’ Home.
SCIOTO
Installation of new officers marked the May 10
session of the Scioto County Auxiliary when the
organization gathered at the Turkey Shoppe for
a luncheon meeting. Mrs. Clyde Everett is the
group’s new president. Serving with her are
Mrs. Carter L. Pitcher, president-elect; Mrs.
Carl G. Braunlin, vice-president; Mrs. Spencer
K. Miller, secretary; Mrs. Ralph Lewis, treas-
urer, and Mrs. W. E. Gault and Mrs. Dow
Allard, directors. Another feature of the after-
noon was a “bed-clothing shower” for the Scioto
County Home for the Aged.
Spring flowers in pastel hues decorated the
tables with corsages for each guest. Mrs. Gault
interestingly reviewed “Camp Fires on the Scioto”
by Charles S. Wood.
At a short business meeting preceding the
installation, presided over by Mrs. W. A. Ray,
outgoing president, annual reports were made
and the auxiliary project for the year, the raising
of a fund to educate a young woman in nursing,
was completed. Mrs. Everett appointed her
new committee chairmen for the year.
Hostesses for the afternoon included Mrs. C.
W. Wendelken, chairman; Mrs. R. P. Elder, Mrs.
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ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic, 2
weeks, starting June 19, July 24. Aug. 21. Surgical
Technic, Surgical Anatomy & Clinical Surgery, 4
weeks, starting July 10, Aug. 7, Sept. 11. Personal
Course in General Surgery, 2 weeks, starting Sept.
25. Surgery of Colon & Rectum, 1 week, starting
Sept. 11. Esophageal Surgery, 1 week, starting Oct.
16. Breast & Thyroid Surgery, 1 week, starting
June 26, Oct. 2. Thoracic Surgery, 1 week, starting
June 12, Oct. 9. Gallbladder Surgery, 10 hours,
starting June 19, Oct. 23. Fractures & Traumatic
Surgery, 2 weeks, starting June 12, Oct. 9. Basic
Principles in General Surgery, 2 weeks, starting
Sept. 11.
GYNECOLOGY — Intensive Course, 2 weeks, starting
June 19, Sept. 25. Vaginal Approach to Pelvic
Surgery, 1 week, starting Sept. 18.
OBSTETRICS — Intensive Course, 2 weeks, starting
Sept. 11.
MEDICINE — Intensive General Course, 2 weeks, start-
ing Oct. 2. Electrocardiography & Heart Disease,
2 weeks, starting July 17. Gastroscopy, 2 weeks,
starting July 17, Sept. 25.
DERMATOLOGY — Formal Course, 2 weeks, starting
Oct. 16. Informal Clinical Course every 2 weeks.
UROLOGY — Intensive Course, 2 weeks, starting
Sept. 25. Cystoscopy, Ten Day Practical Course,
every 2 weeks.
General, Intensive and Special Courses in all
Branches of Medicine, Surgery and the Specialties
TEACHING FACULTY — ATTENDING
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for June, 1950
625
Arthur Dearth, Mrs. Arthur Beumler and Mrs.
Howard Sellards.
STARK
Mrs. A. E. Boyles was named president-elect
of the Stark County Auxiliary at its annual
election of officers held in April at the Alliance
Woman’s Club. The new president for the
1950-1951 year is Mrs. George Wilcoxon, who
succeeded Mrs. Mark Herbst. Other officers
elected include: Mrs. R. L. Rutledege, vice-
president; Mrs. L. B. Schumaker, recording
secretary; Mrs. M. E. Stillwell, corresponding
secretary and Mrs. William R. Ferraro, treasurer.
TRUMBULL
The Trumbull County Auxiliary met on
April 21 at the Warner Hotel for luncheon,
celebrating its tenth anniversary and also
honoring its past presidents — Mrs. W. G. Drown,
Mrs. E. R. Westbrook, Mrs. D. R. Beers, Mrs.
J. M. Gledhill, Mrs. A. L. Sparks and Mrs.
Densmore Thomas. Mrs. C. W. Kirkland, state
president, interestingly addressed the group.
Mrs. B. E. Goodman described the work of
the Y. W. C. A., told of its aims and stressed
the need of funds to repair the “Y” building.
Mrs. Robert Held showed slides of pictures taken
on a recent tour of the United States.
The new Trumbull County officers are: Mrs.
A. W. Beale, president; Mrs. M. T. Knappen-
berger, president-elect; Mrs. Louis Ralston, vice-
president; Mrs. John LaVoo, recording secre-
tary; Mrs. Garner Scullard, corresponding secre-
tary; Mrs. C. W. Mathias, treasurer; Mrs. D. R.
Mathie, parliamentarian.
TUSCARAWAS
Mrs. William Hudson and Mrs. M. W. Ever-
hard were appointed to represent the Tuscarawas
County Auxiliary at the annual state auxiliary
convention in Cleveland, being named April 12
when the group met at the home of Mrs. W. W.
H. Curtiss. The constitution and by-laws were
read and Mrs. H. F. Van Epps and Mrs. C. J.
Miller appointed to make proposed changes. A
social hour and refreshments followed the busi-
ness session.
WILLIAMS
The Williams County Auxiliary held a luncheon
meeting on April 11 at the Hotel Elder. Later
the members were invited to the home of Mrs.
John Diesen for an enjoyable social hour.
COMING MEETINGS
American Medical Association, Annual Session,
San Francisco, June 26-30.
American College of Radiology, San Francisco,
Calif., June 25.
Conference of County Medical Society Officers,
San Francisco, June 25.
Eighth Councilor District Annual Meeting, Mc-
Connelsville, June 15.
INDEX TO ADVERTISERS
Abbott Laboratories 611
Ann Arbor School, The 622
Ar-Ex Cosmetics, Inc. 627
Ayerst, McKenna & Harrison, Ltd. 527
Baker Laboratories, Inc. 597
Bell, Kathryn S., Inc. 622
Birtcher Corporation, The 616
Bowen, Charles F., M. D. 624
Camp, S. H., Company _ 531
Cincinnati Sanitarium 536
Clinical and Pathological Laboratory . 619
Coca-Cola Company _ 613
Columbus Orthopaedic Appliance Co. 625
Cook County Graduate School of Medicine 625
Denver Chemical Manufacturing Co. 607 j
General Electric X-Ray Corp. 529
Hanger, J. E., Inc. 623
Harding Sanitarium i 534
Ingleside Home, Inc. 609
Lederle Laboratories, Inc. 599
Lil’y, Eli, and Company Insert between
Pages 540 & 541
Maltbie Laboratories, Inc. . 605
McMillen Sanitarium 536
Mead Johnson & Company , Back Cover
Medical Protective Company J 620
Medico Press, The 615
Mercer Sanitarium, The 534
Miller, W. H _ M. D. 620
New York Polyclinic Medical School 609
Num Specialty Company 619
Oak Ridge Sanatorium 535
Parke, Davis & Company 628 and
Inside Back Cover
Philip Morris & Company 538
Pogue, The Mary E., School 619
Quincy X-Ray & Radium Laboratories 622
Resthaven : 618
Rupp & Bowman Company 623
Sawyer Sanatorium 525
Schering Corporation - 539
Schmid, Julius, Inc. 601
Sealy Mattress Co. 617
Searle, G. D., & Company 593
Stoneman Press 607
U. S. Vitamin Corporation 595
Upjohn Company 537
Van Wagner Company 624
Wander Company 540
Wendt-Bristol Company 618
Wickhaven Sanitarium 534
Windsor Hospital 534
Winthrop- Stearns, Inc. 530
Wyeth, Inc 603
626
The Ohio State Medical Journal
Qlallilied AduetitUamesttl
Rates: 50 cents per line. Minimum charge of $1.00 for each insertion. Price covers the cost
of remailing answers. Forms close 16th of the month preceding publication.
FOR SALE : Six-room home and four-room office com-
bination in midwestern Ohio community of 100,000. Active,
growing general practice grossed $18,000 in 1949. Office
completely furnished. Specializing. Available about July 1.
Box 96, Ohio State Medical Journal.
WANTED : Capable young physician for temporary posi-
tion in Industrial office. 200 Republic Building, Cleveland.
WANTED : Thoroughly competent physician for Industrial
Office. Must be graduate of Class A School with adequate
hospital training. Salary, $6,000 per year. 200 Republic
Building, Cleveland 15, Ohio.
BACTERIAL INCUBATOR: Hot Pack Model 808, 115 v.
all electric, wet or dry, completely automatic, brand new,
temp, range 30 to 60 deg. cent. Inside 18x18x19%, 2
shelves adjustable any height. Will sell for $200 f. o. b.
Ashland, crated. M. D. Shilling, M. D., 408 Center St.,
Ashland, Ohio.
SANBORN ELECTROCARDIOGRAPH, direct writing, like
new, used a few times. Price $500, net, including base on
ball bearing wheels, f. o. b. Ashland. M. D. Shilling, M. D.,
408 Center St., Ashland, Ohio.
FOR SALE : Two electric sterilizers, Brown-Berger.
McCarthy cystoscopes, urethrascope, metal and glass in-
strument cabinet. Box 95, Ohio State Medical Journal.
STAFF PHYSICIAN for 600 bed hospital for the mentally
ill. Attractive offer with excellent opportunities. Experi-
ence in psychiatry not necessary. Salary plus complete
maintenance for physician and family. Contact Milton P.
Smith, M. D., Superintendent, Tiffin State Hospital, Tiffin,
Ohio.
WANTED General practitioner to locate in Ohio rural
community of about 600 families. Death of the two former
resident physicians leaves the community without adequate
medical service. Excellent school ; three Protestant churches ;
good water and sewerage systems ; three hospitals within
15 miles ; financial assistance available if needed. Write
Mrs. W. W. Windham, Rushsylvania, Ohio.
PORTABLE X-RAY 80 KV (Waite-Bartlett, Picker),
nearly unused, perfect condition. Also available complete
set of cassettes with screens, leadbox, tank, hangers, portable
Bucky. Total price $650. Fluoroscope, cassette holder at
nominal charge. Box 607, Ohio State Medical Journal.
PHYSICIAN as health commissioner of Ashtabula County
General Health District, full time basis. Salary $6,500 and
car allowance. Apply to Board of Health, Jefferson, Ohio.
FOR SALE : Good used X-ray and physiotherapy equip-
ment. Also accessories. Very reasonable. “Write for list.
Box 601, Ohio State Medical Journal.
OPENING for M. D. with W. Va. location and license
in growing industrial area of S- E. Ohio and W. Va.
Facilities of small hospital available. Write Box 97,
Ohio State Medical Journal.
SHOCK-PROOF X-RAY UNIT, deliver 90-90. Oil im-
mersed switch, half wave retified tube and two sets wells
in built-in transformer case. Spot film attachment. Good
condition operating now ; will demonstrate. Price, $450
cash. Optional cables aeromax macklet shock-proof tube,
D-Focas, excellent condition. Plat built-in type bucky
without top, electro release. Price bucky, $75. Box 610,
Ohio State Medical Journal.
FOR SALE : Eye, ear, nose and throat practice ; fur-
niture and instruments. Inquire of the Estate of the late
Dr. O. J. Walker, Estate Dept., (Mr. Groves), Dollar
Bank Bldg., Youngstown, Ohio.
FOR SALE : 40-yr. established practice in good In-
dustrial and Rural community of about 40,000 city popu-
lation with all conveniences — hospital, laboratories, etc.
Physician 65 desires to retire. This is a worthwhile con-
sideration. You will like this location. Write Box 608,
Ohio State Medical Journal.
FOR SALE: E. E. N. T. Practice with instruments, fur-
niture, active records and valuable contracts. In large
city, the same location over 35 years. Box 609, Ohio
State Medical Journal.
FOR LEASE: Widow wishes to lease three-room equipped
office in Ohio River city of 9,000 plus several thousand
population in outlying districts. Gross income in 1949
was $15,550. Complete records at disposal of renter.
Might consider selling (home and office combined). Mrs.
E. P. Neitz, Wellsville, Ohio.
YOUNG PHYSICIAN, Ohio license, one year internship,
one year approved medical residency, free in July for
locum tenans or to assist. Box 610, Ohio State Medical
Journal.
FOR SALE : McIntosh Portable Wall Plate 115 volt
AC-DC ; used less than 10 hours ; half regular price, $75.
Box 106, New London, Ohio.
RESIDENT IN MEDICINE, A. M. A. and Board ap-
proved. 1,800 medical admissions. Active out-patient.
Fairview Park Hospital, 3305 Franklin Blvd., Cleveland 15,
Ohio.
FOR SALE: Established general practice of 39 years;
also drugs and equipment. Office available ; small, progres-
sive village on Lake Erie ; physician recently deceased.
Box 114, Vermilion, Ohio.
College Health Directors Hold
Meeting at Kent
The 26th annual meeting of the Ohio College
Health Association was held at Kent State Uni-
versity on May 5 and 6. Dr. A. 0. DeWeese,
director of student health services at Kent was
host to the group and conducted visitors on a
tour of the year-old Kent State model health
center.
Among those on the program as moderators
of discussion sessions were Dr. J. W. Wilce,
Columbus, Ohio State University student health
director; Dr. F. P. Bennett, Mt. Union College
health service director; and Dr. Myrtle V. C.
Dineen, Kent State resident physician.
Featured speaker at the banquet session was
Dr. Marion S. DeWeese, University of Michigan
Medical School, who discussed “The Relation of
Warts and Moles to Cancer.” He is a son of Dr.
DeWeese of Kent State.
COSMETIC DERMATITIS?
Clinical tests confirm the use of
AR-EX Cosmetics for hyper-sen-
I sitive skins. Scented or Unscent-
\{ j ed. Send for Free Formulary.
AR-EX COSMETICS, INC., 1036 W. VAN BUREN ST.,
FREE FORMULARY
DR.
ADDRESS
CITY
STATE
CHICAGO 7, ILL.
for June, 1950
627
acts quickly to relieve the distress of hay fever, shrinks the engorged
mucous membranes, checks hypersecretion, permits free breathing and promotes comfort.
I excellent tolerance
relative freedom from compensatory congestion
lack of appreciable interference with ciliary action.
Its effectiveness is undiminished by repeated use — insuring topical relief throughout
the hay fever season.
!4% solution (plain and aromatic), 1 oz. bottles;
1% solution, 1 oz. bottles; water soluble jelly.
Vs oz. tubes.
NEO-SYNEPHRINE, TRADEMARK REG. U. S. & CANADA.
IBRAND OF PHENYLEPHRINE
Yb% low surface tension, aqueous solution, isotonic
with tears, Vi oz. bottles.
nt and Pto\onSed
INC 4
New York 13, N. Y. Windsor, Ont.
for July, 1950
633
^Jlte, PltuAician'i. Pao-k.i.lteljj
By JONATHAN FORMAN, M. D.
Sex Education
IN RECENT months, there have appeared
many books on the subject of sex which still
appears to be the most fascinating of sub-
jects. The books are widely diversified in their
intent, their content, and their manner of ap-
proach— from heavy scientific tomes to pure
pornography.
We might begin with a study of sexes in a
changing world, Male and Female ($5.00. Wil-
liam Morrow & Company, New York City), by
Margaret Mead of the American Museum of Nat-
ural History. Many of us remember her “Com-
ing of Age in Samoa,” “Growing Up in New
Guinea” or “Sex and Temperament.” This well-
known anthropologist spent 14 years in field
work in preparation for writing this book.
The modern literature would lead one to think
that all nervous tension arose from sexual mal-
adjustments. Any physician can tell you that
this is a problem of ecology, and Man and his
disease are the resultant of millions of forces.
The problem of sex is but one of many requiring
straight thinking and proper attitudes toward
life in general. It is these things that condi-
tion us for failure in marriage as well as in
our work.
In Be Your Real Self, by David Harold Fink,
M. D., ($2.95. Simon and Schuster, 1230 Sixth
Ave., New York City), the author has given us
another book even better than his “Release
From Tension.” You will find this book of
immense value in your attempts at reorientation
of your patients. Working from this viewpoint
sex comes to take a much more important place
in the lives of your patients. If you can get
your patients to make better use of time, space,
things, and people they will come to have a
proper place to put sex and it will come to have
a richer meaning for them even though they
have much less time to be concerned about it.
Every one of us who is interested, as every
physician must be every day that he practices,
with over-domestication of the male and the mis-
education of the female under the misapprehen-
sion that equality means sameness, will want
this book in his library. I look upon whatever
problems sex raises in our changing society as
but another expression of the utter failure of
our educational system to teach us how to master
the machine age. To anyone who is at all in-
terested in pursuing this thought further, I
would recommend Ralph Borsodi’s opus magnum,
Education and Living ($5.00. Devin- Adair Co.,
New York City).
The rise of the neutralized woman is an
outstanding feature of our American mechanical
culture. Amongst all the present-day confusion
about sex equality the fact stands out as Ralph
Borsodi insists that the sexes are complementary
and cannot take each other’s place either in the
home or in industry. The new individuality
which the feminist movement in America has
produced is still best expressed in marriage and
the family. For a study of the growth of this
personality with its new concepts of marriage
and attitudes towards divorce, the woman’s new
position in the family and the new problem which
the change raises are explored successfully in
The American Woman in Marriage ($3.75.
Philosophical Library, New York City), by Sonya
Ruth Das, who comes to the task with a rich
and cosmopolitan background.
These changes demand the elimination of fear
and superstition from our sex lives and the de-
velopment of more realistic patterns for finding
and conserving happiness in marriage. Today
the conservation of happiness is the great need.
It is when the children are grown that in most
marriages today happiness is lost. Modern Pat-
tern for Marriage — The Newer Understanding
of Married Love ($2.25. Rinehart & Company,
New York City), by Walter R. Stokes, M. D.,
attempts to guide young people in such a way
that these values can be conserved.
There comes from the Mount Sinai Hospital
and Vassar College a guide to happy marriage
in the form of questions and answers as raised
by GIs in the European Theatre, Sex, Questions
and Answers by Fred Brown and Rudolf T.
Kempton, ($2.95 Whittlesey House, 330 West
U2nd Street, New York City). This book em-
phasizes that in Man, sex conduct is governed
largely by external group and cultural forces
and sex function is largely a learned process.
As in everything else, our educational system
does little or nothing to teach our youth how
to live within the biologic norm. So much of
today’s sex learning is inaccurate and faulty.
It is, however, a good sign that so many
people are looking for facts and guidance as
is indicated by the experience of these authors
and by the great number of attempts to meet
this need as shown in this review.
After years of inertia following one war
634
The Ohio State Medical Journal
and preceding another, our knowledge of sex
has been definitely increased. This, most would
call progress. Be that as it may, the natural
methods of Birth Control have been more clearly
defined. In the present edition of their
book, The Illustrated Encyclopedia of Sex, ($4.95.
Garden City Pub. Co., Garden City, N. Y.),
Drs. Willy, Vander, and Fisher give this first
place. During recent years also the intrinsically
great investigations of Steinach and Voronoff
have failed as methods of rejuvenation. On
the other hand, it has been established by
proper hygiene and diet the vigor of the sexual
apparatus and organism can be maintained far
into old age. This appears to depend largely
upon the general aging processes. It is there-
fore, only another phase of “Keeping one’s
health.”
Much space is devoted by these authors to the
activity of the endocrine glands in relation to
sex. Here many a reader will learn for the
first time about the nature and effects of feminine
insensibility and may perhaps find the solution
of many a mystery that has heretofore darkened
his or her life. The illustrations in this Eng-
lish work prove most helpful.
Man’s development and behavior from the
zoological viewpoint is closely bound up with
sex. It is, therefore, stupid for us to ignore
our zoological heritage. James G. Needham,
emeritus professor of entomology in Cornell,
has given us a summary of this heritage in
About Ourselves (Ronald Press, New York City).
The first part ’ of his book is concerned with the
biological aspect of man and then in the second
part, the author considers society in its biological
aspects.
Today, we are concerned with population up-
surge, The Population Upsurge in the United
States, by Joseph S. Davis, ($1.00. Food Re-
search Institute, Stanford University, Stanford,
Calif.). This is largely a matter of breeding
and feeding. So sex does become of great im-
portance.
The subject of family life is important
enough that all should have instruction in it.
Based upon years of teaching, Robert A. Harper
of the Department of Sociology in the Ohio State
University, has written a text, Marriage ($2.70.
Appleton-Century-Crofts, Inc., New York City),
which fits well into the practical preparation
for marriage type of course or study.
“Wives are young men’s mistresses; compan-
ions for the middle-aged; and old men’s nurses,”
was one of Francis Bacon’s wise sayings of mar-
riage. John Buncle, Jr., has prepared a manual
entitled Of Wives and Wiving (Henry Regnery
Co., Chicago), of instruction, exhortation and
admonition gathered from older authors for the
guidance, delight, and moral fortification of con-
temporary readers. This little volume of quo-
tations is a delightful addition to any library.
“Read your insurance policy before you sign,”
is the way Father Liederbach begins his book
of instruction and marriage counseling. When a
Catholic Marries by C. A. Liederbach (50 cents.
The Bruce Publishing Company, Milwaukee,
Wise.) assembles in a few pages instruction
for those who will soon marry — Catholic and
non-Catholic alike.
Since marriage is a sacred institution designed
for the production and rearing of a family, the
fertility, or the lack of it, becomes of major
concern in any discussion of this subject. Th. H.
van de Velde, M. D., the distinguished authority,
has dedicated the third volume of his triology to
the subject, Fertility and Sterility in Marriage
($7.50. Random House, New York City). The
author gives one great guiding principle in the
field of behavior:
“The expert mastery of the physical as-
pects of sex must not become an end in
itself — for otherwise the elusive ecstasy and
permanent happiness alike are forfeited; it
remains only a just and necessary human
demand which mistakes do not nullify/’
Every mother plans on having the perfect
child but does not know how to go about it.
A persuasive new book on this subject is How
To Create the Perfect Baby, by R. Swinburne
Clymer, M. D. ($2.50. Philosophical Publishing
Co., Beverly Hall, Quakertown, Pennsylvania).
This volume introduces the Art of Stripiculture.
This art takes on a scientific turn after a 100
pages of instructions on how to plan and wish
for beautiful features, great integrity, and desir-
able qualities. The next 50 pages cover the role
of calcium, iodine, thyroid, phosphorus, iron,
vitamin P and C. An interesting cult threading
many scientific facts and beliefs into a new pat-
tern which can do nothing but good to the
woman at the breeding stage who wants to create
the perfect baby.
The story of how life begins and goes on has
been depicted on an educational film and now it
has been condensed into a book, Human Growth,
by Lester F. Beck ($2.00. Har court, Brace &
Co., New York City).
In March, 1945, Leonard H. Biskind of Mount
Sinai Hospital in Cleveland, Ohio, published in
The Journal a series of answers to questions in
regard to pregnancy and labor. This list has
been extended and republished in Modern Medi-
cine and in The Western Journal of Surgery and
finally in book form, Having Your Baby ($2.50.
Western Journal of Surgery Publishing Co.,
Portland, Oregon). As the book now stands it
is a series of practical instruction in regard to
pregnancy based upon the most modern concepts
of prenatal care, the conduct of labor and de-
livery, and the course of the puerperium. A
most valuable book for the expectant mother.
So much of the material put out for sex edu-
cation became pornographic that it is a real
pleasure to come across a book which has cut
for July, 1950
635
loose from the past and tells all in a straight-
forward, clearly understandable manner in just
120 pages. Sex Without Fear, by S. A. Lewin,
M. D., and Sarah K. Greenberg, M. D., with il-
lustrations by John Gilmore, Ph. D. ($3.00.
Lear Publishers, Inc., 105 E. 15th St., New
York City), is intended as an aid in practice
and covers every aspect of sex and sex relation-
ships from genital anatomy to methods of con-
traconception. The publishers have initiated a
new policy in that they are offering physicians
discounts up to 50 per cent to enable them to
keep sufficient copies on hand to meet the needs
of their practice.
The book is beautifully designed and attrac-
tively illustrated by John Gilmore, the former
art editor of Clinical Symposia. Dr. Lewin is
a well-known author in the field of lay health
education.
Somewhere in the Nineteenth Century, literary
criticism became obsessed with the function of
passing judgment on the merits of poetry and
poets. In recent years, interpretative criticism
has appeared. Roy Basler has given us a
Freudian interpretation of Coleridge’s “Chris-
tabel,” Tennyson’s “Maud,” Poe’s “Ligeia,” Eliot’s
“Prufrock,” in his book, Sex, Symbolism and
Psychology in Literature ($3.50. Rutgers Uni-
versity Press, New Brunswick, New Jersey).
The close relationship between organized
religions and symbolism gives us an interest in
Pierre Gordon’s Sex and Religion ($5.00.
Social Sciences Publishers, New York City), in
which he collects and coordinates certain ideas
scattered throughout the literature of the ages,
and uses these to solve other problems such as
incest.
SEX IN CHILDHOOD
For dealing with children who have the prob-
lem of adjusting themselves to the various
phases of the maturation of the sexual urge in
its physical sense, there is a marvelous chap-
ter on “physical expression of the sexual urge”
in The Envelope — A Study of the Impact of the
World Upon the Child ($3.00. The Common-
wealth Fund, New York City). James S. Plant,
M. D., has brought to bear his vast experience
in dealing with problem and delinquent young-
sters and the problem of making satisfactory
adjustments to intense response arising from
sexual stimulation and the fact that “raw” un-
sublimated expressions of sexual hunger are not
acceptable to society. There are few persons,
indeed, who strike a comfortable balance be-
tween these two sets of demands. Dr. Plant
makes a distinction not often emphasized, the
physical side of the sexual urge and the language
values of sexual expression.
While citing many obstacles and failures, Dr.
Plant sums up this matter as follows: “Society
is so anxious that the physical urge be sublimated
into socially useful activities that it bends its
every energy towards the frustration of the
admal physical expression, hoping to divert
that energy to other channels. And at that
it does a pretty efficient job.”
Certainly, the language component looms large
in the sex urge. Sex expression becomes a mode
of communication for which they lack words.
It leads the adolescent to feel he is grown,
that she is wanted for herself, that both are
“better,” more popular than others. This book
if you will read it will serve as an antedote
for much of the current writings on sex in
youngsters.
In the guiding of the child’s development, we
need standards and in Dr. Plant’s brilliant work
you will find excellent guideposts in matters of
sex. Dr. W. W. Bauer of the A. M. A. Head-
quarters, working with Gladys Gardner Jenkins »
and Helen Shacter, has produced a general guide
to their development and instructions on how to
help them in the painful process of growing
up, in These are Your Children ($3.50. Scott,
Foresman & Co., Chicago). The book places its
emphasis on three fundamental truths, i. e., (1)
there is an infinite variation upon a basic same-
ness that is found in all of our children; (2)
growth is a continuous process; and (3) the
tremendous influence of a child’s first years. The
book contains suggestions for sex education at
each age level.
Another book devoted exclusively to setting
up guideposts for parents, sex educators and
family counselors is The Normal Sex Interest
of Children, by Frances Bruce Strain ($2.75.
Appleton-Century-Crofts, Inc., New York City).
This book is not a dry tome of documentary re-
search but a lively handful of observations. It
does, however, attempt to lift the man of ignor-
ance and uncertainly in the belief that this will
make him more normal and therefore happier.
Presenting the analytic side of this problem
and quite in contrast to Dr. Plant’s excellent
exposition is Children in Conflict, by Madeleine
L. Rambert ($3.25. International Universities
Press, Inc., New York City). This is a report
on twelve years of psychoanalytical practice.
Mile. Rambert has to offer an original innova-
tion, a technique of her own, in the form of
puppet games of such a kind that it allows each
youngster to unfold his personality to the gaze
of the analysts.
Teachers, leaders, parents, and other adults
who are related to girls in the period of
adolescence often have a hard time understanding
them. From her work in the Y. W. C. A., Grace
Loucks Elliott has written a book entitled
Understanding the Adolescent Girl ($2.00.
Woman’s Press, New York City). It is simply
the story of maturation of a normal girl, her
problem and how her elders can help.
The problems of sex in European children are
636
The Ohio State Medical lournal
somewhat different, at least in our minds. The
fact is, however, that the French middle class is
as beset by the harassing problems of sex edu-
cation as we are over here. In England, the
boarding schools accentuate this problem. Sex
education in the school becomes a matter of the
greatest importance. Egon Larsen has, there-
fore, made an English translation of Sex Prob-
lems in School, by Rene Allendy and Hella Lob-
stein ($2.00. Staples Press, New York City).
The appearance of Dt. Kinsey’s report em-
phasized the recurrent theme in the editorials
of Henry McClure Young in the Urologic and
Cutaneous Review over a period of 25 years.
His widow has selected from hundreds of these
the ones that seem to fit the current needs
of our young folks, Essays on Sex ($5.00.
Christopher Publishing House, Boston, Mass.)
These essays contain many advance ideas that
are the most stimulating of anything that I have
read recently.
“In times when so much is heard of sexual
difficulties and when the spot light of press and
radio tend to be concentrated very largely upon
certain aspects of sex, we do well to remind our-
selves that a happy married life is not some-
thing extremely rare, but is in fact enjoyed by
a great number of people.” With these words,
Eustace Chesser, M. D., begins her book on
Sexual Behavior, Normal and Abnormal ($3.75.
Roy Publishers, New York City). After a clear
exposition of the “Sex Chains” and how they are
forged to give normal and abnormal behavior,
the author gives us three excellent chapters on
reeducation for normal living which should prove
helpful to all of us physicians — especially the
majority who do not give sex much consideration.
Conditions in this whole field of sexology have
been controlled by ignorance. Stekel maintains
that in sexual matters doctors are dangerous
laymen! Dangerous because they give profes-
sional advice to their trusting patients; laymen
because in sexual matters they are burned by
the superstition and prejudices to which they
themselves had been exposed as children.
Stekel is the man who dealt the death blow to
the superstition about masturbation. His ob-
servations he has finally summarized in Auto-
Erotism ($4.00. Liveright Publishing Corp., New
York City). This translation will prove help-
ful to all physicians who wish to inform them-
selves as well as their patients about this very
important deviation.
Most of us are quite unfamiliar with the na-
ture of sex crimes. J. Paul deRiver, M. D.,
criminal psychiatrist and sexologist to the Los
Angeles Police Department, has brought out a
psycho-analytical study of such cases from his
own files, The Sexual Criminal ($5.50. C. C.
Thomas, Springfield, III.) It is the author’s
rich experience which makes this book im-
portant to the rest of us if only we wish to
understand the crimes currently displayed
in the news.
Recent years have been full of critical ques-
tions concerning Alfred C. Kinsey’s pioneer ex-
plorations in the tabooed territories of sex.
Shortly after his report on the Sex Behavior of
the Male appeared, Albert Deutsch assembled
a symposium designed to present an interpreta-
tion of the major points entitled Sex Habits of
American Men ($3.00. Prentice-Hall, Inc., New 7
York City). Each contributor is an authority
in this field. This book has done a great deal
to make the Kinsey report successful.
This report and studies of the Committee for
the Study of Sex Variants in the book, Sex
Variants — A Study of Homosexual Patterns, by
George W. Henry ($8.00. Paul B. Hoeber, Inc.,
New York City), make it clear that the prob-
lems of sexual adjustment are still far from solu-
tion. There is need for more knowledge and
certainly for more respectability and understand-
ing in the handling of the problem. The work
of the Committee is all to this end.
A new book in this field of sex deviation is
that by Louis S. London and Frank S. Capiro
entitled Sexual Deviations ($10.00. Washington
Institute of Medicine, Washington D. C.) It
contains 700 pages of clearly organized authorita-
tive information by men of broad experience.
ALCOHOLISM
Clinical experience shows that alcoholism is
much less frequent in women than in men in a
ratio of about 1 to 5. On the other hand, what
alcoholic women seem to lack in quantity, they
certainly do make up in “quality.” They are
more abnormal. This is usually ascribed to the
fact that women are still subjected to more re-
pressions than men. Dr. Benjamin Karpman,
chief psychotherapist at St. Elizabeth’s in Wash-
ington, has collected a series of case studies to
show the psychodynamics of alcoholism in the
book The Alcoholic Woman ($3.75. The Linacre
Press, Washington D. C.) He has chosen that
type of alcoholic woman for presentation in
three cases with drunkened sexual careers of un-
usual promiscuity. In doing so he has delib-
erately ignored those into whose lives no
sexual abnormality inserts itself — their neurosis
taking another form.
These girls have missed nothing. There is a
full-fledged Oedipus situation with all of its
ramifications in aberrant sexual channels; mas-
turbation, perversions — open or half-hearted — as
well as incestuous and homosexual components.
This is a strong book and has been characterized
as pornography by some critics. Certainly we
have a right, however, to a complete literature
on alcoholism.
for July , 1950
637
W&M PI
THE McMILLEN SANITARIUM
COLUMBUS, OHIO
An Active Treatment Hospital
For All Nervous and Mental Disorders including Alcoholism and Drug Addiction
50 Years Continuous Operation
SHOCK THERAPY
ROBERT A. KIDD, M. D.,
Senior Psychiatrist
NICHOLAS MICHAEL, M. D. ) _ _ _ . . \ HERBERT L. PARISER, M. D.
LAWRENCE TURTON, M. D. J Consultm^ Psychiatrists j MILTON PARKER, M. D.
Telephone: Fa. 1315
FOUNDED IN 1873
Write for descriptive booklet
THE CINCINNATI SANITARIUM
5642 Hamilton Avenue Cincinnati 24, Ohio
Telephones: Kirby 0135 , Kirby 0136
One of the oldest private hospitals
in the United States operated for
the care and treatment of nervous
and mental patients.
Modernly equipped to provide the
use of all accepted methods of treat-
ment. Constant medical supervision
with registered nurses in charge.
Ample classification facilities.
Conveniently located, twenty nine
acres of beautiful grounds assure
complete privacy.
MEMBER OF: American Hospital As-
sociation, Ohio Hospital Association,
Central Psychiatric Hospital Assoc.
APPROVED BY: American College of
Surgeons, Council of Hospitals.
LICENSED BY State of Ohio.
D. A. JOHNSTON, M.D.. .Medical Director
W. N. WRIGHT, M.D. Resident Psychiatrist
HENRY GRUENER, M.D. Resident Physician
ELLIOTT OTTE Business Administrator
Rest Cottage, beautifully furnished, is
a separate department devoted to
the care of certain psycho-neuroses,
rest, and convalescent cases.
638
The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association , a scientific society, non-profit corporation, with a definite
membership, for scientific and educational purposes.
Vol. 46 July, 1950 No. 7
Jonathan Forman, M. D., Editor
Charles S. Nelson, R. Gordon Moore,
Managing Editor — Bus. Mgr. Asst. Managing Editor
Foramen Magnum and High Cervical Cord Lesions
Simulating Degenerative Disease of the
Nervous System
KENNETH H. ABBOTT, M. D.
The Author
• Dr. Abbott, Columbus, Ohio, is a grad-
uate of College of Medical Evangelists, 1936;
fellow, International College of Surgeons and
American College of Surgeons; member of
Harvey Cushing Society, American Academy
of Neurology, American boards of Psychiatry
and Neurology, and Neurological Surgery;
neurosurgeon, Mt. Carmel and Grant Hos-
pitals; on neurosurgical staff, Children’s, White
Cross, University and St. Francis Hospitals;
and instructor, neurology, College of Medicine,
Ohio State University.
IN the past decade there has been a renewed
interest in the differential diagnosis of the
patient with bizarre and somewhat wide-
spread neurologic signs and symptoms. This
healthy reinvestigation into the problem has
pointed our attention to the region of the
foramen magnum and the upper cervical segments
of the spinal cord as a locale of mass lesions,
such as tumors, protruded intervertebral discs,
and fracture dislocations, as the occasional cause
of such bizarre symptom complexes. Not only
are tumors, protruded discs, and fractures known
to give rise to these syndromes, but also epidural
thrombophlebitis and inflammatory processes
and the syndrome known as platybasia or basilar
invagination (basilar impression) probably are
not infrequent causes of widespread neurologic
signs so commonly attributed to the degenerative
disease groups of the central nervous system.
It is the purpose of this paper to give thoughtful
consideration to such lesions as these in refer-
ence to their differential diagnosis from de-
generative disease of the nervous system, such
as multiple sclerosis, amyotrophic lateral scler-
osis, posterolateral sclerosis, progressive spinal
muscular atrophy, and kindred syndromes.
The cases herein reported will in part ex-
emplify the error in making the diagnosis of
degenerative disease on the basis of the bizarre
neurologic picture alone. It is hoped that cer-
tain pitfalls in the diagnosis can be pointed out
so that space-occupying lesions may be rec-
ognized and remedied before irreparable dam-
age to the nervous system has resulted.
Presented before the Section on Nervous and Mental Dis-
eases at the annual meeting of the Ohio State Medical
Association, Columbus, April 21, 1949.
The first case herein reported, that of a
meningioma of the foramen magnum, is of suf-
ficient rarity and interest to warrant its being
reported in detail. The other cases will be
recorded in less detail, though they may be of
equal interest, but they too emphasize the possi-
bility of high cervical cord lesions giving rise
to diffuse signs and symptoms.
REPORT OF CASES
Case 1. A woman, aged 50 years, of Jewish
descent, was first seen on December 16, 1947.
She had been well until three years prior to this
time, when she had complained of tinnitus in
the left ear. This was associated with “some
difficulty in walking,” which was described
variously as “slightly drunk” or “unsteady”
and was worse when the patient was walking in
the dark. The tinnitus disappeared, and the
walking improved. About two years previously
(the fall of 1945) she had noticed the insidious
onset of numbness in the tips of the fingers
645
of the right hand. Examinations made at this
time had suggested a diagnosis of posterolateral
sclerosis. By June, 1946, there was marked
numbness of the right hand with definite loss
of temperature sensation. At times her symp-
toms regressed; however, after a few months
the numbness had progressed up the right
forearm to the arm and then to the shoulder.
Simultaneously with the sensory loss there was
a mild motor deficit in the right hand and
subsequently in the right lower extremity. By
the fall of 1946' the sensory loss was severe in
the right extremities. It seemed that pain and
temperature senses were most severely affected,
though other sensory modalities were also dis-
turbed. In November, 1946, “a peculiar numb-
ness” appeared in the left hand. After this
there was rapid involvement of the entire left
upper extremity, soon followed by sensory dis-
turbance over the left breast and then of the
left lower extremity.
In January,. 1947, the patient had been
examined by a competent neurologist, who noted
that the symptoms of which she complained
were those of “severe loss of use of the hands
and arms,” and “a drunken, wobbly gait.” Ex-
amination at that time revealed marked hypes-
thesia of the right extremities with hyper-
esthesia and hyperalgesia (dysesthesia?) of the
left extremities. Nystagmoid movements, posi-
tive Romberg sign, marked loss of vibratory
sense in the left upper extremity, and poor ex-
ecution of the finger-to-nose and finger-to-finger
tests were observed. There was bilateral weak-
ness in the upper extremities but more on the
right than on the left. The deep reflexes were
hyperactive in all four extremities with positive
pyramidal tract signs. She was thought to have
multiple sclerosis.
The patient was examined in February by two
competent neurologists in a midwestern city, at
which time pantopaque myelograms were made
on two occasions. A diagnosis was made of
multiple sclerosis or “an inflammatory lesion.”
In March and April she received roentgen ther-
apy to the back of the neck without any improve-
ment. During the following seven months there
were many changes in her symptoms, varying
back and forth from hypalgesia to hyperalgesia
and at times what appeared to be actual im-
provement.
At the time of my first examination of the
patient, she was complaining of inability to
walk without assistance, numbness in both
upper extremities and the right lower extremity
with painful hyperesthesia and hyperalgesia
in the right side of the thorax and the right
lower extremity. Other symptoms of which she
complained were inability to use the right ex-
tremities (“I drag my right leg like I’d had
a stroke”) and pain in the back of the neck
and head on the left side with a sense of
pressure in the left side of the head, particularly
in the left ear.
The past history was not particularly of in-
terest except possibly for an attack of stabbing
pain in the left eye that had occurred five years
previously and lasted only a few days. Three
years previously she had experienced tinnitus
whidh disappeared “after a few months.” Two
years previously, prior to the onset of the
present symptoms, the patient had tripped,
striking her head and also fracturing the left
radius.
Neurologic examination made in December,
1947, did not disclose involvement of the cranial
nerves. There was no nystagmus. There was
marked weakness of both right extremities with
only feeble movements in the right fingers and
fair movement of the right leg, foot and toes.
The right extremities were severely spastic,
while there was slight spastic weakness of the
left extremities. She was able to walk with aid.
The sensory examination was most interesting
in that its results were exceedingly irregular.
The right extremities disclosed marked sensory
Figure 1. Pantopaque myelogram, lateral view, disclosing
partial block to flow of the opaque medium at Cl and
outlining the lower border of the tumor.
loss to all modalities, but there were small areas
which appeared normal or hyperesthetic and
dysesthetic, the lower extremity being less af-
fected than the upper extremity. The deep
reflexes were all hyperactive with bilateral
patellar and ankle clonus, all pyramidal tract
signs being more marked on the left than on the
right. The superficial abdominal reflexes were
absent. Babinski, Oppenheim, Gordon, Gonda,
Chaddock and Hoffmann signs were bilaterally
positive. There was hypesthesia over the left
second cervical dermatome.
Examination of the cerebrospinal fluid revealed
20 mg. of protein/ 100 cc.; the results of further
analysis were also within normal limits. •
The diagnosis of multiple sclerosis seemed the
only probable one with such irregular sensory
findings, although nystagmus, optic atrophy,
and other cranial nerve signs were noted to be
conspicuously absent, while the left suboccipital
and posterior cervical pain seemed unusual for
such a diagnosis.
The patient was seen on a few occasions in
the following four months, during which time
she became progressively worse. By the middle
of April the neurologic status had become that
of quadriplegia and of inability to move the head,
associated with severe left suboccipital, occipital,
and posterior cervical pain. Spontaneous pain
in both upper extremities became more severe;
however, there remained irregular sensory
changes over the trunk and extremities and
ability to move the toes of the left foot. The
remainder of the neurologic status was about
646
The Ohio State Medical Journal
the same except for moderate atrophy of the
right extremities and slight atrophy of the left
extremities. It was then evident that this
patient did not have multiple sclerosis. A
pantopaque myelogram (Figure 1) disclosed a
large filling defect at the foramen magnum.
A small amount of the opaque medium entered
the posterior fossa. Thus, quite tardily a neo-
plasm in the foramen magnum was diagnosed.
On April 28, 1948, limited suboccipital craniec-
tomy and bilateral laminectomy (Cl and C2) were
performed. When the dura over the cisterna
magna was opened, a reddish-brown tumor was
seen to arise to the left of the midline and lie
posterolateral to the medulla. The tumor, ob-
viously a meningioma, extended from 4 to 5
cm. above the foramen magnum to the level
of the upper border of the second cervical verte-
bra and caused severe compression and distor-
tion of the medulla and adjacent cervical
segment of the spinal cord. Careful dissection
of the tumor disclosed that its origin was from a
small area on the left posterolateral rim of the
dura at the foramen, encircling the left vertebral
artery.
The neoplasm was removed piecemeal, the
vertebral arteries being spared. After this
had been done, the dura was thoroughly cau-
terized.
The pathologist reported: “The specimen con-
sists of a number of fragments of white,
smooth, rather firm tissue, the total weight of
which is 9.5 gm. A rapid frozen section was
done on one of these fragments with a diagnosis
of meningioma. Microscopic sections (Figure 2)
Figure 2. Meningioma of the foramen magnum. Note
its uniform fibrous structure and the presence of psammoma
bodies (hematoxylin and eosin x 100).
of the fixed tumor showed it to be made up of
moderately staining, clumped, spindle-shaped cells
arranged quite frequently in a whorled manner.
Scattered throughout the specimen but quite
frequently seen are small round nodules made
up of blue-staining crystalline material (calcos-
pherites). The tumor is moderately vascular and
in one area there is evidence of fresh hemor-
rhage.” The diagnosis made by the pathologist
was meningioma, fibrous type, with psammoma
( Courville- Abbott classification) .
The patient awakened promptly, and exami-
nation eight hours after operation disclosed an
early return of motor function in the right arm.
Twenty hours after operation she could move
both left extremities and the right upper ex-
tremity. On the third postoperative day she
was able to move all four extremities. On her
ninth postoperative day she took a few steps
with the assistance of two nurses, and at the
same time sensory function was definitely re-
turning to normal in all four extremities. By
the end of three weeks she was able to walk
across the room by herself, and after six weeks
she was able to care for herself at home.
In September, 1948, the patient began to drive
her own car and made no complaints aside
from moderate fatigability. Examination in Sep-
tember revealed normal cranial nerves, no
sensory deficit except for slight hypesthesia
in the right hand, no spasticity or rigidity,
and only moderate general weakness in the ex-
tremities, which seemed to be due to the slow
return of function in the atrophic muscles. The
superficial abdominal reflexes were bilaterally
weakly obtained. A positive Babinski sign re-
mained on the right side.
^ ^ ^
Case 2. A white man, aged 32 years, of Irish
descent, was seen because of intermittent numb-
ness in all four extremities with weakness in the
right upper and left lower extremities of two
years’ duration. He had consulted several com-
petent internists and neurologists who had diag-
nosed the condition as multiple sclerosis, poster-
olateral sclerosis, and “a degenerative disease
of the nervous system.” My examination dis-
closed marked weakness of the right upper and
left lower extremities with slight weakness in
the other extremities. There was an irregular
sensory loss, very difficult to map out, but show-
ing distinctly greater pain and temperature loss
in the right extremities and irregularly de-
creased appreciation of vibratory and position
sense in the left hand and both legs and feet.
Touch and pressure were relatively intact in all
four extremities. In the previous month he had
experienced pain over the left occipital area and
slight hyperalgesia was present over the left
occipital area and slight hyperalgesia was
present over the distribution of left C2.
A myelogram disclosed a large defect in the
pantopaque column with almost complete block
at the lower border of the body of C2 on the
left side. A meningioma, situated posterolater-
ally (left) to the spinal cord and arising from
the spinal meninges along the lower border of
Cl to the lower border of C2, was removed
surgically without incident. The patient was
followed for six months after operation, and
at the end of that time had made a complete
neurologic recovery aside from numbness over
the left C2 dermatome (left C2 had been sec-
tioned in order to remove the tumor).
^ sfc
Case 3. A white man, aged 57 years, a
mechanic, was known to have had a fractured
odontoid process some two years before. He was
seen in consultation because of intermittent
weakness of the extremities (occasionally one
arm or leg, or even all four extremities) and
peculiar patches of paresthesia in the left side
of the face and upper extremities.
He had complained of “burning sensations,”
for July, 1950
647
‘‘numbness,” and “tingling” for short intervals
in the left cheek and eye. These had occurred
at varying times (some ten to fifteen times)
over the previous year and lasted from a few
minutes to hours. The attacks of weakness
were all very transitory and most commonly in-
volved the lower extremities simultaneously
and occasionally the right arm and hand. Usually
when such motor attacks occurred he would ex-
perience vague sensory difficulties expressed
variously as “a little numb and tingling,”
“slightly burnt fingers,” and so forth. He had
consulted several internists and a neurologist,
all of whom suggested he might have multiple
sclerosis.
Neurologic examination disclosed dysesthesia
over the left cheek, slightly and irregularly
hyperactive deep reflexes in all extremities, de-
creased superficial abdominal reflexes and bilat-
erally equivocally positive Babinski signs.
Roentgenograms of the cervical vertebrae dis-
closed that the previously fractured odontoid
process was displaced slightly posterior with con-
siderable calcium deposited at the fracture line
about its base at the point of its union to the
body of C2.
The patient refused surgical decompression of
the spinal cord by laminectomy. I have been
unable to trace him since then.
* * *
Case 4. A school teacher, aged 33 years,
came for relief of headaches, difficulty with
vision, awkwardness in the use of the upper ex-
tremities, and odd attacks of numbness in the
hands and feet.
The neurologic examination was not at all
satisfactory. There were slight ataxia of the
left upper extremity and paresthesias in both
hands with periods of paresthesias in both feet
(pinprick frequently was recognized as “a burn-
ing point”). The deep reflexes were quite ir-
regular not only at the time of the original ex-
amination, but at subsequent examinations. At
no time was the neurologic picture consistent,
though a definitely positive Babinski sign was
occasionally obtained on the right and an equiv-
ocal Babinski sign on the left. The optic fundi
were within normal limits. There was no evi-
dence of papilledema or optic atrophy. Oc-
casional nystagmoid movements were noted, but
no definite nystagmus. The Wassermann reac-
tions of the blood and cerebrospinal fluid were
negative for syphilis.
From the neurologic examination one would
expect that this patient might be suffering from
a degenerative disease of the nervous system
such as multiple sclerosis; however, roentgen-
ograms of the skull disclosed a mild but definite
platybasia. Suboccipital craniectomy and upper
cervical laminectomy confirmed this diagnosis.
An adequate decompression of the posterior
fossa and upper cervical segment of the spinal
cord gave almost complete relief from all
symptoms.
COMMENT
The earliest review of spinal tumors that
lie above the C4 segmental level appears to
have been that of Antoni in 1920.1 Prior to this
they were of interest only as pathologic museum
specimens and, as pointed out by Cushing and
Eisenhardt,2 this “was true of the example de-
scribed by Antoni (Case XXI) which since 1862
had been in the museum at Lund.” Surgical
repair on these tumors soon followed Antoni’s
report, such as that of Frazier and Spiller3 in
1922, Learmonth’s4 in 1927, and Elsberg and
Strauss5 in 1929 along with other increasingly
frequent reports in the literature since that date.
However, Bogorodinsky0 appears to have been
the first to review the various syndromes re-
sulting from tumors arising primarily in the
foramen magnum. His principal conclusions
have been summarized by Cushing and Eisen-
hardt7 as follows:
1. Extramedullary tumors located at the
juncture of the oblongata and the spinal cord
(that is, craniospinal tumors) run a stereotyped
clinical course which gives rise to a definite
syndrome.
2. The onset is characterized by suboccipital
discomforts, protective rigidity of the cervical
and occipital musculature, and sometimes by
pains and paresthesias in the shoulder girdle
and upper extremities.
3. At its maximum stage the clinical symp-
toms are as follows: (1) Paralyses of the ex-
tremities (hemiplegia, triplegia, or tetraplegia).
(2) Rigidity and paresis of the cervical muscles,
abnormal posture of the head, and paresis of the
XI pair of cranial nerves. (3) Pains and par-
esthesias in the extremities and trunk. (4) Pains
in the occiput and the neck. (5) Hemian-
esthesia or para-anesthesia reaching up to the
upper cervical dermatomes occasionally involv-
ing the skin field of the trigeminus. (6) Sphinc-
teric disturbances. (7) Respiratory disturbances.
(8) Horner’s symptom-complex. (9) Cerebral
symptoms such as paralyses of the X, XI, and
XII pairs of cranial nerves and choked discs
are of infrequent occurrence.
4. Three different types of syndrome may be
distinguished: (1) the hemiplegic; (2) the para-
plegic, which may take either the descending
or the ascending form; and (3) the mixed type.
5. The paralyses of the upper extremities
reveal signs of their derivation from lesions of
both peripheral and central neurons.
6. The striking sensory features are thermic
paresthesias and the peculiar distribution of
disturbances which takes the form of hemian-
esthesia alternans cum radic. cervicalis.
7. Cerebral and cerebellar symptoms are both
mild and infrequent.
8. Vegetative symptoms such as Horner’s
syndrome, respiratory and sphincteric disturb-
ances should be regarded as due to lesions of
the pyramids and of the central sympathetic.
9. The course of the malady is slowly progres-
sive, lasting for months and even years, though
remission of isolated symptoms may occasion-
ally be observed.
10. The degenerative atrophies are not limited
to the level of compression but involve the
cervical, the thoracic and sometimes even the
lumbar segments of the cord.
•648
The Ohio State Medical Journal
11. The extirpation of the tumor by surgical
interference has proved to be an efficient method
of treatment in 50 per cent of the cases that were
operated on.
Although Bogorodinsky6 emphasized the varia-
tion of symptoms that foramen magnum tumors
may present as they grow, it probably was
Friedman8 (and later Neri,* 9 Roussy and Levy,10
Friedman11 and Schick12) who called attention
to the fact that such a tumor may simulate a
degenerative disease of the central nervous
system such as combined system disease. Fried-
man13 in 1941 again called attention to this
in a case report and noted the tendency for re-
mission of symptoms, the condition thus re-
sembling multiple sclerosis. Others (Ecker,14 and
Bennett and Fortis13) have reported cases in
which a diagnosis of syringomyelia (disassociated
syndrome) might justifiably have been made.
Bennett and Fortis15 emphasized that at some
time in the course of development of tumors
of the foramen magnum there is reason to
consider in the differential diagnosis amyo-
trophic lateral sclerosis, combined system dis-
ease, multiple sclerosis, and syringomyelia. The
diagnosis in the case of Gardner17 and his co-
workers was complicated by a positive serologic
reaction for syphilis, a complication which de-
layed recognition and removal of the tumor.
In my case (Case 1) the neurologic signs,
particularly the sensory findings, were irregular,
at times suggesting a combined system disease.
Later on in the clinical course the picture ap-
peared so bizarre that a diagnosis of multiple
sclerosis seemed justified. However, it would
appear most important to emphasize the severe
pain in the left suboccipital, occipital and
posterior cervical areas as well as in the upper
extremities. This distribution of pain, together
with the picture of progressive quadriplegia,
should have been enough to force one to make
the correct diagnosis of tumor of the foramen
magnum. However, it was not until total
paralysis appeared that the fallacy in diagnosis
demanded restudy of this patient. This now
seems an inexcusable error. Certainly when
severe suboccipital and neck pain appears
associated with one of the foregoing neurologic
syndromes, the examiner should first think of
a tumor of the foramen magnum and then
attempt to prove or disprove this diagnosis
rather than give way to the hopeless diagnosis
of a degenerative lesion.
Cushing and Eisenhardt18 called attention to
the fact that this group of meningiomas should
be divided into two distinct subgroups: (1)
Those arising from the basilar (occipital)
groove or process, and (2) those arising from
the spinal canal. The former group they called
“craniospinal” after the suggestion of Bogorodin-
* More specifically referring to high (Cl) lesions of the
cervical segment of the spinal cord.
sky,6 since these tumors primarily arise in-
tracranially and extend down through the for-
amen magnum. These tumors are all situated
anterior or anterolateral to the medulla. The
second group, the spinocranial meningiomas,
are located posterior or posterolateral to the
medulla.
In either group a fairly large mass of tumor
may be found intracranially; but, as Cushing
and Eisenhardt emphasized, it is the cranio-
spinal meningiomas which have been a most
difficult surgical problem. However, Cushing
and Eisenhardt19 stated: “Whether a meningioma
arising from the basilar groove which must be
overlain and concealed by a posteriorly dis-
lodged medulla and its emerging nerves could
be safely exposed and surgically enucleated must
be left for further experience to determine.” Since
then Voss,20 Ecker,14 Keegan,21 and others22* 23
have removed successfully craniospinal meningi-
omas and there has been a growing list of spino-
cranial meningiomas successfully removed.
The greater technical difficulties encountered
in the surgical attack on craniospinal tumors
suggested to me that it would be of interest to
review their symptoms and determine if it is
possible to differentiate clinically between the
two groups (craniospinal and spinocranial). As
has been shown, the syndrome of unilateral
sensory changes of an upper extremity asso-
ciated with either unilateral or bilateral pyrami-
dal tract signs and symptoms is common to
both the spinocranial and the craniospinal
tumors. However, it was noted that spino-
cranial meningiomas tend to produce more
severe suboccipital and occipital pain than
craniospinal meningiomas produce. This is
probably because the second cervical root is
acutely stretched across the posteriorly or pos-
terolaterally situated tumors, as was pointed out
by Cushing and Eisenhardt.24 In the craniospinal
tumors not infrequently there is considerable
suboccipital aching, but from the reported cases
and those that I have had the privilege of study-
ing in a large neurosurgical clinic, the sub-
occipital symptoms are not as severe as those
encountered in the spinocranial group. (Gardner
has called attention to the presence of sensory
loss in the ipsilateral C2 dermatome.)
A review of other symptoms failed to suggest
any other difference in the two groups, even
though it would seem that the craniospinal group
from their position might produce pyramidal
tract signs earlier and with more severe symp-
toms of motor deficit subsequently developing;
however, this was not borne out. To be sure,
it was not always possible to determine in every
case report whether the origin of the tumor was
intracranial or intraspinal.
At the time of the surgical removal of the
tumor (spinocranial) recorded in Case 1, I was
particularly interested in noting the point of
for July, 1950
64 9
attachment to the leptomeninges and dura. It
seemed of importance to note that the origin
of the tumor was on the left posterolateral
margin of the dura over the rim of the occipital
bone forming the foramen magnum and also
encircling the left vertebral artery. The at-
tachment was very discreet and well demon-
strated. The elementary question again arises
whether this origin is spinal or cranial. The
location suggests that this tumor originated
intracranially or at least it might be con-
sidered to have had a cranial origin though, to
be sure, it did not arise from the occipital
basilar groove.
The danger of lumbar punctures with the re-
moval of fluid in cases of spinal and intra-
cranial tumors (particularly in the posterior
fossa) has been well recognized for many
years25 but probably is more forcefully brought
to attention in reviewing the foraminal tumors
of this group. In more than 70 per cent of the
reported cases in which the dynamic relations
of the cerebrospinal fluid were interfered with
by lumbar puncture, the symptoms were im-
mediately made worse. Bennett and Fortis,15
who again called attention to this fact, had to
place their patient in a respirator for three
months after lumbar puncture. However, the
symptoms of the patient in Case 1 did not ap-
pear to be aggravated immediately, either by
lumbar puncture alone or by the multiple panto-
paque myelographies performed via the lumbar
route.
Although an increased total protein in the
cerebrospinal fluid should suggest the possibility
of a neoplasm, Friedman13 and others have re-
ported normal concentrations of total protein
in the cerebrospinal fluid. This was also the
situation in Case 1. Thus, unless there is an
obstruction to the flow of the cerebrospinal fluid
or embarrassment of local circulation, the total
protein in the cerebrospinal fluid may not be
elevated.
Any patient giving evidence of sensory changes
(paresthesias or sensory loss) in one or both
upper extremities associated sensory changes
in either C2 dermatome and with pyramidal
tract signs (ipsilateral, contralateral, or bila-
teral) should be considered as possibly having
a tumor of the foramen magnum. Other syn-
dromes, such as Brown-Sequard, disassociated,
and combined system, and multiple sclerosis
syndromes, particularly if associated with sub-
occipital pain or aching, should arouse strong
suspicion of the presence of a spinocranial or
craniospinal or high cervical cord tumor. The
absence of an increased concentration of protein
in the cerebrospinal fluid does not argue against
the probable presence of these lesions. Although
palsies of the cranial nerves (tenth, eleventh, and
twelfth) may occur, as well as diplopia and
cerebellar signs, they are more commonly absent.
Severe occipital and suboccipital pain asso-
ciated with the foregoing symptoms suggests
that the lesion is a spinocranial tumor and, if
so, more easily amenable to surgical attack
than a craniospinal tum'or.
It would seem advisable to perform myelog-
raphy in all such patients rather than to
allow quadriplegia to develop before the diag-
nosis is made, or to find the tumor at postmortem
examination.
Although this discussion has centered mainly
around tumors of the foramen magnum, similar
remarks might be directed toward the tumors
cephalad to the fourth cervical segment. How-
ever, in most of these tumors there is usually
evidence of involvement of one of the upper
cervical nerve roots together with pyramidal
or sensory tract signs. To be sure, many of
these tumors, if not the majority of them, give
a progressive course typical of tumor, though
there is an occasional one, such as described in
Case 2, in which there is a wide variation in
the symptoms with complete remission of all
subjective symptoms and possibly signs. The
same is probably true of an occasional frac-
tured odontoid process, as mentioned previously.
Of considerable interest are the groups of pa-
tients suffering from platybasia or so-called basi-
lar impression or basilar invagination of the skull
which in recent years has been emphasized
by Chamberlain26 and by Gustafson and Old-
berg27 and others. Usually the obvious cases
are diagnosed from the roentgenograms; how-
ever, those cases which can be considered from
the roentgenographic evidence as being border-
line cases are the ones that may give rise
to difficulties in their diagnosis. Such cases,
however, may show marked changes at the time
of operation. In one such case (Case 4) that I
have encountered, there was evidence of exten-
sive adhesions and arachnoiditis associated with
what might be considered “grade 1+” platy-
basia. In this case there was marked ob-
struction of the subarachnoid space with highly
bizarre and changing neurologic symptoms,
which at first were thought to be due to multiple
sclerosis. In such cases the patients may and
frequently do respond very well to surgical de-
compression. Thus again in all cases of
suspected degenerative diseases, such as multiple
sclerosis, and so forth, the patient should be
given the benefit of roentgenographic study for
the possibility of platybasia being present.
Another group of cases in which we are not
primarily interested here, but which should be
mentioned are those on which Fay28 has focused
attention in which, in his opinion, there has been
an inflammatory process in the upper cervical
epidural area. These he refers to as cases of
“epidural thrombophlebitis” and “epidural in-
flammation with secondary involvement of the
650
The Ohio State Medical Journal
spinal cord.” There are some neurologists
who undoubtedly give very little credence to
this diagnosis. I have had a very limited ex-
perience in this field, having seen only two
such cases in which there was obvious evidence
of infection at the level of C2 in one case and
C3 in another. When the dura was opened,
marked adhesions between the arachnoid and
the dura and between the arachnoid and the
spinal cord were encountered. The operation
was done in both instances with the purpose of
performing a rhizotomy for local (radicular)
pain; at the same time minimal motor or sensory
long tract signs had been found prior to opera-
tion. The pantopaque myelogram had shown
an irregular defect at this level which I felt
must be due to arachnoiditis. It seems probable
therefore that more severe infections might
give rise to symptoms not unlike multiple
sclerosis or amyotrophic lateral sclerosis or both.
Neither of these patients showed any change in
liis neurologic status aside from the minimal
sensory loss following the posterior root rhiz-
otomy. However, it may be that as a result of
further investigation by way of surgical ex-
ploration on those patients who show the so-
called spinal type of multiple sclerosis similiar
inflammatory lesions will be found by other sur-
geons, and Fay’s reports will thus be confirmed.
I have not had experience with patients
suffering from protruded cervical discs in the
upper cervical segments; hence, I have only
mentioned that they may, in all probability, give
rise to syndromes similar to those under discus-
sion. The reports of Bucy29 and others appear
to confirm this.
SUMMARY
Any patient giving evidence of sensory
changes, paresthesias or sensory loss in either
C2 dermatome and in one or both upper ex-
tremities associated with pyramidal tract
signs, ipsilateral, contralateral, or bilateral,
should be considered as possibly having a tumor
of the foramen magnum, an upper cervical
tumor, or other space-occupying lesion, regard-
less of whether or not these symptoms are ac-
companied by evidences of intracranial changes.
Other syndromes, such as Brown-Sequard, dis-
associated syndrome, combined system disease,
and multiple sclerosis syndrome, particularly
if they are associated with suboccipital pain or
aching, should arouse strong suspicion of the
presence of a high cervical, spinocranial, or
craniospinal neoplasm or of a protruded inter-
vertebral disc in the cervical segments cephalad
to C4. The absence of an increased concentra-
tion of protein in the cerebrospinal fluid does
not argue against the probable presence of these
lesions. If such syndromes are accompanied by
palsies of the tenth, eleventh, and twelfth cran-
ial nerves or even by diplopia and cerebellar
signs, their presence does not rule out the
presence of a tumor in this region though these
symptoms are commonly present in degenera-
tive lesions of the nervous system. If any of
these syndromes are present, the possibility of
basilar invagination (platybasia) must also be
suspected. Severe occipital or suboccipital
pain associated with the foregoing symptoms
suggests that the lesion is a spinocranial tumor
and, if so, is more amenable to surgical attack
than a craniospinal tumor. It would seem
advisable to perform myelography in all such
cases rather than to allow quadriplegia to
develop before the diagnosis is made or to
find the tumor at postmortem examination.
BIBLIOGRAPHY
1. Antoni, N. R. E. : Uber Riickenmarkstumoren und
Neurofibrome. Studien zur Pathologischen Anatomie und
Embryogenese. Miinchen, J. F. Bergmann, p 436. 1920.
2. Cushing, H., and Eisenhardt, L. : Meningiomas.
Springfield, 111., Charles C. Thomas, p 87. 1938.
3. Frazier, C. H., and Spiller, W. G. : An Analysis of
Fourteen Consecutive Cases of Spinal Cord Tumor. Arch.
Neurol, and Psychiat., Chicago 8, 455-501. 1922.
4. Learmonth, J. R. : On Leptomeningiomas (Endothe-
liomas) of the Spinal Cord. Brit. J. Surg., 14, 397-471.
1927.
5. Elsberg, C. A., and Strauss, I. : Tumors of the Spinal
Cord Which Project into the Posterior Cranial Fossa.
Arch. Neurol, and Psychiat., Chicago 21, 261-273. 1929.
6. Bogorodinsky, D. K. : Syndrome of Craniospinal
Tumor. Tashkent, Govt. Publ. U. S. S. R., p 104. 1936.
7. Cushing, H., and Eisenhardt, L. : Meningiomas.
Springfield, 111., Charles C. Thomas, 178-179. 1938.
8. Freidman, E. D. : Cervical Cord Lesions in the
Guise of Combined System Disease. M. J. and Rec., 126,
734-739. 1927.
9. Neri, M. V.: LaForme Ataxique Initiale des Com-
pressions Medullaires Cervicales. Rev. Neurol., 1 :60-64, 1932.
10. Roussy and Levy: Existence d’une dissociation, dite
corticale, des troubles de la sensibilite etteinte bulbo-
protuberantielle et medullaire superieure. Rev. Neurol., 1,
145-162. 1930.
11. Friedman, E. D. : Lesion of the Upper Cervical
Portion of the Cord Resembling Combined System Disease.
Presentation of a Case. Arch. Neurol, and Psychiat., 37,
p 430. 1937.
12. Schick, Wm. : Tumor High in Cervical Region
of the Spinal Cord Simulating Combined System Disease.
Arch. Neurol, and Psychiat., 32, p 1343. 1934.
13. Friedman, E. D. : Compression of the Upper Cervical
Cord in the Guise of Combined System Disease. Intemat.
Clin., 3. 102-110. 1941.
14. Ecker, A. D. : Removal of Tumor Arising Anterior
to the Medulla. Arch. Neurol, and Psychiat., 46, 908-912.
1941.
15. Bennett, A. E., and Fortix, A. : Meningioma Ob-
structing the Foramen Magnum. Arch. Neurol, and Psy-
chiat., 53. 131-134. 1945.
16. Lereboullet, J., and Puech, P. : Tumeur de la Moelle
Cervicale haute avec Prolongement Intracranien Simulant
la Sclerose Lateral Amyotrophique. Operation. Guerison.
Bull, et mem. Soc. med. d. hop de Paris, 56, 828-830.
1941.
17. Gardner, W. J., Karnosh, L. J., and McNerney, J. C. :
Meningeal Tumor in the Foramen Magnum. Arch. Neurol,
and Psychiat., 39, 1392-1307. 1938.
18. Cushing, H., and Eisenhardt, L. : No. 2. Also see
p 88.
19. Ibid, p 180.
20. Voss, O. : Basale Meningeome der hinteren Schodel-
grube. Arch. f. klin Chir., 189, 494-497. 1937.
21. Keegan, J. J. : Reported by Bennett, A. E., and
Fortix, A. No. 10.
22. Love, J. G., and Adson, A. W. : Tumors of the
Foramen Magnum. Tr. Am. Neurol. A., 67, 78-81. 1941.
23. List, C. F. : Multiple Meningiomas. Removal of
Four Tumors From Region of the Foramen Magnum and
Upper Cervical Region. Arch. Neurol, and Psychiat., 50,
335-341. 1943.
24. Cushing, H., and Eisenhardt, L. : No. 2. Also see
p 90.
25. Bennett, A. E. : Cerebellar Herniation into Foramen
Magnum. J. A. M. A., 100, 1922-1925. 1933.
26. Chamberlain, W. E. : Basilar Impression (Platybasia).
Yale J. Biol, and Med., 11, 487-496, 1939.
27. Gustafson, W. A., and Oldberg, E. : Neurologic
Significance of Platybasia. Arch. Neurol, and Psychiat.,
44, 1184-1198. 1940.
28. Fay, Temple. Personal Communication.
29. Bucy, Paul C. : The Simulation of Multiple Sclerosis
and Other ’ Degenerative Diseases of the Spinal Cord by
Herniation of Cervical Intervertebral Discs. Cincinnati
J. Med., 30:16-18. 1949.
for July , 1950
651
The Emergency Management of Acute, Massive
Upper Gastrointestinal Hemorrhage
STANLEY 0. HOERR, M. D.
The Author
• Dr. Hoerr, Cleveland, Ohio, is a graduate
of Harvard Medical School, Boston, 1936;
diplomate, American Board of Surgery; fel-
low, American College of Surgeons; formerly
attending surgeon, University Hospital, and
associate professor of surgery, Ohio State Uni-
versity School of Medicine; now, assoc, sur-
geon, Cleveland Clinic.
THE patient who suddenly vomits blood or
passes a large tarry stool invariably pre-
sents a troublesome problem to the physi-
cian responsible for his care. The well-known
fact that most of these acute hemorrhages sub-
side spontaneously is of small comfort when one is
dealing with a particular individual whose death,
if he should exsanguinate, will be complete,
even though this same death may be expressed
as a tiny percentage in a large series of cases.
The first question the physician must ask
himself is this: Is the bleeding so rapid that
death may occur in a matter of hours? It is
unnecessary to have elaborate aids in deciding
this point, and it takes priority over every other
consideration. The clinical evidences of shock —
weakness, pallor, a weak, thready, rapid pulse,
and cool, damp extremities — bespeak a serious
and rapid loss of blood. If shock is present, the
immediate requirement is support of the cir-
culation, and the most effective means is by
prompt blood transfusion. Contrariwise, a pa-
tient who is warm and has a slow full pulse is
safe, for the moment at least, insofar as his
circulation is concerned. If one sees a patient
very soon after the onset of bleeding, it is pos-
sible to misinterpret the syncope or faintness,
which often accompanies the effort of vomiting
or moving the bowels, for hemorrhagic shock;
the lapse of a few minutes, and the prompt im-
provement which results from simple recumbency,
will assist in the differentiation. But if doubt
persists, it is far better to give a blood trans-
fusion which in retrospect proves to have been
unnecessary, than to withhold blood from a pa-
tient who badly needs it.
RATIONALE OF BLOOD TRANSFUSION
This prompt and liberal use of blood transfusion
for the patient with a serious hemorrhage rep-
resents a departure from practices of the past.
It has been taught by able clinicians that “shock”
and its lowered systolic blood pressure is actually
beneficial to the patient by permitting a clot
to form over the site of the bleeding, and it
has been argued that to raise the blood pressure
to normal levels too quickly, by giving blood,
will “blow off the clot” and start fresh bleed-
ing. This point of view is no longer held by
most investigators of the problem. The prac-
tical dangers of a prolonged hypotension, re-
sulting in irreversible renal damage, or precipitat-
Presented before the Section on Surgery at the Annual
Meeting of the Ohio State Medical Association, Columbus,
Ohio, April 19, 1949.
ing a coronary or cerebral thrombosis in an
elderly person, is held to outweigh the theoreti-
cal possibility of renewing the bleeding. Most
patients in actual or impending shock respond
satisfactorily to a single transfusion of 500 cc
whole blood, but an occasional badly depleted
patient may require up to 1500 cc in the first
five or six hours. Plasma is not an adequate
substitute for whole blood, although it may some-
times act as an indispensable stop-gap during
the time that properly cross-matched whole
blood is being secured. The use of the usual
electrolytes— glucose in water, or glucose in
saline — is to be condemned; although these solu-
tions will temporarily increase the blood volume,
their ultimate effect is deleterious through a
relative reduction of the essential components
of the blood stream.
INITIAL EXAMINATION
While the state of the circulation is being
ascertained, the physician may examine the nose,
mouth and throat, listen to the chest, gently
palpate the abdomen (looking especially for
epigastric masses or an enlarged spleen), and
perform a rectal examination. This will enable
him to exclude the oropharynx as a source of
bleeding, to rule out gross pulmonary lesions
which might cause confusion between hemoptysis
and hematemesis or to suspect a gastric
neoplasm. If the spleen is palpable, bleeding
from esophageal varices is always to be con-
sidered. Tarry feces on the glove will confirm
the fact that bleeding is high, and very rarely
a rectal neoplasm or a Blumer’s shelf will
shed unexpected light upon the basic diagnosis.
In the severe bleeder it is always desirable
to obtain baseline determinations of the total
erythrocyte count, hemoglobin, hematocrit and
total plasma protein. The initial values will not
influence the decision concerning an immediate
blood transfusion, but they will prove of great
%
652
The Ohio State Medical Journal
value in estimating the progress and rate of hem-
orrhage, and the adequacy of blood replacement
by comparison with samples taken later. In inter-
preting the admission values it must be remem-
bered that a nearly normal blood count is not in-
consistent with a massive hemorrhage of short
duration; and on the other hand, that a severe
anemia does not necessarily mean a massive hem-
orrhage, but may merely reflect a chronic loss of
blood.
GENERAL MEASURES
After the institution of any indicated therapy
for hemorrhagic shock, adjuvant measures are
in order. If the patient is in pain or has severe
discomfort, demerol will probably be preferable
to morphine, since it does not increase gastro-
intestinal tonus. The fears of an apprehensive
patient who is free of pain are best allayed with
a barbiturate. An ulcer-type diet with non-
absorbable alkalis may be started almost at once
providing that the patient has not been vomit-
ing. Such a feeding regimen is beneficial if the
lesion is a peptic ulcer or gastritis (which to-
gether account for about 80 per cent of all cases
of massive upper gastrointestinal hemorrhage),
and will not be harmful if the bleeding is due
to some other cause. On the other hand, if the
patient is retching and vomiting, the stomach
should be kept empty by means of a Levine tube
attached to constant suction. The danger that
such a tube may increase bleeding by passing
over the lesion would seem to be less than the
strain imposed by vomiting. Ice applied extern-
ally to the epigastrium is to be avoided, because
it increases gastric motility. Some investigators
are advocating the oral administration of throm-
bin in doses of 10,000 Iowa units in an effort
to promote clot formation at the bleeding site.
It is difficult to see how this can affect bleed-
ing from a large artery, but there can be no
harm in using it.
METHOD OF OBSERVATION FOR FURTHER
HEMORRHAGE
When the physician has taken the preliminary
measures outlined above, he may ask himself
a second question: Will the bleeding stop spon-
taneously? It is assumed by nearly all investi-
gators that a spontaneous arrest of the hemor-
rhage is the happiest outcome for all concerned
The alternative treatment, an emergency opera-
tion, is not applicable to bleeding from esophageal
varices, nor to that small but important group
in whom the bleeding appears to come from
numerous sites often too minute to visualize
even at autopsy (as in a blood dyscrasia).
Even when the lesion is a discrete one in the
stomach or duodenum, a gastric resection is
nearly always indicated — a formidable procedure
in these poor-risk patients. Fortunately, an
emergency operation is rarely needed, but since
it will offer an occasional patient his only
chance of survival, the physician must attempt
to select that patient as promptly and accurately
as possible.
The selection of this patient who will die
without an operation can rarely be made within
the first six or eight hours of hospitalization.
Many patients will continue to bleed for some
hours after treatment is first started, and fairly
brisk hemorrhages lasting for several days
may still cease spontaneously. The next step
to be taken by the physician, therefore, is to
set up a means of continuous observation which
will make apparent any deterioration of the con-
dition of the patient.
A useful plan for observation is the following:
(1) A chart of the pulse and blood pressure.
These determinations are made and recorded
by the nurse at intervals of 15 to 60 min-
utes. This not only supplies the physician
with a graphic record, but permits him to
write orders covering the giving of additional
blood during his unavoidable absences. Thus
an order may be written: “Notify doctor and
start blood transfusion if systolic blood pres-
sure falls below 90 mm Hg,” or “Call doctor if
pulse rate exceeds 120 or systolic blood pressure
falls below 100.” Sharp increases in pulse rate
or drops in blood pressure are danger signals
which should be heeded, and may herald a re-
currence of very rapid bleeding.
(2) A determination of total erythrocytes,
hemoglobin and hematocrit every eight hours,
day and night. Successive values will show the
over-all trend. Progressive drops will indicate
either inadequate blood replacement, or persist-
ing hemorrhage, or both. Some hemodilution is
to be expected for twenty-four hours or more
after the cessation of a massive hemorrhage.
(3) The bedside appraisal of the patient at
intervals not to exceed eight hours for the first
day at least. The chart may be reviewed, and
the occurrence of hematemesis or melena ascer-
tained. (The physician should recall that tarry
stools may persist a day or longer after bleeding
has ceased.) Patients who have ceased bleeding
•generally show a steady improvement both in
appearance and sense of well-being.
INDICATIONS FOR EMERGENCY SURGERY
This triple check-up on the patient will deter-
mine quite clearly whether or not he is continuing
to bleed. At University Hospital the clinical rule
has been found helpful in which a pint of blood is
given every eight hours, if the patient’s condition
demands it; if this much blood fails to hold him
in circulatory equilibrium it is assumed that
bleeding is from a large vessel, that spontaneous
arrest is unlikely, and emergency surgery should
be planned. Spontaneous arrest also is deemed
unlikely in the patient who appears to bleed in-
termittently but very rapidly, lapsing into shock
or syncope on one or more occasions while under
for July, 1950
653
treatment, after quiescent periods which may last
up to several days.
It will be noted that nothing has been said up
to this point about the effect of the age of the
patient in deciding for or against operation. Al-
though the age factor has been stressed by vari-
ous eminent surgeons, some of whom advocate
emergency surgery in every patient over 50
years of age who presents himself with a mas-
sive hemorrhage, it is well known that a
majority of older patients will respond to non-
operative measures. It seems more logical, there-
fore, to exercise selection in these patients, also,
on the basis of the criteria already outlined.
It is true, however, that the majority of emer-
gency operative procedures will be performed in
the older age group, for two reasons: (1) arterio-
sclerosis is often present in the eroded blood
vessels, and loss of vessel contractility may
interfere with the spontaneous arrest of bleed-
ing; (2) older patients tolerate blood loss and
shock less well than their younger brothers.
The elderly patient must therefore be observed
with especial care, and in the border-line cases
one should favor surgery.
It has been observed by many clinicians that
the longer the hemorrhage has lasted, the
heavier becomes the operative risk. Some sur-
geons refuse to operate upon patients who have
been bleeding for more than forty-eight hours.
This contraindication to emergency surgery has
assumed less importance in recent years. It will
usually be possible to decide for or against oper-
ation within an observation period of twenty-four
to forty-eight hours, but if a sound reason for
surgery should become manifest after this time,
operation is still justified.
INDICATIONS FOR EMERGENCY X-RAY
As long as the patient is doing well on a
conservative regimen, it is not necessary for the
physician to know the exact source of the bleed-
ing. If the patient is going to require an
operation, however, the source of bleeding be-
comes of great practical significance and the
physician must ask himself a third question:
Is the bleeding lesion amenable to emergency
operation? In some patients previous X-ray or
gastroscopic studies will have established the
existence of a gastric or duodenal ulcer. All
too frequently, however, the most serious hemor-
rhages are first hemorrhages in patients upon
whom no diagnostic studies have ever been made.
It is unwise to depend upon a clinical diagnosis
in such a patient. Even though his condition
is poor, he should be taken to the X-ray de-
partment for an emergency barium swallow to
be administered by the senior roentgenologist.
Blood should be available during this examina-
tion. The presence or absence of esophageal
varices is first determined; if present, they are
the presumptive source of hemorrhage, and
emergency operation will not help. If a definite
lesion in stomach or duodenum cannot be dem-
onstrated, it is probably wiser to refuse surgery,
transfuse further, and hope for recovery.
OPERATIVE PROCEDURE
The patient who comes to operation is one
who has either lapsed into shock from rapid
bleeding on one or more occasions while under
treatment, or has failed to hold his own while
receiving 500 cc blood every eight hours. He
has a proved lesion in the stomach or duodenum.
He is critically ill and a poor surgical risk,
but the risk of not operating is felt to be even
greater. A general anesthesia will be required.
At least six pints of compatible blood should be
available for use in the operating room. A direct
attack is made upon the bleeding lesion. If the
lesion is in the stomach, a gastric resection, in-
cluding the lesion, is carried out. If the lesion is
in the duodenum, it will be excised if possible;
if not, the vessels in the ulcer bed will be
ligated. Whether the ulcer is retained within
the duodenum or not, the duodenal stump is
turned in and the gastric contents permanently
diverted by means of a gastric resection includ-
ing at least 50 per cent of the stomach. It is
not enough merely to ligate the vessels, through
a gastrotomy or duodenotomy; after such a pro-
cedure the incidence of fatal secondary hemor-
rhage within a few days of operation is very
high. An emergency vagus resection is con-
traindicated.
SUMMARY
The primary need of a patient with acute
massive upper gastrointestinal hemorrhage is
support of the circulation by blood transfusion.
Most of these hemorrhages subside under con-
servative management irrespective of the source
of the bleeding. Plans are presented for deter-
mining promptly the continuation of dangerous
bleeding, and for selecting the occasional patient
who will require an emergency operation to
arrest the hemorrhage.
BIBLIOGRAPHY
1. Allen, Arthur : Acute Massive Hemorrhage from the
Upper Gastrointestinal Tract. Surgery, 2 :713, 1937.
2. Amendola, Frederick H. : The Management of Massive
Gastroduodenal Hemorrhage. Ann. Surg., 129 :47, 1949.
3. Bisgard, J. D., Matson, G. M., and Hirschmann, J. :
Adynamic Ileus and Thermal Influences on Gastric and In-
testinal Motor Activity. J. A. M. A., 118 :447, 1942.
4. Bohrer, J. V. : Massive Gastric Hemorrhage with Spe-
cial Reference to Peptic Ulcer. Ann. Surg., 114 :510, 1941.
5. Costello, Cyril: Massive Hematemesis. Ann. Surg.,
129:289, 1949.
6. Dunphy, J. E., and Hoerr, S. O. : The Indication for
Emergency Operation in Severe Hemorrhage from Gastric
or Duodenal Ulcer. Surgery, 24:231, 1948.
7. Fraser, R. W., and West, J. P. : The Management of
Bleeding DVodenal Ulcers. Ann. Surg., 129 :299, 1949.
8. Hoerr, S. O., Dunphy, J. E., and Gray, S. J. : The
Place of Surgery in the Emergency Treatment of Acute
Massive, Upper Gastrointestinal Hemorrhage. Surg., Gyn.
& Obst., 87:338, 1948.
9. Rogers, T. M. : Management of Gastric Hemorrhage
Using Topical Thrombin. J. A. M. A., 137:1035, 1948.
10. Stewart, J. D., Schaer, S. M., Potter, W. H., and
Massover, A. J. : Management of Massively Bleeding Peptic
Ulcer. Ann. Surg. 128 :791, 1948.
11. Warren, R., and Lanman, T. H. : Surgery In Bleed-
ing Peptic Ulcer. Surg., Gyn. & Obst., 87 :291, 1948.
654
The Ohio State Medical Journal
Clinical Significance and Management of the
Hypasthenic Patient
JOSEPH M. HAYMAN, Jr., M. D.
The Author
• Dr. Hayman, Cleveland, Ohio, is a graduate
of University of Pennsylvania School of Medi-
cine, 1921; fellow, American College of Phy-
sicians; physician-in-charge. University Hospi-
tals; and professor of medicine, School of Medi-
cine, Western Reserve University.
FROM its derivation hypasthenia means a
little asthenia, and may be applied to the
large group of patients who come to our of-
fices complaining of weakness or fatigue.
Common lay and professional opinion regard-
ing the usual causes of hypasthenia are quite
divergent. The former think of vitamin defici-
ency (thanks to effective advertising campaigns),
constipation, sluggish liver, a weak heart, tuber-
culosis, or cancer. The physicians think of
Addison’s disease, hypotension, hypoglycemia,
anemia, myxoedema, hyperthyroidism, undulant
fever, or a pleuroglandular endocrine dysfunction.
A few years ago, Dr. F. N. Allen1 reviewed
the records of 300 patients studied at the Lahey
Clinic because of complaints of weakness, fatigue,
or weak spells. Physical disorders were found
to explain the complaint in 61 patients or 20 per
cent while “nervous conditions” were held re-
sponsible for 80 per cent. In the group in which
physical disorders were believed responsible for
the symptoms, the diagnosis was made in 28
or 46 per cent by routine history and physical
•examination, while the others, or slightly
•over half, required more or less laboratory
investigation.
If in anything like 80 per cent of patients
with hypasthenia the symptoms are due to
emotional stress, this possibility should certainly
be considered from the first visit. A diagnosis
of functional disorder must not be made by exclu-
sion, but on just as characteristic symptoms and
signs as those of any organic diseases. More-
over, it must never be forgotten that a patient
may have serious organic disease and serious
functional disease at the same time, both of
which require treatment. The history must in-
clude more than just a list of symptoms and
previous diseases. There are a number of points
which are characteristic of hypasthenia of ner-
vous origin. The feeling of weakness is great-
est in the morning, wearing off during the day;
it varies greatly from day to day without
change in activity; it is temporarily improved
by a great variety of unrelated drugs. The
duration of symptoms and the relation of their
onset to events in the family or business are
important guides. The patient who has been
tired all of her life, who has never felt well,
is probably not seeking help because of organic
Presented before the Section on General Practice at the
Annual Meeting of the Ohio State Medical Association,
April 20, 1949, Columbus, Ohio.
disease. The larger group of functional hypas-
thenias, however, give quite a different story.
They got along fairly well up to a certain point,
and can usually tell quite accurately when they
began to have symptoms. A little careful ques-
tioning will usually bring out that this has
coincided with prolonged periods of work under
strain, another woman, or business reverses.
It is common in women at the menopause, when
the children are grown and no longer dependent
while the husband is more and more taken up
with business and golf and correspondingly
forgetful of birthdays and anniversaries. These
are much more important etiological factors
than decrease in ovarian function.
METHOD OF STUDY
After the history, with an attempt to get a
picture of the whole patient, his background —
social, economic and emotional as well as medi-
cal— every hypasthenic patient should have a
thorough physical examination, and a few routine
laboratory tests. These are a urinalysis, hemo-
globin, white count, smear, and STS. A roent-
genogram of the chest is always indicated in
young people who have recently begun to feel
tired, and is advisable at all ages. If the physi-
cal examination and these laboratory tests do
not furnish any lead or evidence of organic
disease, it is usually more profitable to go back
to the history in an effort to learn more about
the patient than it is to multiply laboratory pro-
cedures. The patient whose functional hy-
pasthenia is “benign,” of short duration and
due chiefly to environmental factors, is relieved
to know that he has no evidence of organic dis-
ease. The psychoneurotic on the other hand
does not accept it, or seems disappointed. Ex-
tensive laboratory investigation is bad for the
latter group. It gives them the feeling that
they have some obscure disease which the doctor
for July, 1950
655
cannot find but that perhaps if he did one more
test or X-ray he might find it. They are apt
to go from place to place seeking a more
“thorough” examination.
CLASSIFICATION
This leads to a classification of hypasthenic
states. For the purpose of management they
may be grouped into:
1. Early symptoms of organic disease.
2. Post infectious hypasthenia.
3. Constitutional inferior, and neurocircu-
latory asthenia.
4. Psychoneuroses.
Complaints of abnormal weakness, lassitude,
depression, inability to concentrate, associated
with infection or organic disease are usually
of short duration, are progressive in intensity
and usually accompanied by loss of weight and
fever. Of infections, tuberculosis, subacute
bacterial endocarditis, rheumatoid arthritis, and
syphilis are the most important, and the diag-
nosis or at least, a lead should be obtained by
the history, physical examination and routine
laboratory tests outlined. I have, perhaps
erroneously, omitted chronic brucellosis and focal
infections from this list. Chronic brucellosis, of
course, does occur, but not as frequently as the
diagnosis is made. In addition to the general
symptoms of hypasthenia, chronic brucellosis
presents fever, arthralgia and a positive ag-
glutination reaction. A positive skin test simply
indicates that the patient has at some time in
the past come in contact with the antigen, and
is not evidence that the present symptoms are
due to brucellosis any more than a positive
tuberculin reaction is evidence of active tubercu-
losis. Nor have I included “focal infections,”
whether in teeth, tonsils, prostate or tubes among
the causes of hypasthenia. If any of these are
found in the course of the preliminary examina-
tion, they should be properly treated. But the
wholesale extraction of teeth, removal of tonsils,
and suspension of uteri usually results in an
increase rather than amelioration of symptoms.
Nor can I agree with Turnbull’s belief2 that
“toxic allergens” from food poisoning are a
common etiologic factor in the tired, weak, ex-
hausted, depressed patient. Food sensitivity
can produce many and bizarre symptoms, but
there are usually more violent symptoms at
least intermittently — such as migraine head-
ache, vomiting, or hives, in addition to those
of hypasthenia. If no lead is derived from
history, and the suspicion of sensitivity is still
entertained, its significance can be determined
by two weeks on a rigid elimination diet as
suggested by Rowe.
The early stages of cancer are not characterized
by hypasthenia, although this is a common fear
of many patients, some of whom return year
after year with the conviction that they have
malignant disease, and only beg the doctor to
find where it is. Hodgkin’s disease and the
lymphoma group present a much more difficult
problem, but biopsy of an enlarged lymph node
or a recurrent Pel-Ebstein type of fever should
point the way to the correct diagnosis.
Hypotension and hypertension per se are
rarely the cause of hypasthenic symptoms.
Hypotension does occur in a number of patients
with these complaints,3 and hypertension in an
even greater percentage. Under -normal condi-
tions the blood pressure in the aorta is about
10 mm. higher than in the brachial artery, and
about 10 mm. lower in the digital arteries.
This represents a drop of approximately 20 mm.
from the aorta to the periphery. Beyond the
arterioles the pressure falls rapidly, for capil-
lary pressure is around 25 mm. Hg. Thus, a
normal capillary pressure can be maintained in
spite of great variation in arterial pressure,
and the efficiency of the blood supply to the
tissues need not suffer. Many individuals with
systolic blood pressures of 100-110 mm. Hg.
experience no untoward effects. Indeed, in the
mass, low blood pressure distinctly favors lon-
gevity. These facts and the lack of correlation
between variations in pressure and symptoms
makes it difficult to assign to hypotension a
primary role in hypasthenia. If a definite pos-
tural hypotension can be demonstrated, with a
fall in both systolic and diastolic pressures on
assuming the erect posture, the possibility of a
hypersensitive carotid sinus reflex, central ner-
vous system syphilis, or a tumor at or near the
bifurcation of the carotid should be entertained.
ENDOCRINE HYPOFUNCTION
Hypofunction of one or another of the en-
docrine glands has frequently been invoked as a
cause of hypasthenia. Indeed, the same symp-
toms are attributed to mild degrees of both
hypo- and hyperthyroidism. But it must be
remembered that our estimations of basal meta-
bolic rate are based on average values for a
given surface area and age, and do not take
into account the variations encountered among
normal active people. Minor deviations of the
basal metabolic rate, in the absence of char-
acteristic changes in appetite, weight, heat
tolerance, etc., do not justify a diagnosis of ab-
normal thyroid function.
The presence of asthenia in Addison’s dis-
ease has raised the question whether the milder
symptoms of hypasthenia may not be due to
milder degrees of adrenal insufficiency. But
as Paschkis and Price4 have pointed out, the
diagnosis of “mild hypoadrenia” on clinical im-
pression and the results of substitution therapy
are unsatisfactory. They attempted to deter-
mine whether a more accurate diagnosis could
be made on the basis of chloride excretion or
656
The Ohio State Medical Journal
glucose tolerance tests. More asthenic patients
than controls showed abnormally high excretions
of Na and Cl and flat sugar curves. But on
repetition of the tests normal values were
frequently obtained without any change in symp-
toms. The authors conclude that while their re-
sults may be interpreted as indicating adrenal
cortical involvement in some cases of asthenia,
it does not follow that this is the cause of the
symptoms. The considerable variation of the
tests on repetition militates against the assump-
tion of any organic disease, and the lack of
correlation with symptoms makes it unlikely
that even a functional or transitory insufficiency
is the cause or main factor in the patient’s suf-
fering. They believe rather that the cause of
metabolic changes is to be sought in an “un-
stable personality,” manifest in the psychological
sphere as a neurosis and in the somatic sphere
in various ways, including the secretion of
hormones.
Hypasthenia is a well-recognized consequence
of certain infectious diseases and surgical opera-
tions. It is characteristically more pronounced
after some infections than others, notably in-
fluenza, typhus, and meningitis. The patients
usually feel pretty well in the morning, but tire
quickly, are weak and irritable. It seems per-
fectly reasonable to assume that cellular func-
tion, enzyme systems or other intimate pro-
cesses of cellular activity, may not recover from
the damage inflicted by a hostile parasite syn-
chroneously with the disappearance of the in-
vader. But in addition, there is frequently con-
siderable anxiety at this time. The patient has
been through a threatening experience, his doctor
and friends have congratulated him on his re-
covery, and yet he has not recovered. Has
some hidden infection been overlooked? Will
he ever feel “normal” again? Or is this the
beginning of the end, like Bill Jones who has
never done a day’s work since the influenza in
1918 or Mrs. Smith who has never recovered
from that appendectomy ten years ago?
Usually simple explanation and reassurance
will allay the anxiety; and good food, fresh air
and a little more time will complete the cure.
In those patients who do not make progress,
and in whom symptoms persist in fluctuating
intensity, it is well to consider whether the
illness has not been the precipitating factor in
bringing out suppressed hostility, guilt or
anxiety. Those diseases in which persistent
structural damage accounts for hypasthenic
symptoms, as encephalitis, hepatitis, myocarditis
or even brucellosis, usually present definite
evidence on physical examination or laboratory
test. Where these are not apparent some time
spent in listening to the patient, learning some-
thing of him as a person, and perhaps consulta-
tion with a psychiatrist, is apt to be more ef-
fective in preventing chronic invalidism than an
for July, 1950
empirical succession of tonics, vitamins, or
hormones.
CONSTITUTIONAL INADEQUACY
Another group of patients who make the
rounds of our offices is made up of those whom
Alvarez5 characterizes as constitutionally in-
adequate. They give a long rambling story of
many ills, prolonged incapacity from minor
illnesses, lack of physical stamina, and a variety
of treatments with no lasting relief from their
fatigue, weakness or pains.6 Frequently they
are of an asthenic build, with a body poorly
proportioned and as if poorly put together. Yet
they do not look sick, and are relatively free
from symptoms in an environment shielded from
physical and emotional stress. The neurocircu-
latory asthenias or effort syndromes who were
such a problem in both World Wars, and are
by no means uncommon in civilian practice, are
examples of this group.7
Certainly not all “normal” people can stand
the same amount of physical and emotional
strain. The question is whether these patients
are simply on the poor side of a normal distri-
bution curve, or whether they are “pathological.”
Some have hypoplastic cardiovascular symptoms,
an abnormal increase in blood lactic acid for a
given amount of exercise, and an inefficient res-
piratory mechanism. Their performance can-
not be significantly improved by training. Does
this mean that they are poor protoplasma, that
the hand of the potter slipped? Students of
these people in the army in the last war came
to the conclusion that the majority of them were
essentially psychoneurotics with a deep sense
of insecurity, perhaps resulting from early en-
vironment. In a protected atmosphere they are
free from symptoms but are unable to cope with
either average physical or emotional stress.
Whatever the essential etiology, they are a
difficult group to treat and the prognosis for any
real improvement is poor. Tonics, hormones,
vitamins, sedatives, and operations give no
lasting benefit. The more physicians these pa-
tients visit, and the more often hope is raised
by a “new” treatment, only to be dashed again,
the more firmly they naturally become con-
vinced that they have some hidden, obscure, and
probably incurable disease. Barring possible
benefit from prolonged psychotherapy, the only
sensible and practical way to handle these pa-
tients seems to be to adjust their environment,
reducing the strain to the level at which they
are symptom free. This requires sympathetic
understanding, and an attempt to explain that
not all people, any more than all horses, can
do the same amount of work. That unfortunately
they have taken on more than they can do. That
they have no demonstrable organic disease, no
infection or tumor which is going to shorten
life. That if they want to be free from symp-
toms they will have to curb financial or social
657
ambition, and be content to be a pawn rather
than a knight in this game of chess, but with
the assurance that “they also serve who only
stand and wait.”
PSYCHONEUROSES
Finally, there is the group of hypasthenics
which made up 80 per cent of Allan’s series,
whose symptoms are due to “nervous” or emo-
tional states. The points in the history of the
weakness, fatigue, depression and discourage-
ment which are characteristic of an emotional
etiology have already been mentioned. These
patients can be divided into two groups: those
whose symptoms are of relatively short duration,
and began during a definite period of over-
worry, not work, tension, uncertainty or anxiety;
and those whose asthenia goes back for years,
often to childhood, with periods of exacerbation
and remission. In the latter there is frequently
a family history of “nervous breakdowns,” and
often such obviously nervous symptoms as a
lump in the throat, inability to take a satisfac-
tory breath, or accentuation of symptoms in
church or when shopping.
Relatively few of these patients, particularly
of the first group, need psychiatric consultation.
Not every patient with a running nose is sent
to an otolaryngologist, nor every one with a
murmur to a cardiologist. Moreover, frequently
psychotherapy is inadvisable even if it were
available. Not all wounds heal more rapidly if
probed, and probing into the mechansim of an
acute emotional reaction, precipitated by cer-
tain circumstances may delay rather than hasten
relief. In this first group, reassurance that
symptoms are not due to organic disease, a
chance to tell his story, a sympathetic ear to
receive a recital of fears and worries, and con-
fidence that the physician understands what is
the matter, even if the patient does not, is more
effective than a succession of prescriptions. Such
a chance to talk often enables the patient to see
for himself the relation of his situation to his
symptoms. With correction of the environmen-
tal trauma symptoms usually disappear. Di-
rect advice as to change in business, social or
family relations, however, must be given with
the greatest caution. It is frequently rejected,
and if accepted and unsuccessful the physician
is blamed. Such changes must be made by the
patient as he himself comes to realize their
necessity. But during this period, it is helpful
to prescribe in detail many nonspecific meas-
ures— hours of sleep, regularity and character of
exercise, advice about diet, even when there
is no evidence of deficiency. While the use of
sedatives has come to be looked upon with
disfavor in some quarters, they can frequently
be used with great benefit if judiciously pre-
scribed. Phenobarbital in small doses is usually
better than bromides and one of the short act-
ing barbiturates for insomnia. The patient should
understand that these are not curative, but in
the nature of a crutch which he must only use
until he is able to get along without them.
The second division of this psychoneurotic
group, those who have had symptoms for years,
is without doubt the most difficult group to
handle or help. With such a patient our first
objective should be that of the old but still
virile admonition “primum non nocere” — above
all do no harm. This means, among other
things, not treating for fallen womb one month,
and vitamin deficiency, anemia, glandular dysche-
nesia and allergy on successive visits. The first
step, of course, is thorough routine physical
and laboratory tests. Next is sufficient time
to get to know the patient, and to form an
opinion of the relative importance of discover-
able organic disease and emotional factors in
the production of symptoms. These people can-
not be helped by production line, or compulsory
health insurance medicine. They need time and
hard work. They are not financially profitable.
I am not a psychiatrist, either by training,
ability or philosophy. I have never cured one of
these patients. But I do not know any greater
satisfaction than seeing one gradually lose
symptoms, take his or her place, though per-
haps haltingly, in the family or social group,
and pay fewer and fewer visits to the office.
The first essential to accomplish this is to
be a good listener and to appreciate the advan-
tage of silence. If the doctor can keep quiet,
as a rule the longer the silence the more signif-
icant the explosion of the patient at the end
of it. I think the next most important point is
to keep from giving direct advice, or express-
ing approval or condemnation. I do not think
the psychiatrists give enough credit to Socrates
for their techniques. You remember he never
expressed his own opinion, but was very skill-
ful in asking an apparently innocent question
which would make his pupil scrutinize what he
had just said. In those who are helped, as a
rule neither doctor nor patient understand the
dynamics of the symptoms, but a good rapport,
a feeling that there is some noncritical confidant,
assurance that organic disease has not been
found, and a dim vision of the effects of anger,
fear or other emotions on physical symptoms is
sufficient to permit the patient to suppress or
otherwise handle his problem, and so to lead
a more normal life.
Some of these patients, particularly those
with obsessive-compulsion reactions, marked de-
pression or suicidal thoughts need expert psy-
chiatric help. But even here we have an im-
portant role. You can lead a horse to water,
and you can send a patient to a psychiatrist,
but unless he goes willingly, even eagerly, he
might just as well save his money. Therefore,
before referral, we must spend enough time, at-
658
The Ohio State Medical Journal
tempt enough explanation, build up enough hope
so that he goes willingly. The psychiatrist will
not promise cure, but I think the chances of
relief are greater and the total cost no more
than a hysterectomy.
SUMMARY
In summary, the patient who complains of
hypasthenia presents a difficult diagnostic prob-
lem and one which in general is poorly handled.
In a small percentage the symptoms of weak-
ness, fatigue and loss of efficiency presage or-
ganic disease. These can usually be identified
by careful physical examination and relatively
few laboratory tests. When the symptoms are
due to prolonged convalescence the history usually
furnishes the clue. In the majority of these
patients no organic cause for the symptoms can
be found. Some are acute situational reactions
in which the prognosis is good, explanation and
reassurance the most effective therapy. Those
in whom symptoms are of years’ duration, or
date from childhood, present the most difficult
therapeutic problem. Some may be constitutionally
inferior, others are frankly psychoneurotic. In
spite of this, considerable relief of symptoms
may be obtained by superficial and supportive
therapy by the wise physician.
BIBLIOGRAPHY
1. Allan, F. -N. : The Clinical Management of Weak-
ness and Fatigue. J. A. M. A., 127 :957, April 14, 1945.
2. Turnbull, J. A. : The Tired, Weak, Exhausted, De-
pressed Patient. Am. J. Digestive Dis., 10 :218, June, 1943.
3. Bortz, E. L., and Piersol, G. M. : Asthenia : Clinical
Types and Principles of Treatment. Ann. Int. Med.,
6:319, Sept., 1932.
4. Paschkis, K. E., and Price, A. H. : The Chloride
Excretion Test in Asthenia. J. Clin. Invest., 23:29, Jan.,
1944.
5. Alvarez, W. C. : Constitutional Inadequacy. J. A. M. A.,
119:780, July, 1942.
6. Osgood, C. W. : Constitutional Asthenia. Wisconsin
Med. Jour., 41 :776, Sept., 1942.
7. Jones. M., and Scarisbrick, R. : Effort Intolerance in
Soldiers. War Med., 2:901, Nov., 1942.
Contact Dermatitis Due To Cinnamon
Unusual cases of contact dermatitis, although
reported already in uncountable number, still
merit attention, particularly when the contact
proves to be a commonly utilized foodstuff.
Failure to recognize the possibility of simple
foods as external irritants may prolong a simple
contact dermatitis into irreversible lichenified
eczema.
REPORT OF A CASE
S. B., a 59-year old white female baker, with
a non-allergic background, presented herself
October 26, 1949 because of a severe erythemato-
papular eruption of both hands. The fingers
were swollen, and intermingled with acute vesicu-
Submitted February 10, 1950.
lar lesions were seen chronic lichenified areas
on the dorsum of both hands. The dermatitis
was extremely pruritic, and involved in ascend-
ing fashion both wrists and forearms. The
palmar aspects of the hands were also involved,
but to a lesser extent than their dorsal aspects.
The skin was otherwise entirely negative- in-
cluding the absence of past or present evidence
of fungus infection of the feet.
History revealed chronic dermatitis of the
dry eczema type of the hands for two years,
with frequent remissions and exacerbations, the
latter definitely tied up with longer hours at
work and holiday baking.
A diagnosis of occupational dermatitis was
made and the patient was advised to bring in
samples of foodstuffs she used in baking.
Flour, shortening, liquid soap and cinnamon
were applied as patch tests. Shortening was ap-
plied full strength, but the flour, soap and the
cinnamon were diluted with equal parts of water.
Within 15 minutes of application of cinnamon
the patient complained of a definite burning
itchy sensation beneath the patch. No such
reaction occurred with the flour, shortening or
liquid soap. The cinnamon patch was removed
while the patient was still at the office, and a
tentative diagnosis of cinnamon sensitivity was
made. It was felt that the skin was generally
quite reactive yet, and perhaps cinnamon diluted
one-half and one-half in water was not a fair
test at this time. The patient was advised
to remain home from work, and was put on wet
boric acid compresses and boric acid ointment.
Soap was interdicted. On return to the office after
two days for a reading on the flour, soap and
shortening tests, all of which were negative,
a small area of erythema still remained where
the cinnamon had been applied. The patient
made an uneventful recovery and returned to
work after ten days, but avoided cinnamon
entirely.
On February 2, 1950, about six weeks after
complete subsidence of all symptoms, the pa-
tient was asked to return to this office for an-
other patch test to cinnamon. A small batch
of cinnamon was diluted 1 to 3 parts of water
and applied as a patch test to the flexor aspect
of the upper arm. The patient returned in
twenty-four hours for a reading, and on re-
moval of the patch a very definite erythema
and beginning vesiculation was apparent over
the site of the test. There could be no question
of reactivity to the cinnamon. As controls, my
office secretary and I each applied 50 per cent
cinnamon in water to our arms as a patch test,
which was left on for forty-eight hours. No
reaction occurred. Of interest is the fact that
cinnamon taken orally by the patient caused
no local or systemic distress.
SUMMARY
A case of contact dermatitis of the hands due
to cinnamon is reported in a 59-year old baker
with a history of dermatitis for two years. Dur-
ing this length of time recurrent exposures to an
unsuspected food spice resulted in chronic re-
peated irritation of the skin with resultant
eczematous changes. Removal of the source of
irritation resulted in speedy uneventful return
of the skin to normal.
— Francis W. Epstein, M. D., Toledo, Ohio.
for July, 1950
659
The Treatment of Thrombo-Embolic Disease
NOBLE FOWLER, M. D., and JOHNSON McGUIRE, M. D.
The Authors
• Dr. Fowler, Cincinnati, Ohio, is a graduate
of University of Tennessee College of Medi-
cine, 1941; member, American Federation for
Clinical Research; consultant in cardiology,
V. A. Hospital, Dayton; and instructor in medi-
cine, College of Medicine, University of Cin-
cinnati.
• Dr. McGuire, Cincinnati, Ohio, is a grad-
uate of Johns Hopkins University School of
Medicine, 1924; member, American College of
Physicians; chief clinician, cardiac clinics;
associate professor of medicine and director,
cardiac laboratory, University of Cincinnati.
THE thrombotic or embolic occlusion of vari-
ous strategically located vessels, e. g.,
coronary or pulmonary arteries, has long
been recognized as a leading cause of death.
Recent studies have shown that 50 per cent of
all patients confined to bed have venous thrombi
in the deep veins of their legs.1 Studies have
shown also that about 3 per cent of all deaths
are due to pulmonary embolism. The importance
of these observations has been greatly aug-
mented by the recent discovery of specific
methods of prevention and therapy of thrombo-
embplic disease, namely, the use of venous liga-
tion 'and the anticoagulants heparin and dicu-
marol.
The problem of treatment of thrombo-embolic
disease will be considered according to the fol-
lowing outline.
1. Definitive treatment of venous throm-
bosis and pulmonary embolism.
2. Symptomatic therapy of pulmonary em-
bolism.
3. Anticoagulant therapy in patients who
have rheumatic heart disease and em-
bolism.
4. Treatment of arterial embolism.
5. Management of superficial throm-
bophlebitis.
6. Treatment of coronary thrombosis.
The definitive therapy of venous thrombosis
and pulmonary embolism may be discussed under
the following headings.
1. Venous ligation.
2. Heparin alone.
3. Dicumarol alone.
4. Heparin and dicumarol combined.
Since at least 75 per cent of pulmonary
emboli arise from deep leg vein thrombosis, the
therapy of pulmonary embolism will be here
considered as similar to that of deep venous
thrombosis.
VENOUS LIGATION
Allen, Linton, and Donaldson2 and Linton
feel that either leg vein thrombosis or pulmonary
embolisih are indications for ligation of the
femoral vein. These authors reported 464 cases
in vfhom ligation had been performed. None
died of the operation and only three died of
subsequent pulmonary emboli. There was only
one patient who developed postoperative phleg-
mon and leg ulcer.
Veal and Hussey performed venous ligation
among 84 cases of deep venous thrombosis of
the leg. There were no operative deaths. There
Presented before the Section on Medicine at the An-
nual Meeting of the Ohio State Medical Association, Co-
lumbus, April 19-22, 1949.
were nine pulmonary emboli subsequent to the
operation; three of these were fatal.
Ochsner favors bilateral ligation of the femoral
vein as the treatment for phlebothrombosis. He
thinks that ligation should not be done for throm-
bophlebitis unless it is suppurative.
Carlotti reported the results of femoral vein
interruption done for pulmonary embolism in
60 patients on the medical wards of the Mas-
sachusetts General Hospital. The ligation was
unilateral in many instances. Death occurred
in 28.3 per cent of the patients. Among 213
similar patients who had no operation, the mor-
tality rate was 50.7 per cent.
Fine and Starr consider anticoagulants useful,
but dangerous because of the likelihood of hemor-
rhage following their use. These authors be-
lieve that pulmonary embolism of undetermined
site of origin and venous thrombosis limited
to the area below the knees should be treated
by ligation of both femoral veins above the
profunda.
HEPARIN TREATMENT
We shall now consider the therapy of deep
venous thrombosis and pulmonary embolism by
means of heparin alone. In 1946, Bauer reported
the results of heparin therapy in 209 cases of
venous thrombosis. Only three deaths oc-
curred— a mortality rate of 1.4 per cent. Among
264 cases of deep venous thrombosis treated
conservatively, there were 47 fatal pulmonary
emboli — a mortality rate of 18 per cent. The
only complications were hematuria in three cases
and mild hemarthrosis without residua in two
instances. The heparin treated cases of deep
venous thrombosis were followed up to three
years. The incidence of postphlebitic edema,
induration, ulceration and leg pain was
markedly reduced.
Murray prefers anticoagulant therapy to
venous ligation for the following reasons: The
660
The Ohio State Medical Journal
manifestations of hypercoagulability are gener-
ally widespread and not localized to the area
of the thrombus; it is difficult to define the area
involved by the thrombus; even if the area in-
volved can be defined, it is often impossible to be
certain how high the thrombus has extended;
a pulmonary embolus which is not immediately
fatal may gradually produce death by thrombosis
extending from the site of embolism. Murray
treated 386 patients who had venous thrombosis
by means of heparin. None developed pulmonary
emboli. The incidence of post-phlebitic edema,
ulceration and varicose veins over a nine-year
period was greatly reduced. Murray gave hep-
arin by continuous intravenous drip in such
a manner as to keep the clotting time at 15
minutes. If the patients were able to be up
within a week, the heparin was administered for
three to four weeks.
Zilliacus3 reported the treatment of 576 cases
of venous thrombosis with heparin. Only three
of these patients had fatal pulmonary emboli
after the heparin was begun. Of 214 patients
who received conservative therapy for the same
disease, 20 developed subsequent fatal pulmon-
ary emboli. The incidence of post-phlebitic
ulcer, swelling, and varices was much smaller
in the heparin treated group, but only among
those in whom heparin was begun prior to the
extension of the thrombus into the thigh. Zil-
liacus also reported 103 cases of pulmonary
embolism who were treated with heparin; there
were no deaths in this group. Sixty-five pa-
tients who had pulmonary embolism received
no specific therapy; of these, 21 died.
DICUMAROL THERAPY
Barker4 has given dicumarol alone to a
total of 1,983 postoperative patients. Of these,
352 had venous thrombosis and 329 had pul-
monary embolism. Among the patients suffering
from venous thrombosis, subsequent thromboses
were reduced from an expected 25.3 per cent
to 2.8 per cent and fatal emboli from an expected
5.7 per cent to none. Among the patients suf-
fering from pulmonary embolism, subsequent
emboli were reduced from an expected 43.8 per
cent to 1 per cent and fatalities were reduced
from an expected 18.3 per cent to 0.3 per cent.
COMBINED TREATMENT
Heparin and dicumarol are often combined in
the treatment of venous thrombosis and pul-
monary embolism. Wright and Foley5 recom-
mend treatment of either venous thrombosis or
pulmonary embolism by means of immediate
heparin and dicumarol therapy; the heparin is
discontinued after the prothrombin time falls
to 20 per cent, indicating adequate dicumarol
effect. The patient, if asymptomatic, is got out
of bed after a week, and the dicumarol is
discontinued after two weeks.
Jorpes reported favorable results of anticoagu-
lant therapy in 57b patients who had deep venous
thrombosis; in his group, some received heparin,
some dicumarol, and some received both.
We should now like to consider heparin and
dicumarol with regard to their dosage, method
of administration, and contraindications.
The dose of heparin is regulated by its effect
on the clotting time. Heparin may be ad-
ministered in one of four w'ays.
1. In a menstruum of gelatin and dextrose
as Heparin/Pitkin Menstruum8 or as Depo-
Heparin. By this method doses of 200 to 400
mg. of heparin are given subcutaneously every
twenty-four to forty-eight hours.
2. Intermittent intravenous injection — 50 to
75 mg. every three to four hours in 50 to 100
cc of saline. .Here the clotting time should
be 15 minutes or more two and one-half hours
after each dose of heparin.
3. By constant intravenous drip, using 100
mg. of heparin to 1000 cc of normal saline;
the drip runs at approximately 25 drops a
minute; the rate of flowr is adjusted so as to
keep the clotting time between 20 and 40
minutes. The clotting time is determined every
two hours.
4. Intermittent subcutaneous or intramuscu-
lar injection. This method has been described
by Walker, and by Walker and Rhoades. Un-
diluted heparin, i. e., 5 cc containing 50 mg.
may be given subcutaneously or intramuscularly
every four to six hours.
The dose of dicumarol is regulated by its effect
on the prothrombin time. The primary action of
dicumarol is a selective inhibition of prothrom-
bin formation by the liver. Its action is tem-
porary, and other functions of the liver are be-
lieved to be unaffected, even by its long use.
Dicumarol is given orally; its action begins in
twelve to seventy-two hours and lasts seventy-twTo
hours or longer after its discontinuation. The
Quick method of prothrombin time determina-
tion has been described as the only accurate
measure of dicumarol effect.* The prothrombin
time should be kept between 10 and 30 per cent
of normal by dicumarol therapy; most major
bleeding from the use of dicumarol occurs when
the prothrombin time is less than 10 per cent
of normal; some patients will develop thromboses
if the prothrombin time is allowed to rise above
30 per cent of normal.
Dicumarol therapy is not begun until a pro-
thrombin time has been done and found normal.
The patient is then given an initial dose of 300
mg., followed by 100 or 200 mg. the second
day and then 50 to 100 mg. daily thereafter.
It is to be emphasized that the daily dose of
dicumarol is to be administered only after the
* Note: Some authorities now feel the two-stage method
of determining prothrombin time to be more accurate.
for July, 1950
661
prothrombin time has been determined for that
day.
When heparin and dicumarol are used together,
a more rapid effect on the clotting mechanism
is obtained than if dicumarol is used alone. When
heparin is given intravenously, the maximum
effect on the clotting time is obtained in 10
minutes, the effect persists for one and one-half
to three hours. Heparin should be admin-
istered by one of the methods described above;
dicumarol is begun concomitantly. When the
prothrombin time has fallen to 20 per cent of
normal or below, the heparin is discontinued and
the dicumarol is given as usual.
CONTRAINDICATIONS TO ANTICOAGULANT
THERAPY
We should now like to list some of the
contraindications to anticoagulant therapy.
Wright felt that anticoagulants should not be
used in the event of recent operation upon the
central nervous system, subacute bacterial en-
docarditis except in the case of arterial embolic
occlusion, hemorrhagic blood diseases, recent
threatened abortion, or in obstetrical cases within
six weeks prior to delivery. He felt that care
should be used in the presence of hepatic or
renal disease, granulating wounds, or open ulcer-
ations. Barker, et al., listed the following as
contraindications to dicumarol; definite renal in-
sufficiency, hepatic insufficiency or hepatogenous
jaundice, subacute bacterial endocarditis, hemor-
rhagic blood diseases, purpura, and recent oper-
ation on the brain or spinal cord. In contrast
to the views of Wright, Bauer felt that there
are no absolute contraindications to heparin.
MANAGEMENT OF OVERDOSE OF ANTICOAGULANTS
We should now like to consider the methods
of combating the results of overdose of heparin
or dicumarol. Serious bleeding is seen infrequently
as a result of anticoagulant therapy if the proper
precautions are observed. Barker gave dicu-
marol to 1,983 postoperative patients; only four
died while receiving dicumarol. Two deaths
were not due to the drug. Wright had no
deaths among 800 patients treated with dicu-
marol. Bauer had no serious bleeding among
209 patients who were treated with heparin.
During dicumarol therapy, if the prothrombin
time falls below 10 per cent of normal on two
successive days, the patient should be given 30
mg. of synthetic vitamin K intravenously. If
bleeding occurs during the administration of
dicumarol, 64 mg. of vitamin K should be ad-
ministered intravenously immediately and again
in four hours. If there is no benefit in 12
hours, the patient should receive 300 to 500 c-c
of fresh citrated blood. The dicumarol is, of
course, temporarily discontinued.
Bleeding during the administration of heparin
may be treated as follows. The heparin is
discontinued. Protamine sulfate, 50 to 100 mg.,
given intravenously as a 1 per cent or 2 per cent
solution will return the clotting time to normal
within five minutes.
SYMPTOMATIC TREATMENT OF PULMONARY
EMBOLISM
DeTakats has described the symptomatic ther-
apy of pulmonary embolism. He recom-
mends that cases of massive pulmonary em-
bolism be treated so as to combat the reflex
bronchial and pulmonary arterial spasm which
is often seen. The patient should be placed in
a semi - sitting position and given oxygen.
Atropine, 1/75 grain, is given hypodermically
by a nurse. When the physician arrives, 1/60
to 1/75 grain of atropine is given intravenously,
and 1/2 grain of papaverine is given intraven-
ously. The atropine and papaverine are re-
peated three to four times daily. Of 45 pa-
tients receiving this treatment, 35 did not
die of that attack. DeTakats felt that patients
who have had massive pulmonary embolism and
who develop right-sided heart failure during the
ensuing few days, should be considered candi-
dates for embolectomy.
A recent use of anticoagulant therapy is in
the treatment of patients who have rheumatic
heart disease with auricular fibrillation and re-
peated peripheral emboli. Sprague and Jacob-
sen have treated one such ambulant patient for
15 months without incident or recurrent em-
bolization.31 Wright32 has treated 22 such pa-
tients without the occurence of any emboli during
the time of therapy. Six of Wright’s patients
have been treated for a year or more.
MANAGEMENT OF ACUTE ARTERIAL OCCLUSION
Acute arterial occlusion, whether thrombotic
or embolic, is an indication for anticoagulant
therapy. Heparin and dicumarol15 or heparin
alone33 may be used. Anticoagulants should be
given as soon as the diagnosis is made, and
certainly within twenty-four hours of the oc-
clusion with the idea of preventing secondary
thromboses and gangrene. Survival of the af-
fected extremity was achieved in 10 of 11 pa-
tients with arterial embolism and in 13 of
16 patients with arterial thrombosis who were
treated with anticoagulants.
ANTICOAGULANTS IN ACUTE MYOCARDIAL
INFARCTION
The anticoagulant therapy of acute myocardial
infarction has been a topic of increasing interest
during the past few years. In 1946, Peters
reported a mortality rate of only 4 per cent
among 50 patients suffering from coronary
thrombosis who had received dicumarol therapy;
among 60 controls taken from previous cases
of coronary thrombosis at the same hospital,
the mortality rate was 20 per cent. The in-
cidence of embolism among the treated group
662
The Ohio State Medical Journal
was 2 per cent, and among the untreated group,
16 per cent. In 1946, Wright also reported 76
patients who had had myocardial infarction and
who were treated with dicumarol. The mor-
tality rate in his group was 19 per cent, but
only cases with a poor outlook were treated.
There were no controls in this group. In 1947,
Nichol reported the dicumarol therapy of 62
patients representing 68 attacks of coronary
thrombosis. The mortality rate was 12 per cent.
In 1947, Parker and Barker treated 50 pa-
tients suffering from acute myocardial infarction
by means of anticoagulants. A group of similar
cases seen in 1945 were used as controls. The
treated group had only one-fourth as many
vascular complications as the control group, but
the mortality rate was not significantly dif-
ferent in the two groups. In 1948, Glueck,
et ah, reported the treatment of 44 patients
suffering from myocardial infarction by means
of heparin and dicumarol combined. In the
treated group, 20 per cent died and 7 per cent
had complicating thrombo-embolism. In 44
untreated controls, 45 per cent died and 27 per
cent had complicating thrombo-embolism. Also
in 1948, Wright reported the results of anti-
coagulant therapy in 800 cases of myocardial
infarction treated in several hospitals.7 The
over-all mortality rate in the treated group was
15 per cent; in the control group, the over-all
mortality rate was 24 per cent.
SUPERFICIAL THROMBOPHLEBITIS
Superficial postoperative, postinfectious, or
posttraumatic thrombophlebitis require anti-
coagulant therapy. The other types of super-
ficial thrombophlebitis do not require anticoagu-
lant therapy unless complicated by pulmonary
embolism.
SUMMARY AND CONCLUSIONS
The existence of either deep venous thrombosis
or pulmonary embolism is a definite indication
for either venous ligation or anticoagulant
therapy. It is felt that anticoagulant therapy
is to be preferred to deep venous ligation unless
one of the following conditions is present: sup-
purative thrombophlebitis; definite contraindica-
tions to anticoagulant therapy; repeated pul-
monary emboli despite adequate anticoagulant
therapy; unavailability of laboratory facilities
adequate for anticoagulant therapy. It is also
felt that anticoagulant therapy should be initiated
with heparin and dicumarol; the heparin is dis-
continued after the dicumarol has become ef-
fective. Patients suffering from massive pul-
monary embolism should be treated so as to
combat reflex bronchial and pulmonary arterial
spasm. Patients suffering from acute peripheral
arterial occlusion, whether thrombotic or embolic,
should receive anticoagulant therapy. Patients
suffering from rheumatic heart disease and re-
peated peripheral arterial emboli may benefit
from constant ambulatory anticoagulant ther-
apy. The mortality rate among patients suffer-
ing from acute myocardial infarction can prob-
ably be lowered by the use of anticoagulant
therapy for four weeks.
The use of anticoagulant therapy in cases
of deep venous thrombosis of the lower extremity
not only decreases the incidence of pulmonary
embolism, but also diminishes the likelihood of
such post-thrombotic sequelae as dependent
edema, varices, leg ulcer, and chronic venous
insufficiency of the limb.
BIBLIOGRAPHY
1. Hunter, W. C., Sneeden, V. D., Robertson, T. D., and
Snyder, G. A’ C. : Thrombosis of the Deep Veins of the Leg.
Its Clinical Significance as Exemplified in 351 Autopsies.
Arch. Int. Med. 68 :1-17, 1941.
2. Allen, A., Linton, R., and Donaldson, G. A. : Venous
Thrombosis and Pulmonary Embolism : Further Experience
with Thrombectomy and Femoral Vein Interruption.
J. A. M. A., 128 :397-403, 1945.
3. Zilliacus, H. : On the Specific Treatment of Throm-
bosis. and Pulmonary Embolism with Anticoagulants, with
Particular Reference to the Post-thrombotic Sequelae. Supp.
Acta. Med. Scandinav., 170-171, 1946.
4. Barker, N. W., Hines, E. A., Kvale, W. F., and Allen,
E. V. : Dicumarol. Its Action Clinical Use, and Effective-
ness as an Anticoagulant Agent. Am. J. Med., 3 -.634-642,
1947.
5. Wright, I. S-, and Foley, W. T. : Use of Anticoagulants
in the Treatment of Heart Disease. Am. J. Med., 3 :718-739,
1947.
6. Loewe, L. : Anticoagulation Therapy with Hepar-
in/Pitkin Menstruum in Thromboembolic Disease. Am. J.
Med., 3:447-467, 1947.
7. Wright, I. S., Marple, C. D., and Beck, D. F. : Re-
port of the Committee for the Evaluation of Anticoagu-
lants in the Treatment of Coronary Thrombosis with
Myocardial Infarction. Am. Heart J., 36 :801-815, 1948.
The Story Behind the Word
Some Interesting Origins of Medical Terms
Impetigo — This common skin disease is so
called because of its contagious nature. It is
derived from the Latin word “impeto,” I attack.
It is mentioned by Celsus in his book De Medi-
cina written about A. D. 30.
Licorice or Liquorice — This substance has been
used medicinally since ancient times and was
recommended for the treatment of sore throat
by Dioscorides a surgeon in Nero’s army. The
term literally means “sweet root” and is a
corruption or contraction of the Latin term
“glycyrrhiza.” This in turn is derived from
the Greek words “glukas,” sweet, and “rhiza,”
root.
Trachea — A term of ancient Greek origin liter-
ally meaning the “rough windpipe.” It is
derived from the Greek word “trachus” mean-
ing rough, it being understood that the “ea”
ending comes from the Greek word “arteria”
or artery which literally means a windpipe.
Bougies — These flexible instruments for
urethral exploration which are now usually made
of woven silk and varnished, were at first made
of wax or elastic gum. Medically we borrowed
the term from France where the word “bougie”
signified a wax candle and was so named from
the town of Bougie in Algeria.
— Harry Wain, M. D., Mansfield, Ohio.
for July, 1950
663
The Use of CO2 in Inhalation Therapy
ADOLPH SHOR, M. D.
The Author
• Dr. Shor, Cincinnati, Ohio, is a graduate
of University of Cincinnati College of Medi-
cine, 1940; diplomate, American Board of
Anesthesiologists; and member, American So-
ciety of Anesthesiologists.
THE physiological basis for therapeutic use
of C02 lies in the fact that C02 is the
most powerful respiratory stimulant known.
Normally the tension of C02 in the body fluids
is maintained within narrow limits. This re-
lationship may be upset temporarily by admin-
istering additional C02, but unless the added
load is overwhelming in amount, the organism
will rapidly excrete the excess.
THE PHYSIOLOGY
With an excess of C02, the following results
rapidly occur:
1. The respirations increase both in rate and
depth. If the normal alveolar C02 tension of
40 mm of Hg., is increased by 1.5 mm of Hg.,
the respiratory minute volume will be doubled.
2. There is increased bronchial peristalsis,
increased ciliary function and hyperemia of the
bronchial mucosa.
3. There is a rise in the systolic blood pres-
sure, with a peripheral vasoconstriction but a
cerebral vasodilatation. Therefore, the vital
central nervous system has an increased blood
supply.
4. The distensibility of the myocardium is
increased, yielding a greater filling and greater
output of the heart.
5. The tonus of the skeletal muscles is in-
creased, enhancing the venous return to the heart.
Miescher in 1885 showed, by experiments with
man, that additional C02 in inhaled air will re-
sult in increase in respiratory exchange. In
1924 Yandell Henderson did much to advance the
widespread use of C02 as a therapeutic agent. Ex-
amples of those conditions where C02 may be
given with value are:
1. Asphyxia as in CO poisoning.
2. Hiccough of persistent nature.
3. Unproductive cough as in bronchitis, bron-
chiectasis, unresolved pneumonia, etc.
4. Postoperative atelectasis — prophylaxis and
treatment.
In CO poisoning, the value of C02 lies not only
in its ability to increase respiratory ventilation,
but as Haldane and others have shown, the
affinity of hemoglobin for CO is decreased by
the presence of an excess of C02. The treat-
ment consists in the immediate administration
of 02 containing 5 to 10 per cent C02. If the
respirations are shallow or absent, artifical res-
piration is indicated. Here the oxygen is the
essential element of treatment; however, the
addition of a small amount of C02 to the inhaled
gas speeds the recovery period.
Submitted June 13, 1949.
In asphyxia neonatorum most authorities
agree that artificial respiration with oxygen is
the treatment of choice. In those infants who
have had artificial respiration and have begun
to breath without assistance but whose respira-
tion does not appear to be wholly satisfactory,
with a possibility of some atelectasis persisting,
carbogen with a C02 content of not more than
5 per cent may be given. Here the admin-
istration must be stopped as soon as the desired
effect is noted, for any prolonged exertion will
exhaust these patients.
In persistent hiccough C02 may be given with
oxygen or with air. In some cases 5 per cent
C02 will terminate the hiccough within a couple
of minutes, in other cases or even in the same
case at a different time, this concentration will be
found to be ineffective.
However, if higher concentrations of C02 are
given when lower concentrations do not help,
it will be found that most cases of hiccough
can be stopped by this treatment. Sometimes
the amount of C02 necessary may be high enough
to cause dizziness or even unconsciousness. Such
high concentrations will not be harmful if
hypoxia is avoided and the duration of treat-
ment is not extended beyond two minutes in
using C02 in air or five minutes in using C02
in 02. The physiological factor involved is not
the deep breathing per se, but the stimulation of
the respiratory center and the relaxation which
C02 in high concentration produces. It must
be mentioned, however, that rarely causes of
persistent hiccough are not benefitted by C02
whatever concentration may be used.
UNPRODUCTIVE COUGH
In the treatment of unproductive cough, the
basis for the use of Co2 lies in effects locally on
the lung itself, as pointed out by Banyai in
1945, namely the hyperemia of the bronchial
mucous membranes with increased ciliary func-
tion and increased production of mucous asso-
ciated with an increased bronchial peristalsis
and wider lung excursions.
It is in the prophylaxis and treatment of
664
The Ohio State Medical Journal
postoperative atelectasis that C02 is most com-
monly used. With the widespread adoption of
the stir-up regime in the past, the incidence
of postoperative atelectasis has been greatly
reduced, and the treatment of atelectasis has
been greatly improved. As is well known, the
stir-up regime consisted originally in having the
patient turn, take deep breaths, and cough at
frequent intervals. The main reason for adding
C03 inhalations to the stir-up regime is rather
obvious to anyone working in most hospitals to-
day— namely the nursing problem. Even though
the nurses try to enforce the stir-up regime,
in many hospitals there are too few nurses to
do a thorough job on the multitude of operative
patients. For that reason, it has been found that
administering C02 to the patient takes less time
and results in more effective stirring of the pa-
tient than had been obtained heretofore. The
need for additional oxygen, along with the C02
is minimal; therefore, although many men still
prefer 5 per cent to 10 per cent C02 in 02 many
others now use C02 and air therapeutically
in the prophylaxis and treatment of atelectasis.
THE ADVANTAGES
The arguments for the use of CO_> in air are:
1. It is faster — the effect should be obtained
within one minute — 5 per cent in 02 takes
15 minutes; 10 per cent in 02 takes 5 minutes.
2. It is more efficient, frequently 5 per cent
C02 in oxygen is not effective, and 10 per cent
may be needed for as long as ten minutes.
When the effect does occur, the terminal alveoli
are filled with oxygen, thus are prone to be-
come atelectatic in that the 02 may be absorbed
within a few. minutes. When using C02 in
air, the terminal alveoli are filled with air of
which the nitrogen takes almost twenty-four
hours to be absorbed; hence, after full expansion
with oxygen, atelectasis can recur within min-
utes, after expansion with air atelectasis should
not recur in less than a day.
3. It is easier to administer. All one needs
is a small cylinder of C02 with a yoke and
rubber connection. The gas is allowed to flow
gently over the nose and mouth until the pa-
tient takes several deep breaths, then is discon-
tinued. With carbogen (C02 in 02) a large
cylinder is necessary because so much gas is
used.
4. It is cheaper, both in absolute cost of the
individual gases and in total value required
per patient.
DISADVANTAGES
The main argument used against employing
C02 in air is that too high a concentration may
be inhaled, resulting in anesthesia. However,
when it is given, if several deep breaths only
are taken by patient or if given for not more
than one minute, it should not be harmful in any
way.
The main problem involved in teaching others
to give C02 in air is to prevent an overdose.
If the patient is told to breathe deeply, then
one cannot be sure when a sufficient amount has
been given. For this reason the patient should
be told to breathe normally and the inhalations
are stopped as soon as he is seen to be breath-
ing deeply. Sometimes patients cannot be
taught not to help — that is, they try to
breathe deeply from the start, and, because
of this, it has been found wise to limit the
time of inhalation to one minute to prevent
overdose. The same problem occurs in giving
carbogen by mask for there the administration
is often started by the nurse, then forgotten,
resulting in too-long exertion with exhaustion.
When giving carbogen, the patient should be
watched and the inhalations stopped as soon as
the desired effect is obtained, just as when C02
in air is given. Sometimes a mistake is made,
in which tank is used, and instead of 5 per cent
carbogen, one may use pure C02. If this is
given by mask, the result will, at best, be un-
pleasant for the patient — at worst may cause
a fatality.
The uses of C02 therapeutically has been dis-
cussed; however, a word of warning concerning
its dangers is indicated. As in the use of all
drugs, the contraindications are relative in most
instances, absolute in a few. Some conditions
where C02 is definitely contraindicated are:
1. Pulmonary embolism.
2. Tendency to hemorrhage, pulmonary, gas-
tric, etc.
3. Laryngeal stricture.
Some relative contraindications are:
1. Emphysema.
2. Hypertension.
3. Cardiac pathology.
In giving C02 to a patient for any reason,
it must be remembered that the administration
must be discontinued as soon as the desired
effect is obtained, for the continued administra-
tion of C02 will result in the exhaustion of the
patient.
SUMMARY
In summary, the use of C02 as a therapeutic
agent has been reviewed. Its value in the treat-
ment of asphyxia, persistent hiccough, unpro-
ductive cough, and atelectasis has been pointed
out, with some mention being made of the basis
for its use. Some of the major contraindications
have been listed with definite warning as to the
possibilities of occurrence of overdose.
BIBLIOGRAPHY
1. Barch, Alvan L. : Principles & Practices of Inhala-
tional Therapy, 1944.
2. Sheldon, Russell E. : Control of Hiccough by Inhala-
tion of Carbon Dioxide. J. A. M. A., 89:1118, 1927.
3. Banyai, Andrew L. : Modern Concepts of the Man-
agement of the Cough. Marquette Medical Review, Vol. XI,
No. 1, Dec., 1945.
4. Wiggers, Carl J. : Physiology in Health and Disease,
1937.
5. Goodman, Louis, and Gilman, Alfred : The Pharma-
cological Basis of Therapeutics, 1946.
for July, 1950
665
Full-Term Intra -Abdominal Pregnancy
J. L. REYCRAFT, M. D., E. R. HILL, M. D., and W. B. CROSLEY, M. D.
The Authors
O Dr. Reycraft, Cleveland, Ohio, is a grad-
uate of Western Reserve University School
of Medicine, 1915; diplomate, American Board
of Obstetrics and Gynecology; assoc, obstetri-
cian, University Hospitals; and asst, clinical
prof., obstetrics and gynecology.
• Dr. Hill, Cleveland, Ohio, is a graduate
of Western Reserve University School of
Medicine, 1940; clinical instructor, obstetrics
and gynecology, University Hospitals and
Cleveland City Hospital.
• Dr. Crosley, Burbank, California, is a
graduate of Western Reserve University School
of Medicine, 1940; member, American Board
of Obstetrics and Gynecology; formerly, dem-
onstrator, gynecology. Western Reserve Uni-
versity School of Medicine; and now, instruc-
tor, obstetrics and gynecology. College of
Medical Evangelists, Los Angeles, California.
THE following is a case report of an intra-
abdominal pregnancy with a six-year fol-
low-up.
This patient, Mrs. M. T., was a 34-year-old
white female admitted to Cleveland City Hospi-
tal because of continuous abdominal pain and
tenderness associated with pregnancy.
Her last menstrual period was March 24, 1942,
and five months from her period the abdominal
pain began insidiously. It was of a cramp-like
nature, and somewhat more severe in the righi
lower quadrant. It was associated with nausea
and the patient had vomited occasionally since
early in pregnancy. There was one episode of
vaginal spotting.
Physical Examination. Fetal heart rate 140
in left lower quadrant near midline. Blood
pressure 110/60; pulse 84; temperature 37.
Examination was essentially negative except ab-
domen showed 6% months’ pregnancy in trans-
verse position. Head in the right flank and
breech in the pelvis. A large tumor-like mass
the size of a grapefruit was present in the
anterior wall of the uterus, thought to be a
fibroid, with lower pole behind the symphysis. It
was felt that the tumor would cause distortion
and probably degenerate before delivery, there-
fore ,a Caesarian section and myomectomy were
recommended.
Laboratory Findings: Red blood count 3.65;
hemoglobin 70 per cent; white blood count 6,200;
urinalysis negative; Wassermann negative.
X-ray report in October, 1942: AP and lateral
films of abdomen and pelvis showed the presence
of a fetus approximately 6% months’ gestation
size situated with the back extending transversely
across the abdomen with the head in right mid-
abdomen. A poorly defined mass was situated
in the right abdomen, which was thought to
represent the fibroid described clinically.
The patient was discharged to be followed in
the outpatient department. Her findings re-
mained essentially the same except for progres-
sively more severe lower abdominal pain marked
in the right lower quadrant, partially controlled
with codeine. One episode of pain sent her to
the emergency room where the resident in ob-
stetrics attempted an external version without
success. She was also observed in the hospital
for forty-eight hours because of this severe pain.
The patient was readmitted on December 18,
1942, because of near-term pregnancy and pro-
gressively more severe right lower quadrant
pain. Physical examination was essentially neg-
ative except for the abdomen which revealed a
pregnancy palpable to the level of four fingers
below the xyphoid. The fetus was still in a
transverse position with the head on the right
and the breech on the left. Between the head
and the symphysis lay a mass about the size
of a grapefruit which seemed to be continuous
with the uterus. Fetal heart rate 144 left of
midline.
Laparotomy for transverse position and fibroid
From the Department of Obstetrics and Gynecology,
Western Reserve University and Cleveland City Hospital.
Submitted May 14, 1949.
666
complicating pregnancy was performed on
December 21, 1942. The abdomen was opened
in layers through a sub-umbilical midline in-
cision. There was no free peritoneal fluid. Ex-
amination revealed a uterus the size of a twelve
weeks’ pregnancy. Above the uterus was a
smooth, large glistening sac to which the
omentum and bowel were adherent and which
was lying between the uterus and liver. The
hair of the fetal head could be seen through
these membranes. After freeing the omentum
and bowel from the amniotic sac which seemed
parasitic, it was ruptured and the fetus was de-
livered. The infant breathed spontaneously and
the only abnormality was a torticollis of the
neck. The membranes were then dissected free
as far as possible from the surrounding intestine
and omentum and amputated. The placenta was
implanted over the bifurcation of the aorta
and left in situ after amputating the cord as
proximal as possible and ligating with chromic
catgut. The peritoneal cavity was then cleansed
of blood and clots and the omentum brought
down and the abdomen closed in layers.
Postoperative Course. Temperature was not
elevated beyond 37.8 degrees C. The wound
healed per primum. The patient complained of
persistent lower abdominal heaviness and ir-
regular vaginal bleeding which was at no time
excessive.
Six weeks’ postpartum pelvic examination re-
vealed a full, slightly tender cul-de-sac with
slight tenderness in both lower quadrants. The
patient was doing her work and leading a normal
life. The baby was normal. Four months’
postpartum examination revealed that menses
had been established April 2, 1943, and were
normal in character. Because of the persistence
The Ohio State Medical Journal
of the pelvic mass a Friedman test was performed
and found to be negative.
The patient was readmitted to the hospital
on May 20, 1943, and operated for chronic
cholecystitis with cholelithiasis. Because of her
recent intra-abdominal pregnancy, a careful ex-
amination of the pelvis was made. A mass about
4V2 inches in diameter and IV2 inches in thickness
was palpated a little to the left of the mid-
line lying over the bifurcation of the aorta.
This mass was rather firm, reddish in color, and
smooth. Attached to the mass were a few vas-
cular adhesions but no small bowel. The fundus
of the uterus felt normal but was slightly adher-
ent to the mass. The hand could not be inserted
posteriorally all the way into the cul-de-sac
between the fundus and the placental mass.
During palpation a few of the adhesions were
broken and there was slight oozing in this
region. The surgeon then proceeded with the
cholecystectomy which the patient tolerated well.
On June 10, 1943, hystero - salpingograms
showed the uterine body to be well outlined. The
lower uterine segment was displaced to the
right of the body of the uterus. The left tube
and ovary were outlined and only a small
segment of the right tube filled. Films of the
pelvis made twenty-four hours following salpingo-
grams showed radio-opaque material still present
in the pelvis. She was discharged June 15,
1943, in good condition.
Dispensary visit on October 30, 1945, revealed
a firm mass palpated through the cul-de-sac,
nodular in shape, and not movable. Milk was
expressed from both breasts. Since the patient
complained of epigastric pain and abdominal
distention, a gastro-intestinal series was done
with the following conclusions: (1) No evidence
of a pathological process involving the rectum,
colon or terminal ileum. (2) No evidence of or-
ganic disease involving the esophagus, stomach,
or duodenum.
The patient’s last dispensary visit, six years
after delivery, revealed a marital outlet with a
moderate rectocele and a small cystocele. The
cervix was posterior with a healed transverse
laceration, freely movable and non-tender. The
fundus was anterior and normal size for a multi-
para. There were no adnexal masses present.
In the posterior fornix was a very firm nodular
fixed mass which was tender to palpation. The
mass extended across the cul-de-sac; the size
was undetermined because it could not be out-
lined throughout its entire extent.
No gastro-intestinal or genito-urinary symp-
toms were present, hence X-rays of these sys-
tems were not deemed necessary.
DISCUSSION
In Ronald Reid’s review of 236 cases of intra-
abdominal pregnancy in 1938, statistically:
1. The correct diagnosis preoperatively was
made in only 35 per cent of cases.
2. Two hundred twenty-eight babies showed
deformities, usually due to pressure.
3. Infant mortality rate in near-term infants
was 35 per cent.
4. Maternal mortality rate was 14 per cent, —
shock, hemorrhage and peritonitis account-
ing for the majority of deaths.
The persistence of the placental tissue with
either degeneration and fibrosis or potentially
a malignancy remains in the realm of possibility
and can only be determined by a careful follow-up.
Incidence: In Sunde’s series of 38 cases, 5
per cent of chorioepitheliomas were preceded by
extra-uterine pregnancies.
Preston and Gay find 2.6 per cent of choriomata
are preceded by an extra-uterine pregnancy.
P. Klein points out that the aggressiveness of
the fetal cells can be observed during the
normal implantation of the ovum but it is more
pronounced in an implantation of the ovum
in an unfavorable medium, especially in the
tube. He found recorded in the literature 15
cases of chorioepithelioma in the tube following
extra-uterine pregnancy.
Heilman and Simon state that, if the placenta
is easily removable, its complete excision is
mandatory.
Biological Tests: A negative biological test
does not rule out chorioepithelioma. G. Tuch-
schund reported two cases of chorioepithelioma
with a negative A-Z test for both urine and
blood.
Time Element: In one of Novak’s cases oc-
curring in the fifty-third year, the last child-
birth preceded the appearance of the chorio-
epithelioma by seventeen years.
SUMMARY
A case of full-term intra-abdominal preg-
nancy delivered by laparotomy with placenta left
in situ and baby living and well is presented.
A six-year follow-up is included on this case.
BIBLIOGRAPHY
1. Sunde-Davis: Chapter 13, Vol. 1, Page 8.
2. Klein, P. : Malignant Chorioepithelioma in the Tube
Following an Extra-Uterine Pregnancy, Archiv. fur Gyne-
kologie, 129:662-675, 1927.
3. Reid, Ronald: A Case of Abdominal Pregnancy, Brit.
Med. Jour., June 18, 1938.
4. Heilman, A. M., and Simon, H. J. : Full-Term Intra-
Abdominal Pregnancy. Am. J. Surg., 29 :403, 1935.
Galactosemic Cataract
Galactosemia is a metabolic disorder of in-
fancy, characterized by the symptoms of in-
ability to gain weight and lack of growth. The
essential signs are those of hepatomegaly,
splenomegaly, melituria, and albuminuria. In
over half of the case reports the presence of a
cataract has been mentioned, both nuclear and
zonular changes having been described. No
case report has yet, to the author’s knowledge,
been reported in the ophthalmological literature.
It is the purpose of this paper to so present a
case of galactosemia with associated cataract.
The heredity of the disorder as well as a care-
ful summary of the literature will be undertaken.
— Harold F. Falls, M. D.,
Ann Arbor, Mich.
Brief author’s abstract of paper presented at charter
session of the Association for Research in Opthalmology,
East-Central Section, Jan. 10, 1950.
for July , 1950
667
Hygiene of Pregnancy
ROBERT F. DALY, M. D.
The Author
• Dr. Daly, Columbus, Ohio, is a graduate
of Ohio State University College of Medicine,
1937; fellow, American College of Surgeons;
and clinical asst, professor, obstetrics and gyne-
cology, College of Medicine, Ohio State Uni-
versity; chairman, obstetrics, Mt. Carmel Hos-
pital.
IT is distinctly understood that this discussion
will be limited to matters of hygiene. It
seems to me that the best way to approach
the subject is to mention some of the outmoded
notions concerning it and to emphasize that one
is never justified in going against folklore until
there is no shadow of doubt that it is pure
superstition. In most instances, it will be found
to be a combination of superstition and truth.
To begin at the top, suppose we consider
mental hygiene as our first point. Fear of
pregnancy and complications has been thrust
upon women throughout generations. Frequent
reference to the suffering of women in labor
is contained in the Bible and is carried on down
to the present generation in some of the motion
pictures of the present day. It apparently al-
ways is “open season” at the bridge table when-
ever a member of the club reports that she is
pregnant, and this notice is the signal for each
well-wishing fellow club member to relate
the horrible and dire consequences of some
particular case that she can relate to the pros-
pective mother. Why women should treat one
another like this is beyond my understanding,
but it nevertheless is a fact.
At the other extreme there is in the popular
pseudo-scientific literature of the ladies-home-
literature variety, considerable evidence that
childbirth is a great ecstasy and that anyone
who indulges in the use of analgesics is more
or less a quack. This too seems a little extreme,
and I believe that there are certain cases
which no doubt lend themselves to that degree
of hypnosis or psychosomatic prophylaxis neces-
sary, but certainly from a practical standpoint,
the time necessary to make such a program ef-
fective is excessive in the case of the general
practitioner or the specialist who is as busy as
most of them are today. Certainly there is
some conservative middle-of-the-road policy
which may best be used, in which two things
should be pointed out: one, that the woman who
so desires at least can be assured of an effective
analgesia which should leave her with a very
satisfactory impression of the rigors of child-
birth; two, that there are some women cer-
tainly -who, with some encouragement, very
well can approach pregnancy with somewhat
less fear, and thereby be better patients to
handle from a standpoint of the amount of early
analgesia necessary, and thereby shorten the
period of time during which said analgesics
are required. There is no question that this is
better on the average for the infant, and that
Presented before the Section on Obstetrics and Gyne-
cology, at the Annual Meeting of the Ohio State Medical
Association, Columbus, April 19-22, 1949.
it makes a shorter period of time during which
the patient is more or less irrational and a strain
on the nerves, particularly of the relatives. It
is our place and duty to prepare the patient
for the lying-in period and to stress the fact
that this procedure has been normal for years
and years, and that most cases have been
terminated successfully and happily; that her
expectancy of living is very excellent. During
the prenatal period a little time spent on ex-
plaining some of the minor aches and pains on
a normal basis and even of anticipating some
of them, may well be worth while.
Mention might be made of the subject of
maternal impression. The laity rather exten-
sively still clings to an old belief that im-
pressions and nervous symptoms of various sorts
might be transferred to the baby. The mother
should be assured that absolutely no connection
exists between the mother and the child except
at the placental site, and that this structure pro-
vides no nerve pathways by which such nerve
impulses can be transmitted. There have been
no clinical data whatsoever which would support
a viewpoint that the child can be influenced in
any way, for better or worse, by the mother’s
emotional reactions.
Proceding “southward” in our discussion, care
of the eyes may be necessary during pregnancy.
Many of the patients we are seeing never
previously have been under medical care. These
patients are not exempt from the problems of
eyestrain or problems of refraction, and this
fact should be borne in mind. The commoner
symptoms of eyestrain should be watched for
and if there are evidences of any of these symp-
toms, adequate refraction should be advised.
In regard to the nose during pregnancy, twro
facts come to mind that recur frequently during
the course of events in pregnancy. First, I
have seen women who had occasional or frequent
nosebleeds for the first time in their personal
histories during their antepartum period. Sec-
ondly, women who develop upper respiratory
infections during the antepartum period un-
668
The Ohio State Medical Journal
doubtedly show a prolonged recovery time. I
believe that both of these situations are due
to the same physiologic fact. Specifically, there
is congestion of mucous membranes during preg-
nancy due to the altered physiology of the preg-
nant woman. This is a necessary factor in the
proper nourishment of the growing fetus, but
so too are the mucous membranes in other parts
of the body congested. The latter simply are
incidental to the over-all picture, but the nasal
congestion probably is the precipitating factor,
upon which a fragility of the Kesselbach’s area
of the nose may result in nosebleeds. The
delayed recovery time in upper respiratory
infections undoubtedly is a “catarrhal” condi-
tion— simply a congestion of mucous membranes
of the nose which simulates a cold, but the mem-
branes nevertheless may not be acutely or chroni-
cally infected. The treatment of these two situa-
tions should be cautery of the Kesselbach’s area
in the first case, and in the second case topical
or local use of agents to reduce mucous mem-
brane congestion. The ephedrine action of some
nose drops should be borne in mind, in view of
the possible influence on blood pressure, but
we all know some agents in which ephedrine-
like action is reduced or absent.
CARE OF THE TEETH
It has been our practice to encourage oral
prophylaxis during pregnancy. Briefly the only
factor worth mentioning in such an obvious
situation is as follows. We personally believe
that any radical procedure, whether it be care
of the teeth or any other regulation of the
conduct during pregnancy, should be considered
in the following light: That minor procedures
in the normal antepartum case certainly are of
no dire consequence, but more extensive or more
radical procedures very well may be delayed,
if possible, until the second trimester of preg-
nancy. These cases always must be considered
as individual ones, and the necessity of any
surgical procedure must be weighed against the
possible consequences. When there is a choice
in the matter, we believe that in the care of the
teeth, certainly oral prophylaxis and filling of
teeth may well be done at any time during the
pregnancy, but major procedures, including
extraction, could well be delayed until the fourth
month has been passed.
Approximately at six weeks of pregnancy the
breasts become heavier and the veins more
prominent. Frequently this is a source of dis-
comfort. We feel that it is wise to apply a
supporting type of brassiere to the breasts dur-
ing the antepartum period. During the entire
course of pregnancy, particularly in multiparae
there is likely to be some secretion from the
nipple which simply is an expression of secre-
tory activity. If the secretions are allowed to
accumulate and form a crust, the skin beneath
the crust may become irritated, cracked and
thereby become the portal of entry of infection.
We advise all women during the last two
months of pregnancy to spend some time in
cleansing the nipple and in gentle stimulation
of the nipple. If there is appearance of secre-
tion prior to this time then we instruct them,
regarding cleansing the nipple at intervals-,
frequent enough to prevent damage to the skin..
During the last two months, cleansing twice
a day with a mild soap, gentle but increasingly-
stimulating exercise during the drying of the
nipples may well be advised to accustom the:
nipple to the stimulation it will receive in nurs-
ing and to develop what may have been art
undersized or retracted nipple.
ABDOMINAL SUPPORTS
Regarding abdominal supports during preg-
nancy the primigravid woman who never has
worn a girdle seldom requires one during preg-
nancy. If she has, through the course of years,
become accustomed to the wearing of a girdle,
it generally will be found that she will feel
better and that she has made the use of a
girdle necessary by coming to depend upon it.
Those women who once have been pregnant have
abdomens which are more or less like an old
two-way-stretch girdle. In other words, once
having been stretched by a full-term pregnancy
the abdominal wall does not completely return
to its former state, and such being the case,
the second or third pregnancy will be more
poorly supported, will “be carried lower” than
were the previous pregnancies. This factor has
long been one of grandma’s criteria in predeter-
mining the sex of the infant but is more reason-
ably explained in the light of support and the
inefficiency of the postpartum abdomen. The
low backache and the altered posture due to
shifting the center of gravity usually will show
beneficial response to the use of a supportive
type of girdle.
In regard to the commonly called “feminine
hygiene,” we recommend that no douches and
no enemas be taken during pregnancy. There
occasionally may be some justifiable reason to
deviate from this course, but as a general prin-
ciple we feel that this is the proper recom-
mendation.
In the care of extremities, the commonest
problem arising during prenatal care is the
problem of varicose veins. There are three
methods of control of this situation: (1) elastic
stockings or elastic bandages; (2) injection of
the veins, with some escharotic substance; and
(3) ligation with or without injection or strip-
ping. This subject is one which could be dis-
cussed as a separate topic. We feel that any of
the procedures are good; we feel that some
cases require more drastic treatment than
others; and we feel that even though more
drastic, that ligation and injection or stripping
frequently are necessary. This we admit is a
for July, 1950
669
debatable subject and we are expressing” our
viewpoint as a purely personal opinion.
The use of restricting garters is unwise. This
is true in nonpregnant state as well, but it is
more dangerous during the pregnant state. The
stockings can be supported by a loose garter
belt, from a girdle support or from some of the
special appliances which are designed to be
suspended from the shoulders.
GENERAL PRINCIPLES OF EXERCISE, REST
AND RECREATION
We feel that there should be conservatism in
this regard. We express our viewpoint most
often as follows: We feel that the woman during
pregnancy should, with moderation, follow a
pattern of exercise similar to that which she
ordinarily pursues when not pregnant. In other
words, if an athletic woman becomes pregnant
she dare not become completely sedentary, and
on the other hand the sedentary individual or
the office worker need not become an athlete
simply because she is pregnant. We think it
unwise to indulge in violent exercise and we
usually mention such things as bowling, swim-
ming, badminton, pingpong, etc. Certainly walk-
ing and mild types of exercise in the open air
are an aid to the pregnant woman’s morale
even though we do not feel that it is strictly
essential to her well-being. Certainly no ex-
ercise beyond the point of very mild fatigue
should be advised or permitted.
The problem of vacations and trips during preg-
nancy still is open to discussion before final
decision can be reached. It was found during
the war when women by necessity were forced to
travel great distances and at considerable phy-
sical strain that the abortion rate was no higher
than before or since. Again, however, we feel
that conservatism in our advice is wise because
no given patient in different pregnancies can be
generalized in this regard and if abortion does
ensue following trips which perhaps are unneces-
sary, I feel that we may have been unwise in
allowing that. Any trip which is necessary may
be permissible if the patient has evidenced no
symptoms of threatened abortion.
SEXUAL INTERCOURSE DURING PREGNANCY
This problem always arises during preg-
nancy whether or not it is discussed by the pa-
tient and her physician. There might be an oc-
casional exception but certainly they are not
great in number.
Inasmuch as it is probably going to occur
during pregnancy perhaps by some modification
of the time and method, we may thereby safe-
guard the patient’s welfare. We feel that dur-
ing the first four months of pregnancy that
intercourse should be avoided during the so-called
menstrual “anniversaries,” the period of time
when the patient would have been menstruating
had she not become pregnant. After the fourth
month if there is no cramping or bleeding, or
other symptoms of threatened abortion, we feel
that with gentleness intercourse is permissible;
this permission is again withdrawn during the
last two months of pregnancy.
In closing, I would like to mention two or
three topics which frequently arise as questions
from the patient, and our feeling on the ques-
tions. First of all we do not believe that raising
the arms above the head can be harmful inas-
much as it seems very unlikely that the fetus
will have any idea just what the anatomical
relationship of its mother’s arms to her body
may be at any given time. We do not feel
that he can respond by abruptly wrapping the
cord about his neck. Secondly, we do not feel
that the odor of turpentine from painting is
dangerous unless it might be so strong or so
obnoxous to the mother that she be made
so ill by that odor that she vomit and retch so
violently that she disturb the pregnancy physi-
cally.
In regard to stride gravidarum, or the so-
called “stretchmarks” of pregnancy, we per-
sonally do not feel that it makes one iota of
difference whether or not the average woman
uses lubricating oils or grease during pregnancy
on the skin of the abdomen and hips. We have
seen all combinations of cases in which marks
were or were not present in women who did
or did not use some oil or grease. We gen-
erally take the attitude of permitting the use
of these substances so long as the abdomen is
not massaged too vigorously and that the oil
may be pinched into the skin rather than rubbed
in. We feel however that the influence of
mothers-in-law is still a considerable factor and
that for us deliberately to advise against the
use of these oils is gimply to add fuel to
the fire when the stretch marks may appear.
The use of high heels during pregnancy: —
As a matter of maintaining equilibrium in the
presence of pregnancy with its shift of the
center of gravity, we think it probably is a
wise practice to advocate the use of lower or
flat heels on shoes. This is not an absolute
necessity at all times, however, and we do
permit our patients to wear high heels for dress
occasion, and in walking short distances where
they will not grow too tired from the muscular
strain necessary to maintain balance. We feel
the greatest danger of high heels probably is
in their insecurity and not in any great shift
or exaggeration of the hyperextension of the
spine during pregnancy.
Climbing up on stepladders and chairs to do
household duties is a dangerous practice be-
cause of the instability of balance of a preg-
nant woman. The danger is not from the ex-
cessive altitude but in the consequences should
she fall, and she is more likely to fall from
these perches when she is pregnant.
670
The Ohio State Medical Journal
Culture Is Based on History; and History Is Based
Upon the Written Word
PART II
(Concluded from the June Issue)
JONATHAN FORMAN, M. D.
CERTAINLY one of the outstanding achieve-
ments of Science for the Art of Medicine
was the production of the modern X-ray
machine. The first person to be burned by the
rays which emanated from the Crookes tube
was Emil H. Grubb e, M. D., of Chicago.- It was
his burns that suggested the use of X-rays for the
treatment of disease and so he became the first
person to use them for this purpose. It is emi-
nently fitting, therefore, that Dr. Grubbe should
give us the story of X-Ray Treatment, Its Origin,
Birth and Early History ($3.00. The Bruce Pub-
lishing Co., St. Paul, Minn.). In addition to his
own contribution, the author has assembled a ‘list
of martyrs — victims of X-rays.
SIR ARTHUR HURST
One of the British physicians whose writings
I always have followed and enjoyed at a great
personal profit, has been Sir Arthur Hurst. He
retired from the staff of Grey’s Hospital having
reached the age of sixty in 1939. Up to the
time of his death, five years later, he remained
actively occupied with teaching, writing, and
consulting work. Latterly, he had devoted his
leisure hours, with no small enjoyment for him-
self but great profit to you and me, to the writ-
ing of his personal reminiscences. A Twentieth
Century Physician, being the reminiscences of
Sir Arthur Hurst, D. M., F. R. C. P. ($3.50.
Williams & Wilkins, Baltimore, Md.). Trained
in the Oxford School of Physiology, Dr. Hurst
was among the first to foster the regular applica-
tion of physiological principles and methods to
the study of problems at the bedside. All of
this led to “team work.” Professor John A.
Ryle, his physician and friend, with the help
of Lady Hurst, has arranged the manuscripts
into chapters and so we have a peep into the soul
of a great human being and a great physician.
PAUL B. BARRINGER
During the “great snow” of February, 1857,
a baby boy was born in Harris Hotel in the
town of Concord in North Carolina. It seems
that the home of the Barringers was being en-
larged and its roof raised; the contractor had
been slow in his work, “then as now.” So the
parents were caught with this event at the local
hotel. There were no hospitals thereabouts in
those days and people of means would not have
dared to go to them if there had been. In
The Natural Bent ($3.50. University of North
Carolina, Chapel Hill, N. C.), Anna Barringer
has collected and arranged her father’s memoirs.
Because of his contact with so many things in
the last half of the Nineteenth Century, a study
of his active life gives us an insight into the
times — one of the most extraordinary phases of
history, The War between the States; the planta-
tion; camp followers; the pinch of necessity in
reconstruction days. Also covered are his school
days as a student at ‘Kenmore University and at
the University of Virginia (1875); the School
of Medicine (1876); the clinics of New York
(1877-78); the grand tour of Europe (1881);
and student of medicine in Vienna.
Dr. Barringer’s personal recollections ended
with his return to America. His professional
career began with his return to North Carolina
in 1882. He made his first appearance before
the State Medical Society that same year with
a paper on syphilis. This was a disease which
his studies in Paris led him to believe was
much neglected in the South.
In the fall of 1890, he became professor of
for July, 1950
671
physiology and surgery at the University of
Virginia. The book goes on to tell of his part in
building up the Medical College until he accepted
the presidency of V. P. I. in 1907. Death came
on January 9, 1941. This book is a fitting trib-
ute to a great teacher, and is a source of delight
for anyone interested in the development of
our country from 1857 to 1941.
JAMES B. HERRICK
These autobiographies of men who have lived
full lives are a source of much historical in-
formation for those who can judge human nature.
They are almost always good reading regardless
of their value as historical documents. The
beloved James B. Herrick of Rush Medical Col-
lege has told the story of his own boyhood,
medical school days, experiences in hospital
work and private practice, his teachings and
writings.
Anyone who is trying to understand the past
eighty years of medical practice and education
in the Midwest cannot afford to miss this wealth
of information written by a meticulous scholar
who tries very hard to be factual. Memories
of Eighty Years, by James B. Herrick ($5.00.
University of Chicago Press, Chicago, III.).
Whereas Paul Barringer’s memoirs stop when
his days of preparation for living and prac-
ticing in a small town were over, James Herrick
takes on through a full and busy life in a large
city to the end. Everyone who faces the problem
of old age should read his eight-page chapter
on old age.
“Keine Kunst ist alt zu werden
Es ist Kunst es zu ertragen.”
To go along with the story of the two Ameri-
can physicians who studied in Europe and be-
came great teachers of American Medicine:
Dr. Barringer in the small town of Charlottes-
ville, Virginia, Dr. Herrick in Chicago, we have
the biography and philosophy of a European
physician in Janos, The Story of a Doctor, by
John Plesch ($5.00. A. A. Wyn, Inc., New
York City). He gives us 260 pages of science,
politics and personalities in the center of Europe.
In Part Two, he tells us of the theatre, arts
and music, and his escape to England. Finally,
there is the appendix with its essays on “doctor’s
dialogues,” as they are called — 110 pages of
comments on life.
IRMA GROSS DROOZ, M. D.
The titles of the chapters of the autobiography
of a modern physician must be monotonously
alike. The birth of our hero, his impression of
his relatives, his school days, medical school and
its teachers, hospital and postgraduate experi-
ences and through his days of specialization and
practice. The story of Dr. Drooz as told in
Doctor of Medicine ($3.00. Dodd, Mead & Co.,
New York City), is no exception. The young
lady who is the subject of this biography be-
gins her story with the depression of the ’30’s.
And so we have a book of inspiration for those
who find obstacles in their way to the study of
medicine. She was admitted to New York Uni-
versity, however, with the class of 1937. We
follow the young woman medical student with
lively and enlightening comments on all of the
courses and the research in which she came to
have a part during her hospital days and the war
and back to New York with the final chapter on
preventive psychiatry and how she started her
practice thirteen years after she entered medical
school. All this makes a good book for young
people in the biological science courses who might
decide to study medicine.
SIDNEY V. HAAS
On April 5, 1949, more than a hundred physi-
cians and laymen paid tribute to Dr. Sidney V.
Haas, the internationally known pediatrician, at
a luncheon at the New York Academy of Medi-
cine. The committee in charge prepared a small
volume commemorating the event and in honor
of Dr. Haas’ contribution to celiac therapy and
the treatment of the hypertonic infant, and the
completion of his fiftieth year of medical practice.
MEDICAL MISSIONARIES
One of the most interesting stories in medicine
is the work of medical missionaries. In Doctors
Courageous ($3.50. Harper & Bros., New York
City), Edward H. Hume, M. D., has told this
with detachment and a wide perspective even
though he is the son of a missionary to India and
he, himself, has been a missionary to China.
The work in Africa, India, Pakistan, the Near
and Middle East and China is covered in this
study for the Christian Medical Council for Over-
seas Work.
Famous Men of Medicine ($2.50. Dodd, Mead
& Company, Neiv York City), by Caroline A.
Chandler, M. D., author of Susie Stuart, M. D.,
Home Front Doctor, etc., is one of the series
of biographies of famous people for young peo-
ple. The text extends from Hippocrates to Hans
Zinsser and the new frontiers.
More students of medical history should be
encouraged by local societies to write local medi-
cal histories. Dr. Webster Merritt last year
published A Century of Medicine in Jacksonville
and Duval County ($3.50. University of Florida,
Gainesville, Florida). Working under the guid-
ance of the late T. Frederick Daus, an outstand-
ing historian of Jacksonville, Dr. Merritt began
the task of assembling the material and con-
structing the record. As the years go by, fires
destroy records, eye witnesses die, and the task
of reconstructing the medical history of the
times becomes increasingly difficult. Our county
medical societies could do a job of “public
relations” by promoting similar projects.
672
The Ohio State Aiedical Journal
Proceedings of The Council . . .
Special Committees for Year Are Appointed by Incoming President;
Other Matters of Importance Are Transacted at Cleveland Session
A REGULAR meeting of The Council of the
Ohio State Medical Association was held
on Monday evening, May 15, 1950, in the
Rose Room, Hotel Cleveland, Cleveland, Ohio,
on the eve of the 1950 Annual Meeting of the
Association. This meeting followed a social
hour and dinner attended by members of The
Council, a number of past-presidents and com-
mittee chairmen, officials of the Cleveland Acad-
emy of Medicine and members of the Columbus
office staff.
On motion duly made, seconded and unani-
mously carried, the minutes of the meetings of
The Council held on April 22 and 23, 1950,
were approved.
Membership statistics were announced as fol-
lows: Total membership as of May 12, 1950,
7,321; compared to a total membership of 7,479
as of December 31, 1949.
DISABILITY INSURANCE
The Council considered a resolution and state-
ment of policy on compulsory temporary dis-
ability compensation and on motion duly made,
seconded and unanimously carried, authorized
the introduction of the resolution and statement
of policy to the House of Delegates, scheduled
to meet on Tuesday morning, May 16. (See
Minutes of Meetings of House of Delegates
elsewhere in this issue.)
A communication dated May 1 from the Super-
intendent of Salem City Hospital was read and
discussed. On motion duly made, seconded and
unanimously carried, the Executive Secretary was
instructed to write the superintendent of that
hospital as follows:
“The basic principle expressed in the
statement of policy on the practice of medi-
cine by hospitals, adopted by The Council
on April 23, 1950, applies to your com-
munication of May 1, namely:
“It is illegal for a hospital, regardless
of its size or location, to contract for medi-
cal services.
“Interns and residents are agents of the
medical staff of the hospital. The medical
staff is responsible for their acts and should
outline their duties. Ethical principles
which apply to members of the medical staff
apply equally to interns and residents.”
CIVILIAN DEFENSE
Dr. C. C. Sherburne, Columbus, chairman of
the Committee on National Emergency Medi-
cal Service, and Dr. Edgar P. McNamee, Cleve-
land, who represented the Ohio State Medical
Association at the training course in Cleveland
on the medical aspects of atomic warfare, dis-
cussed the question of civilian defense. Dr.
Sherburne reported on a conference which he
had attended recently at the A. M. A. Head-
quarters in Chicago.
Following their discussions, on motion duly
made, seconded and unanimously carried, The
Council adopted a resolution requesting each
county medical society to set up a committee
on emergency medical service to work with
the state committee, which in turn is cooperating
with the Governor and other state officials on the
matter of planning and establishing an Ohio
civilian defense program.
V. A. CONTRACT RENEWED
Renewal of a contract with the Veterans
Administration, as amended, relating to the
care of disabled veterans by physicians in
private practice, who are members of the Ohio
State Medical Association, was authorized on
motion, duly made, seconded and unanimously
carried.
A communication from the International
Rescue and First Aid Association, asking the
Association to supply speakers for a meeting
planned in Columbus, Ohio, was discussed. It
was the general opinion of members of The
Council that the first aid and rescue field is
now being adequately covered by the American
Red Cross and the National Safety Council in
cooperation with various medical organizations
and that duplication of effort on the part of
duplicating organizations in this field is in-
advisable. On motion duly made, seconded and
carried. The Council did not authorize the As-
sociation to provide speakers for the meeting
referred to.
MATTER LEFT TO DELEGATES
A communication from the Medical Society
of New Jersey, asking this Association to ap-
prove a resolution to be presented by New Jer-
sey delegates to the House of Delegates to the
A. M. A. in San Francisco, in which was in-
corporated a twelve-point program covering
health and medical services, was discussed. On
motion duly made, seconded and carried, The
Council did not approve the program submitted
by New Jersey, but instructed the Executive
Secretary to refer the matter to Ohio’s dele-
gates for consideration, leaving it to them to
use their own discretion on the question when
for July, 1950
673
it is brought before the House of Delegates
of the A. M. A.
A vote of appreciation and thanks to Dr.
Lincke, the retiring president, was given by
The Council, on motion duly made, seconded and
unanimously carried.
The Council expressed regret at the inability
of Dr. J. Craig Bowman, Upper Sandusky,
Councilor of the Third District, and Dr. Harry
V. Paryzek, Cleveland, Chairman of the Cleve-
land Committee on Arrangements, to attend
this session due to illness and authorized the
sending of flowers to them.
There being no further business, The Council
recessed to meet with the House of Delegates
on Tuesday morning, May 16.
SESSION HELD ON MAY 18
A regular meeting of The Council of the Ohio
State Medical Association was held on Thursday
afternoon, May 18, 1950, in the Ballroom of Hotel
Cleveland, Cleveland, Ohio, following the second
session of the House of Delegates, with Dr. E.
0. Swartz, the incoming president, presiding.
The principal business transacted was con-
firmation of special committee appointments
made by Dr. Swartz, as follows:
Auditing and Appropriations — Dr. Carll S.
Mundy, Toledo, chairman; Dr. R. J. Foster,
New Philadelphia; Dr. H. M. Clodfelter, Co-
lumbus.
Committee on Cancer — Dr. C. E. Hufford,
Toledo, chairman; Dr. John H. Lazzari, .Cleve-
land; Dr. Carl A. Wilzbach, Cincinnati; Dr. L.
A. Pomeroy, Cleveland; Dr. Robert M. Zollinger,
Columbus; Dr. Robert T. Allison, Jr., Akron;
Dr. E. P. McNamee, Cleveland; Dr. W. D. Nus-
baum, Lancaster; Dr. Walter A. Reese, Middle-
town.
Committee on Chronic Illness — Dr. Harry V.
Paryzek, Cleveland, chairman; Dr. Frank A.
Riebel, Columbus; Dr. Joseph I. Goodman, Cleve-
land Heights; Dr. ,W. B. Lacock, Columbus; Dr.
Cecil Striker, Cincinnati; Dr. Herman J. Nimitz,
Cincinnati; Dr. Jonathan Forman, Columbus; Dr.
John L. Stifel, Toledo, Dr. Floyd W. Craig,
Coshocton, Dr. Nelson D. Morris, Toledo; Dr.
H. W. Brettell, Steubenville.
Committee on Industrial Health and Work-
men’s Compensation — Dr. H. P. Worstell, Co-
lumbus, chairman; Dr. Robert A. Kehoe, Cincin-
nati; Dr. Louis N. Jentgen, Columbus; Dr. John
M. Van Dyke, Canton; Dr. James N. Wychgel,
Cleveland; Dr. Warren A. Baird, Toledo; Dr. a!
L. Bershon, Toledo; Dr. Donald E. Yochem, Co-
lumbus; Dr. Rex H. Wilson, Akron; Dr. Wm.
Ashe, Gallipolis; Dr. Joseph Lindner, Cincinnati.
Subcommittee on Legislation — Dr. G. A. Wood-
house, Pleasant Hill, chairman; Dr. Frank May-
field, Cincinnati; Dr. Floyd M. Elliott, Ada; Dr.
D. J. Slosser, Defiance; Dr. Wm. Garver, Cleve-
land; Dr. Wm. S. Skipp, Youngstown; Dr. Jay
W. Calhoon, Uhrichsville ; Dr. Clyde M. Fitch,
Portsmouth; Dr. James B. Johnson, Jr., Newark;
Dr. Donald F. Bowers, Columbus; Dr. George
F. Linn, Norwalk.
Committee on Medical Service Plans — Dr.
Robert C. Rothenberg, Cincinnati, chairman; Dr.
Wm. M. Skipp, Youngstown; Dr. Jonathan
Forman, Columbus; Dr. R. K. Finley, Dayton;
Dr. Robert E. S. Young, Columbus; Dr. Carll
S. Mundy, Toledo; Dr. Robert T. Allison, Jr.,
Akron; Dr. Azel Ames, Jr., Hamilton; Dr. R.
J. Whitacre, East Cleveland; Dr. Edmond K.
Yantes, Wilmington; Dr. Carl A. Lincke, Car-
rollton.
Committee on Mental Hygiene — Dr. Dwight M.
Palmer, Columbus, chairman; Dr. Neil T. Mc-
Dermott, Cleveland; Dr. Louis J. Karnosh,
Cleveland; Dr. Maurice Levine, Cincinnati; Dr.
Howard Fabing, Cincinnati; Dr. R. E. Pinkerton,
Akron; Dr. 0. M. Lawton, Youngstown; Dr. J.
L. Sagebiel, Dayton.
Committee on National Emergency Medical
Service — Dr. C. C. Sherburne, Columbus, chair-
man; Dr. Robert Conard, Wilmington; Dr. Cyrus
R. Wood, Port Clinton; Dr. Carl R. Damron,
Mansfield; Dr. Robert M. Zollinger, Columbus;
Dr. Harry R. Huston, Dayton; Dr. W. 0. Ramey,
Cincinnati; Dr. E. A. Ockuly, Toledo; Dr. Claude
S. Perry, Columbus; Dr. Drew L. Davies, Co-
lumbus; Dr. Robert E. Tschantz, Canton; Dr.
Maurice M. Kane, Greenville; Dr. Fred Berlin,
Lima; Dr. William J. Graf, Cincinnati; Dr.
Herbert B. Wright, Cleveland; Dr. Morris G.
Carmody, Painesville; Dr. George Sackett,
Cleveland.
Committee on Rural Health — Dr. J. Martin
Byers, Greenfield, chairman; Dr. Carll S. Mundy,
Toledo; Dr. Jonathan Forman, Columbus; Dr.
W. B. Recker, Leipsic; Dr. E. G. Caskey, Mineral
Ridge; Dr. James M. Snider, Marysville; Dr.
H. T. Pease, Wadsworth; Dr. A. D. Harvey,
Lebanon; Dr. L. E. Anderson, Greentown; Dr.
H. R. Mayberry, Bryan; Dr. E. K. Yantes, Wil-
mington; Dr. F. M. Hartsook, Cardington; Dr.
Carl F. Goll, Hopedale; Dr. Kenneth Taylor,
Pickerington.
Committee on School Health — Dr. Thomas E.
Shaffer, Columbus, chairman; Dr. Carl A. Wilz-
bach, Cincinnati; Dr. J. W. Wilce, Columbus; Dr.
Charles T. Atkinson, Middletown; Dr. L. A.
Hamilton, Athens; Dr. T. L. Light, Dayton;
Dr. R. E. Shell, Van Wert; Dr. John F. Miller,
Newark; Dr. Margaret O’Neal, Zanesville; Dr.
F. A. Halloran, Springfield; Dr. H. B. Thomas,
Gallipolis; Dr. Russell C. Bane, Chillicothe;
Dr. J. M. Painter, Kent; Dr. Charles F. Good,
Cleveland.
Committee on Medical Care of Veterans — Dr.
Drew L. Davies, Columbus, chairman; Dr. Rob-
ert Conard, Wilmington; Dr. Harry R. Huston,
674
The Ohio State Medical Journal
Dayton; Dr. Wm. W. Trostel, Piqua; Dr. W.
W. Green, Toledo; Dr. Edgar Northrup, Marietta;
Dr. John H. Marshall, Findlay; Dr. Ivan C.
Smith, Youngstown; Dr. Lewis W. Cellio, Co-
lumbus; Dr. Charles L. Shafer, Mansfield; Dr.
L. D. Allard, Portsmouth; Dr. Robert L. East-
man, Mt. Vernon; Dr. E. H. Crawfis, Cleveland;
Dr. T. H. Vinke, Cincinnati.
Woman’s Auxiliary Advisory Committee — Dr.
H. M. Clodfelter, Columbus, chairman; Dr. M.
D. Prugh, Dayton; Dr. John S. Hattery, Mansfield.
Prior to adjournment Dr. Swartz announced
that the Fall meeting of The Council will be
held at the Granville Inn, Granville, Ohio, on
Friday evening, September 15, and Saturday
and Sunday, September 16 and 17.
There being no further business, The Council
adjourned to meet at the call of the President.
Attest: Chakles S. Nelson,
Executive Secretary.
Allergy May Be Tipoff on Man
Wanted by the F. B. I.
The Federal Bureau of Investigation has re-
quested the medical profession to help in locat-
ing one Frederick J. Tenuto, who has been known
also by several aliases. A complaint was filed
before the U. S. Commissioner at Philadelphia,
Pa., on February 17, 1950, charging this subject
with violating Title 18, U. S. Code, Section 1073,
in that he fled from the state of Pennsylvania to
avoid confinement after conviction for the crime
of murder.
Tenuto is described as follows: Age 35; height
5' 5"; weight 143 pounds; build, stocky; hair,
black; eyes, dark brown; complexion, dark; race,
white; nationality, American; education, six
years; occupation, butcher’s helper, sheet metal
worker, laborer; scars and marks, imperfect
tatoo “S. J.” on left forearm, imperfect tatoo on
right forearm which may be “ANA,” “ANNA”
or “AMA,” small brown mole on right cheek,
IY2 inch scar over right eye. Has suffered from
a recurring skin eruption. This man is con-
sidered extremely dangerous.
Medical records indicate that Tenuto has an
allergy background and is allergic to some types
of hairs and fibers. It was necessary at one
time to furnish him with a cotton mattress. He
has suffered from a type of eczema, which condi-
tion may recur at any time without apparent
cause. At one time due to this condition, his
eyes were swollen almost shut. Medical rec-
ords disclose the following treatment: “Intra-
muscular injections of whole blood, 5 cc. every
other day, and, externally, phenol, 15 gr.,
menthol, 2 gr., glycerine, 1 dram, liquor-carbonis-
detergen, Y2 oz. and aqua qs., 4 oz.”
Anyone having information about this man is
requested to communicate with the nearest
F. B. I. office.
Cincinnati Sanitarium Announces
Expansion of Visiting Staff
The Cincinnati Sanitarium has announced an
expansion of its services to patients through the
establishment of an enlarged visiting staff of
leading Cincinnati psychiatrists.
The visiting staff has been organized with Dr.
Louis Lurie as chairman,
Dr. J. Robert Hawkins,
vice-chairman, and Dr.
John Campbell, secre-
tary. Others on the
visiting staff include Dr.
William Roach, Dr. Max
Lurie, Dr. Robert Buck-
ley, Dr. R. Charles
Smith, Dr. Rolland Les-
lie, Dr. Howard Fabing,
Dr. William T. Gordon
and Dr. Harry Salzer.
Elliott E. Otte, busi-
ness administrator of the
Sanitarium, said the newly-organized group was
formed to develop close cooperation between
the hospital resident staff, headed by Dr. Douglas
A. Johnston, medical director, and visiting psy-
chiatrists. Dr. Wilford N. Wright is resident
psychiatrist, and Dr. Henry Gruener is resident
physician.
The Cincinnati Sanitarium, founded in 1873,
is one of the oldest private hospitals in the
United States for the care and treatment of
nervous and mental patients. It is located on
29 acres of landscaped grounds.
Among the more recent changes are the
new kitchens, completed early this year, which
are equipped with advanced improvements for
the storage of food and the preparation of meals.
The buildings include a rest cottage for the
care of certain psychoneuroses and rest and
convalescent cases. This is operated as a
separate department of the hospital.
The Cincinnati Sanitarium is a member of the
American Hospital Association, Ohio Hospital
Association, and Central Neuropsychiatric Hos-
pital Association, and is approved by the Ameri-
can College of Surgeons and by the Council
of Hospitals, and is licensed by the State of
Ohio.
American College of Physicians
Offers Research Fellowships
The American College of Physicians announced
that a limited number of Fellowships in Medi-
cine will be available from July 1, 1951, to
June 30, 1952. The stipend will be from $2,200
to $3,200. Further information may be obtained
by addressing the College at 4200 Pine St.,
Philadelphia 4, Pa. Applications must be sub-
mitted not later than Oct. 1, 1950.
for July, 1950
675
• • •
House of Delegates
Official Proceedings of Sessions Held During 1950 Annual Meeting;
New Officers, Councilor, Delegates and Committeemen Are Named
MINUTES OF FIRST SESSION
THE first session of the House of Delegates,
held in conjunction with the 1950 Annual
Meeting of the Ohio State Medical Asso-
ciation, convened in the Main Ballroom of Hotel
Cleveland, Cleveland, Ohio, on Tuesday morn-
ing, May 16, 1950.
The meeting was called to order by Dr. Herb-
ert B. Wright, President of the Cleveland Acad-
emy of Medicine, who welcomed the delegates
to Cleveland and introduced the President, Dr.
Carl A. Lincke, Carrollton. Dr. Lincke then
gave his presidential address. (See page 688 this
issue for text of address.)
The roll of delegates was called by the Execu-
tive Secretary, 118 delegates or alternates and
councilors answering the roll call.
On motion duly made, seconded and carried,
the minutes of the sessions of the House of
Delegates held at the 1949 Annual Meeting in
Columbus were approved.
REFERENCE COMMITTEES APPOINTED
Dr. Lincke appointed the following reference
committees to consider business coming before
the House of Delegates and for reports back
to the House:
Resolutions — H. B. Wright, Cleveland, chair-
man; J. Martin Byers, Greenfield; G. A. Wood-
house, Pleasant Hill; R. E. Shell, Van Wert;
0. E. Todd, Toledo; Wm. M. Skipp, Youngstown;
J. S. Adler, Strasburg; George Malley, Zanes-
ville; Newton Spears, Ironton; Gilman D. Kirk,
Columbus; Leonard A. Stack, Lorain.
President’s Address — R. K. Ramsayer, Canton,
chairman; C. T. Atkinson, Middletown; E. H.
Artman, Chillicothe; Carl F. Goll, Hopedale; D.
J. Slosser, Defiance.
Time and Place of Annual Meetings — Joseph
Lindner, Cincinnati, chairman; Kurt Weidenthal,
Hudson; T. L. Light, Dayton; N. P. Stauffer,
Millersburg; W. B. Recker, Leipsic.
Credentials — D. C. Houser, Urbana, chairman;
W. G. Lyle, Minerva; F. P. Berlin, Lima; Paul
F. Orr, Perrysburg; John L. Frazer, Wellston.
Tellers and Judges of Election — M. G. Car-
mody, Painesville, chairman; E. K. Yantes, Wil-
mington; John S. Kiess, Bucyrus; Robert M.
Dumm, Kent.
COMMITTEE ON NOMINATIONS
The next order of business was the nomina-
tion and election of the following to the Com-
mittee on Nominations:
First District — Joseph Lindner, Cincinnati,
chairman.
Second District — J. E. Gillette, Versailles
Third District — Fred P. Berlin, Lima.
Fourth District — A. L. Bershon, Toledo.
Fifth District — David A. Chambers, Cleveland.
Sixth District — Wm. M. Skipp, Youngstown.
Seventh District — Carl F. Goll, Hopedale.
Eighth District — W. D. Monger, Lancaster.
Ninth District — H. D. Chamberlain, McArthur.
Tenth District — Thomas Curran, Columbus.
Eleventh District' — Leonard Stack, Lorain.
RESOLUTIONS INTRODUCED
President Lincke then called for the introduc-
tion of resolutions. The following resolutions
were introduced:
Resolution A was introduced by Dr. C. T.
Atkinson, Middletown, Butler County, and re-
lated to A. M. A. Fellowship.
Resolution B was introduced by Dr. Leonard
A. Stack, Lorain, Lorain County, and related
to A. M. A. Fellowship.
Resolution C was introduced by Dr. A. L.
Bershon, Toledo, Lucas County, and related to
the shortage of interns.
Resolution D was introduced by Dr. Kurt
Weidenthal, Hudson, Summit County, and re-
lated to the practice of medicine by hospitals.
Resolution E was introduced by Dr. C. S.
Higley, Cleveland, Cuyahoga County, and re-
lated to the “Hess Report,” pending before the
House of Delegates of the American Medical
Association.
Resolution F was introduced by Dr. Leonard
A. Stack, Lorain, Lorain County, and related to
the “Hess Report,” pending before the House
of Delegates of the A. M. A.
Resolution G was introduced by Dr. James
Mithoefer, Cincinnati, Hamilton County, and re-
lated to the participation by physicians in the
“get out the vote campaign” in Ohio.
Resolution H was introduced by Dr. S. J.
Shapiro, Warren, Trumbull County, and related
to the waiver of dues for physicians in prac-
itce 50 or more years.
Resolution I, submitted on behalf of The Coun-
cil, related to compulsory temporary disability
compensation.
All of these were referred without debate to
the Reference Committee on Resolutions. (See
minutes of Second Session of House of Delegates
67 6
The Ohio State Medical Journal
for texts of resolutions and action taken by the
House of Delegates.)
Under miscellaneous business the House of
Delegates authorized the reissuance of a charter
to the Fairfield County Medical Society, that so-
ciety having mislaid its original charter.
There being no further business, the House
of Delegates recessed to meet on Thursday
noon, May 18.
MINUTES OF SECOND SESSION
The second session of the House of Dele-
gates was called to order by President Lincke
at 1:30 p. m., Thursday, May 18, 1950, in the
Main Ballroom, Hotel Cleveland.
The roll call showed 118 delegates or al-
ternates and members of The Council in at-
tendance.
Before calling for reports of the Reference
Committees, President Lincke introduced Mr.
E. H. O’Connor, Managing Director, Insurance
Economics Society of America, Chicago, who ad-
dressed the House of Delegates on the question
of compulsory temporary disability compensation.
At the request of President Lincke, Dr. H. B.
Wright, Cleveland, chairman of the Reference
Committee on Resolutions, submitted the fol-
lowing report:
“Mr. President, the Reference Committee on
Resolutions herewith submits the following re-
port on the nine resolutions presented to the
House of Delegates at its session held on Tues-
day, May 16:
RESOLUTION I
(See page 686 in this issue for report on this
resolution, opposing compulsory temporary dis-
ability compensation, which was approved by the
House of Delegates, on motion duly made, sec-
onded and carried.)
RESOLUTION A AND RESOLUTION B
“Resolution A, presented by Dr. C. T. Atkin-
son, Middletown, on behalf of the Butler County
Medical Society, and Resolution B, presented by
Dr. Leonard A. Stack, Lorain, on behalf of the
Lorain County Medical Society, were considered
jointly by the Reference Committee. These re-
solutions deal with the same subject; namely,
fellowship in the American Medical Association.
The committee is in favor of the sentiments
expressed in these resolutions and herewith
submits a composite susbtitute resolution, read-
ing as follows, and recommends its adoption
by this House of Delegates:
“Whereas, There is constantly growing con-
fusion, misunderstanding and criticism among
the members of the American Medical Associa-
tion regarding ‘Fellowship,’ and
“Whereas, A classification of members known
as ‘Fellows’ is, in the opinion of many mem-
bers, unnecessary, and
“Whereas, The relationship between the
American Medical Association and its members
would be improved by establishing a single
membership classification in order that all mem-
bers would receive uniform benefits in return
for their annual membership dues, therefore,
“Be It Resolved, That the House of Delegates
of the Ohio State Medical Association in session
May 16, 17 and 18, 1950, favors a single mem-
bership classification in the American Medical
Association; requests the Board of Trustees of
the American Medical Association to prepare
appropriate amendments to the Constitution and
By-Laws and to submit the same to the House
of Delegates for action; and recommends that
serious consideration be given to formulating
a feasible plan whereby each member would re-
ceive The Journal of the A. M. A., or any spe-
cial scientific journal published by the Associa-
tion, as part of his all-inclusive membership
benefits, and further
“Be It Resolved, That Ohio’s delegates to the
American Medical Association are herewith in-
structed to present this resolution to the House
of Delegates of the American Medical Associa-
tion at the 1950 annual session in San Francisco.
“Mr. President, I move the adoption of this
portion of the report.”
On motion duly made, seconded and carried,
the recommendation of the committee, namely,
that the above composite substitute resolution
be adopted, was approved.
RESOLUTION E AND RESOLUTION F
“Resolution E, presented by Dr. C. S. Higley,
Cleveland, on behalf of the Cleveland Academy
of Medicine, and Resolution F, presented by
Dr. Leonard A. Stack, Lorain, on behalf of the
Lorain County Medical Society, are identical
resolutions dealing with the “Hess Report” re-
garding the practice of medicine by hospitals.
“This resolution reads as follows:
“Whereas, Chapter III, Article VI, Section 6,
of the recently adopted revised Principles of
Ethics of the American Medical Association
reads:
PURVEYAL OF MEDICAL SERVICE
“Section 6 — A Physician should not dispose
of his professional attainments or services to
any hospital, lay body, organization, group or
individual, by whatever name called, or however
organized, under terms or conditions which per-
mit exploitation of the services of the phy-
sician for the financial profit of the agency con-
cerned. Such a procedure is beneath the dignity
of professional practice and is harmful alike to
the profession of medicine and the welfare of
the people.
“Whereas, The committee known as the Hess
committee reported to the American Medical
Association House of Delegates in Atlantic City
in June 1949, in detail, regarding the Practice
of Medicine by Hospitals.
“Whereas, The Hess report in one paragraph
stated in explanation as follows: “Therefore,
hospitals and medical schools cannot charge
patients fees for medical services rendered by
physicians even though the physicians are full
time employees of an individual or institution.
“Whereas, The Hess report wTas adopted by
the American Medical Association House of
Delegates and the Trustees of the American
for July , 1950
677
Medical Association were _ instructed to enforce
the principles and obligations involved.
“Whereas, The House of Delegates of the
American Medical Association in Washington
in December, 1949, reaffirmed its belief in and
confirmed the principles stated in the Hess
report and directed that action by the Trustees
be deferred only until all legal requirements were
met in order to insure that all actions taken
shall comply with the law.
“Whereas, The Trustees of the American Medi-
cal Association are to report to the House of
Delegates in June, 1950, regarding this matter
and the “Hess” committee is to report its fur-
ther study.
“Therefore, Be It Resolved, The House of Dele-
gates of the Ohio State Medical Association
confirms the action of the American Medical
Association House of Delegates regarding the
reaffirmation of the Principles of the so-called
“Hess” report.
“Be It Further Resolved, The House of Dele-
gates of the Ohio State Medical Association re-
quests the American Medical Association House
of Delegates to expedite action and implement
methods that WILL enforce the Section 6,
Article VI, Chapter III of the Principles of
Medical Ethics without delay.
“Be It Further Resolved, Our Delegates to the
American Medical Association are hereby in-
structed regarding these desires and requested
to work for their fulfillment.
“Your committee endorses these resolutions
and recommends their adoption.
“Mr. President, I move the adoption of this
portion of the report.”
On motion duly made, seconded and carried,
the recommendation of the committee, namely,
that Resolution E and Resolution F be adopted,
was approved.
RESOLUTION C
“Dr. A. L. Bershon, Toledo, presented Res-
olution C on behalf of the Toledo Academy of
Medicine, reading as follows:
“American medicine is being charged by cer-
tain factions as offering insufficient medical
care. The Profession recognizes that there is
basis in part for some of these charges, due
to a dearth of General Practitioners and a con-
centration of doctors in the urban centers. This
deficiency of General Practitioners is directly
associated with over-emphasis on specialization
in the university centers resulting in a lack of
interns in the Non-University Hospitals, the
hospitals which are, and should continue to be,
the best training centers for the General Prac-
titioners of Medicine.
“Whereas, There are 807 approved hospitals’
in the United States offering a total of 9,124
internships, and
“Whereas, These hospitals reported only 7,068
first and second year interns on active duty,
leaving 2,056 vacancies on 1 September 1948, and
“Whereas, The University Hospitals compris-
ing only 25 per cent of the approved hospitals,
with only 29 per cent of the total beds1 2 and
only 23 per cent of the total patient admissions,
have 47.4 per cent of the available internships
with only 17 per cent vacancies — or 1 intern to
1. J. A. M. A., Vol. 140, No. 2- May 14, 1949, pp. 157, 158.
2. J. A. M. A., Vol. 140, No. 2, May 14, 1949, pp. 161
through 170.
each 21 1/3 beds — leaving the Non-University
Hospitals with 70 per cent of the total vacancies
— or 1 intern to every 60 beds, and
“Whereas, This critical shortage of interns is
working a hardship on the Non-University af-
filiated hospitals which are taking care of 77
per cent of the patients in our country, making
it more difficult for them to render adequate
service, resulting in poor public relations for the
profession, therefore.
“Be It Resolved, That the approved hospitals
of the City of Toledo, through the Academy
of Medicine of Toledo and Lucas County, hereby
petition the Ohio State Medical Association to
urge the American Medical Association to re-
quest that the teaching University Hospitals
directly connected with their medical schools
cease to offer first year rotating internships,
thus making available approximately 1500 grad-
uates each year to fill the large number of
vacancies in the Non-University affiliated hos-
pitals. The first year men thus released under
this plan would receive an intimate association
with the general practice of medicine in these
Non-University affiliated hospitals and be stim-
ulated to enter this field, thus helping to relieve
the critical shortage of General Practitioners
which is so acute today.
“This resolution refers to the lack of general
practitioners by virtue of concentration of physi-
cians in urban centers and to over-emphasis on
specialization resulting in a shortage of interns
in non-university hospitals. The resolution rec-
ommends that this Association should urge the
American Medical Association to request the
teaching university hospitals to cease offering
first year rotating internships, thus making avail-
able a considerable number of medical school
graduates each year for internships in non-
university hospitals.
“In reviewing this resolution the committee
felt that there are certain impracticable features
in the recommendations. Also, it is a fact that
the House of Delegates and the Council on Medi-
cal Education and Hospitals of the American
Medical Association have been giving serious
study to this question in an effort to find a
workable solution. At the 1949 annual session
of the American Medical Association House of
Delegates the appointment of a special com-
mittee to study this question was authorized.
The matter was again discussed at the Decem-
ber, 1949, session of the House of Delegates
of the A. M. A. It is expected that the special
committee which is trying to work out a plan
for a better distribution of interns will report
its findings and recommendations at the 1950
session of the House of Delegates in San Fran-
cisco this coming June.
“For these reasons your Reference Com-
mittee recommends that Resolution C should
not be adopted by this House of Delegates.
“Mr. President, I move the adoption of this
portion of the report.”
The action of the Reference Committee was
discussed by Dr. Carll S. Mundy, Toledo, Coun-
.678
The Ohio State Medical Journal
cilor of the Fourth District, and by other mem-
bers of the House of Delegates. Following the
discussion, Dr. Mundy presented the following
amendment to become a supplemental paragraph
of the report of the Reference Committee on
Resolution C :
“However, in view of the seriousness of this
situation in many localities, the Ohio delegates
to the A. M. A. are hereby instructed to keep
in close touch with the A. M. A. Committee
considering this question and to do everything in
their power to expedite an early solution to
the problem.”
On motion duly made, seconded and carried,
the amendment presented by Dr. Mundy was
agreed to.
Subsequently, on motion duly made, seconded
and carried, the report of the Reference Com-
mittee as amended, relating to Resolution C,
was approved.
RESOLUTION G
“Resolution G, which was presented by Dr.
James Mithoefer, Cincinnati, on behalf of the
Cincinnati Academy of Medicine, urges members
of the medical profession and members of their
family to participate in the state-wide “get-
out-the-vote campaign” and actively work for
the election of experienced, able candidates. This
resolution reads as follows:
“Whereas, The General Election next Novem-
ber 7 will be one of the most important in the
history of this state, and
“Whereas, It is imperative that well-qualified
persons be elected to public offices, especially to
seats in the United States Congress and the Ohio
General Assembly, and,
“Whereas, It is the duty and responsibility of
each physician, as a good citizen, to qualify for
the privilege of voting and to cast his vote on
Election Day, therefore
“Be It Resolved, That this House of Delegates
urges each member of the Ohio State Medical
Association and voting members of his family
to register with their county board of elections,
if required and if they have not done so; and
to vote on Election Day, and
“Be It Resolved, That all members and mem-
bers of their family give their active support to
the state-wide “get out the vote campaign”
and that they actively work for the election of
experienced, able candidates.
“Your Reference Committee heartily endorses
this resolution and expresses the hope that
each County Medical Society in Ohio, through
its legislative committee and otherwise, will
take an active part in efforts being made to
get all citizens to register and vote and to elect
well-qualified candidates for public offices, espe-
cially to seats in the United States Congress
and the Ohio General Assembly. Your com-
mittee, therefore recommends the adoption of
this resolution.
“Mr. President, I move the adoption of this
portion of the report.”
On motion duly made, seconded and carried,
the recommendation of the committee, namely,
that Resolution G be adopted, was approved.
RESOLUTION D
“Resolution D, presented by Dr. Kurt W’eiden-
thal, Hudson, on behalf of the Summit County
Medical Society, reads as follows:
“Whereas, The Blue Cross Plan, Akron Hos-
pital Service, has desired to include payment
for anesthesia, provided the anesthetist is in
the employ of the hospital, and
“Whereas, Said inclusion is a further attempt
to furnish medical services by hospitals, and
“Whereas, Said inclusion is in direct opposi-
tion to the wishes of the anesthesiologists as
well as other members of the Summit County
Medical Society, and
“Whereas, The Hess Report As Revised is di-
rectly opposed to the furnishing of medical serv-
ices by hospitals for financial gain, and
“Whereas, Such inclusion in hospitalization
plans is another wedge in the furtherance of
socialized medicine, therefore
“Be It Resolved, That the Blue Cross Plans
organized in the State of Ohio be informed by
the Ohio State Medical Association that such
practice is contrary to the wishes of physicians
in general, and to anesthesiologists in particu-
lar, and such hospitalization plans should not
provide coverage which encroaches upon the
private practice of medicine, and
“Be It Further Resolved, That the Ohio State
Medical Association shall oppose all hospitaliza-
tion plans that provide medical services furnished
by hospitals beyond those in common practice
at this time, and
“Be It Further Resolved, That the Hess Re-
port As Revised be accepted by the Ohio State
Medical Association, and
“Be It Further Resolved, That all medical
indemnity insurance plans, particularly Ohio
Medical Indemnity, The Doctors Plan, be urged
to include anesthesia as a medical service to
counteract the trend toward including it as a
hospital service, and
“Be It Further Resolved, That a copy of this
resolution be transmitted to the proper com-
mittees of the Ohio State Medical Association
and the American Medical Association for their
guidance in the desires of this House of Dele-
gates relative to the encroachment of hospitals
upon the private practice of medicine.
“This resolution was reviewed very carefully
by your committee.
“One portion of the resolution refers to the
Hess Report. This subject has already been
disposed of through action on Resolutions E
and F.
“Another section of the resolution urges medi-
cal indemnity insurance plans, particularly Ohio
Medical Indemnity, to include coverage for an-
esthesia services as a part of their contracts.
Your committee has been advised that Ohio
Medical Indemnity has already taken the ap-
propriate steps to carry out this recommendation.
“The balance of the resolution express opposi-
tion to the inclusion of medical services in hos-
pitalization insurance plans. The Ohio State
Medical Association already has a definite policy
on this matter. On October 8, 1939, The Council
for July, 1950
679
of the Ohio State Medical Association adopted
the following principles as a guide in evaluat-
ing hospital insurance contracts:
“ ‘The subscriber’s contract should exclude all
medical services. Contract facilities should be
limited exclusively to hospital facilities such as
bed, board, operating room, medicines, surgical
dressings, general nursing care, and services
of intern and resident staff in assisting the sub-
scriber’s attending physician.’
“Therefore, your committee recommends that
Resolution D not be adopted, and further recom-
mends that this House of Delegates reaffirm
the principles adopted by The Council on Octo-
ber 8, 1939, as the official policy of the Ohio
State Medical Association. Moreover, it recom-
mends that County Medical Societies use these
principles as the basis for conferences and dis-
cussions with representatives of hospital in-
surance plans.
“Mr. President, I move the adoption of this
portion of the report.”
On motion duly made, seconded and carried,
the recommendation of the committee, namely,
that Resolution D not be adopted, was approved.
RESOLUTION H
“Resolution H was presented by Dr. S. J.
Shapiro, Warren, on behalf of the Trumbull
County Medical Society. This resolution recom-
mends that the Ohio State Medical Association
exempt from the payment of annual dues, those
physicians who have been honored for their fifty
years in medical practice.
“The Reference Committee favors the intent
of this resolution and herewith submits a sub-
stitute resolution and recommends its adoption.
SUBSTITUTE RESOLUTION H
“Resolved, That the Constitution and By-Laws
of the Ohio State Medical Association be amended
to exempt from the payment of annual dues
of the Ohio State Medical Association those
members who have been graduates of a medical
school for at least 50 years and that The
Council be instructed to prepare proper amend-
ments to the Constitution and By-Laws of the
Ohio State Medical Association for submission
to the House of Delegates for action at the 1951
annual session of the Ohio State Medical Asso-
ciation.
“The Reference Committee would like to
point out to the House of Delegates that the
Constitution and By-Laws of the Ohio State
Medical Association provide that proposed
amendments to the Constitution and By-Laws
must be published in The Ohio State Medical
Join 7ial at least 30 days prior to the session
of the House of Delegates at which such
proposed amendments are to be acted upon.
“Mr. President, I move the adoption of this
portion of the report.”
President Lincke called for discussion of the
substitute resolution presented by the Refer-
ence Committee and the motion to adopt the
substitute resolution.
Dr. D. C. Houser, Urbana, senior member of
the House of Delegates, a member of the House
of Delegates since 1902 and a past-president of
the Association, took the floor and presented
vigorous objections to this resolution. Dr.
Houser stated that he had always considered it
an honor and a privilege to be an active dues-
paying member of the Ohio State Medical Asso-
ciation and he said he felt that the over-
whelming majority of the older members of the
Association felt the same way. Dr. Houser
said that he believes it would not be proper to
place the older members in an “old age pension”
classification. Dr. Houser recommended that
the substitute resolution and the motion to
adopt the substitute resolution should be dis-
approved.
The motion to adopt the substitute resolu-
tion as seconded was put to a vote and the
motion was defeated by an overwhelming vote.
REPORT, AS AMENDED, APPROVED
Dr. Wright then moved that the report of
the Reference Committee, as amended, be ap-
proved. The motion was seconded and carried.
Dr. Wright then expressed appreciation to
the following members of his committee for the
fine work which they had done and for having
devoted so much time to the resolutions con-
sidered: Dr. J. Martin Byers, Greenfield; Dr.
G. A. Woodhouse, Pleasant Hill; Dr. R. E.
Shell, Van Wert; Dr. 0. E. Todd, Toledo; Dr.
Wm. M. Skipp, Youngstown; Dr. J. S. Adler,
Strasburg; Dr. George Malley, Zanesville; Dr.
Newton Spears, Ironton; Dr. Gilman D. Kirk,
Columbus; Dr. Leonard A. Stack, Lorain.
REPORT ON PRESIDENT’S ADDRESS
Dr. R. K. Ramsayer, Canton, chairman, of the
Reference Committee on the President’s Address,
submitted the following report which had been
endorsed and signed by the following committee
members, including the chairman: Dr. C. T. At-
kinson, Middletown; Dr. E. H. Artman, Chilli-
cothe; Dr. Carl F. Goll, Hopedale; Dr. D. J.
Slosser, Defiance.
“The Committee on President’s Address, com-
posed of Drs. Artman, Atkinson, Goll, Slosser
and Ramsayer, after due study and deliberation,
wishes to submit the following report:
“Doctor Lincke presented a well organized and
complete discussion of the activities, achieve-
ments and objectives of the Ohio State Medical
Association, during his tenure of office, in a
concise, positive and interesting manner. For
the purposes of clarity and analysis, his speech
may be divided into three principal parts.
“The first portion pertains to the activities
and high spots of progress of the past fifty years.
He emphasizes that medical science has pro-
duced its greatest achievements during this
period, and exceeds all those since the dawn of
history.
“Doctor Lincke points out that the progress
made in the field of sanitation and public health
680
The Ohio State Medical Journal
education has advanced from no organization to
a now highly efficient specialty, exerting com-
plete control of public health education and the
collection of vital statistics. Likewise, ther-
apeutics and pharmacology, with its latest de-
velopments of antibiotics, serums and other
drugs, which were unheard of at the beginning
of the Century. Surgery has advanced from
the kitchen-table techniques, with poor or no
anesthesia, to the highly skillful methods used
in the everyday procedures in our modern hos-
pitals. Likewise, the modern hospital of today
was unheard of fifty years ago.
SCIENTIFIC DEVELOPMENTS
“During this period, the development of elec-
tricity, the automobile and the dissemination of
news and information by telephone, telegraph,
press, radio and television, has completely
changed the environment and daily practice
of the physician. The public has become in-
terested in health matters, and not so many
years ago, little or no public attention was
paid to health welfare. The Rockefeller Foun-
dation was about the only organization other
than the medical societies taking an interest
in advancing the art of science and medicine.
“Today, millions of people are taking a keen
interest in these subjects in various manifold
organizations in the field of medical care.
“Likewise, during this interim, many programs
of insurance protection have developed, as wit-
nessed by our Workmen’s Compensation system,
voluntary participation in hospital and medical
care insurance plans and disability coverage and
the like.
“While these things have been taking place,
our own organization has grown and expanded
to meet the demands and needs of our times.
The central office of the Ohio State Medical As-
sociation has grown from one executive secretary
and one stenographer in dingy quarters to its
present fine downtown Columbus offices, with
twelve full-time employees and a number of
part-time assistants. The acknowledgment by
Dr. Lincke that the Ohio State Medical Associa-
tion functions as an efficient organization in
the category of big business behind its of-
ficers, speaks well for an able leadership during
the past year.
OHIO MEDICAL INDEMNITY
“He emphasizes that one of its departments,
the Ohio Medical Indemnity prepayment medi-
cal care plan, is the fifth largest of its kind in
the United States, and provides coverage
against the costs of many illnesses and dis-
abilities for more than 700,000 Ohioans. The
President particularly pays tribute to the em-
ployees of our Columbus office for their faithful
service and interest, and mentions especially
our executive secretary, Chuck Nelson, and his
assistant, Scottie Saville, for their untiring ef-
forts and loyal devotion to duty.
“The second portion of the President’s Ad-
dress pertains to the activities of the Ohio
State Medical Association through its officers
and various committees. During the year just
concluded under the leadership of Dr. Lincke,
our organization has maintained and continued,
by the highest standards, its dedicated principle
of preserving, protecting and promoting the
practice of medicine and public health in the
American Way. The challenge of the profes-
sion, ‘Do right by the people,’ in our personal
and professional relationship, is not going un-
heeded. Categorically, our President has re-
viewed and emphasized the high spots of our many
committees and organizations. Time will allow
for re-emphasis of only a few.
“Our President reaffirms that each county
medical society represents one of the most im-
portant organizations in the community and as
such, either as a society or via its individual
members, has definite obligations to fulfill, as
well as many opportunities of promoting good-
will among the public. These obligations and
responsibilities in the community can only be
reposed in a virile and aggressive leadership
in our several county societies, and upon their
achievements depend the destiny of our state
organization. This will help to eliminate a large
portion of public grievances and quiet those
who would have government medicine. The in-
dividual physician continues to be the master of
our destiny.
THE DOCTOR AS A CITIZEN
“Doctor Lincke emphasizes with top priority
the great need for physicians assuming their re-
sponsibilities as citizens. In these times of
social changes, it was never more important
that the physicians, as an intelligent and edu-
cated component of our civilization, should make
their views known, not only in politics, but in
closer liaison with their representatives in state
and national congresses. Never in the history of
our organization has it been so necessary as in
this election year of 1950, that we vote and work
to cause others to vote, proving ourselves to be
good citizens as well as good doctors.
“Your committee feels that Dr. Lincke, in
his refreshed emphasis on the activities and ex-
pansion of the public relations and educational
committees during his tenure of office, has been
at a loss of expression to note the real facts,
chiefly due to modesty on his part. He should
have said that probably more has been accom-
plished during the past year through his own
efforts and, through the State Association, the
county medical societies and the individual phy-
sicians, than in any previous year.
RURAL HEALTH
“Also, in studying his address we are re-
minded that a former president of some 18
years ago in his annual address said, ‘The
health of the people is one of the prime objectives
of government and unless the medical profession
devises some plan or plans whereby the public
can obtain the best medical and surgical care,
the government may be compelled to provide
such a plan.’ The year-by-year review .of
some of the milestones in public relations since
18 years ago, and especially since the adoption
of the 25-point program of 1945, finds that
our profession has been devising plans for better
and better medical and surgical care and these
plans are rapidly and aggressively being carried
forward towards ultimate completion. One il-
lustration is the activity of the Association’s
Committee on Rural Health, which has already
excited national attention. Medical scholarships
and the doctor placement service are and will
contribute greatly to the solution of the rural
problems.
“Furthermore, the address stresses the far-
reaching effects of the public relations and edu-
cation committees, in disseminating important
facts and information via the speakers’ bureau,
the press, the OSMAgram, the radio and tele-
vision to all the communities in Ohio, again
developing a strong buhvark against government
medicine. Also, the rapidly growing and ex-
for July, 1950
681
panding Ohio Medical Indemnity, Inc., is a con-
crete example of financial benefits to the
citizens of Ohio and a powerful asset in times
of sickness.
“In conclusion, our Committee, in complete
unanimity, agrees that Dr. Lincke has given a
very comprehensive review of the medical past,
with its tremendous accomplishments, and has
challenged the profession for a greater and
more glorious future. We hope our sons will
pick up the gauntlet and ride forward, to fur-
ther accomplishments without the aid of govern-
ment subsidies. Dr. Lincke, in his own modest
way, has proven himself a dynamic leader and
has achieved much in many difficult circum-
stances. He has acquitted himself well, and
is deserving of the Society’s “heartfelt thanks”
for his year of unselfish service to our
Association.”
On motion duly made, seconded and carried,
the report of the Reference Committee on
President’s Address was approved.
TIME AND PLACE OF MEETINGS
The next order of business was the report
of the Reference Committee on Time and Place
of Annual Meeting.
Dr. Joseph Lindner, Cincinnati, chairman of
that committee, submitted the following report:
“Mr. President and members of the House
of Delegates, the Committee on Time and Place
of Annual Meeting deems it advisable to recom-
mend a change in the place for the 1952 An-
nual Meeting. Columbus has been chosen as
the place for the 1952 Annual Meeting, but
experiences from last year’s Annual Meeting
show that present facilities in Columbus are
not adequate.
“Therefore, your committee recommends that
the 1952 Annual Meeting be held in Cleveland
during the month of May, if possible, the exact
time to be designated by The Council.
“Also this House of Delegates should act
with respect to the 1953 Annual Meeting. Your
committee recommends that the 1953 Annual
Meeting be held in Columbus, providing the new
civic auditorium being planned for Columbus
is ready and available by the month of May,
1953. The question of setting the exact date
of the meeting should be left to The Council.
(Note: The 1951 Annual Meeting will be held
in Cincinnati, April 24, 25 and 26.)
“Mr. President, I move the adoption of the
recommendations of the Reference Committee
on Time and Place of Annual Meeting.”
The motion was duly seconded and unani-
mously carried.
The report of the committee was signed by
Dr. Joseph Lindner, Cincinnati, chairman; Dr.
Kurt Weidenthal, Hudson; Dr. T. L. Light, Day-
ton; Dr. N. P. Stauffer, Millersburg; and Dr.
W. B. Recker, Leipsic.
ELECTION OF PRESIDENT-ELECT
President Lincke then called for nominations
for the office of president-elect, the Constitution
and By-Laws requiring that such nominations
must be made from the floor.
Dr. C. C. Sherburne, Columbus, a delegate from
Franklin County and a past-president of the
Association, placed in nomination the name of
Dr. Fred W. Dixon, Cleveland, retiring Coun-
cilor of the Fifth District. Dr. Wright, Presi-
dent of the Cleveland Academy of Medicine, and
a delegate from Cuyahoga County, seconded the
nomination.
There being no further nominations, on
motion duly made, seconded and carried, the
nominations were closed and the Executive
Secretary was instructed to cast the unanimous
ballot of the House of Delegates for the elec-
tion of Dr. Dixon to the office of president-elect.
This was done and Dr. Dixon was elected to the
office of president-elect.
At the request of President Lincke, Dr. Sher-
burne escorted Dr. Dixon to the rostrum where
he was introduced and given an ovation by the
House of Delegates. Dr. Dixon then made a
brief talk pledging his support of the policies
and programs of the Association.
ELECTION OF COUNCILORS
The President then called for the report of'
the Committee on Nominations. Dr. Joseph
Lindner, Cincinnati, chairman of that committee,
submitted the following report:
First District
As Councilor for the First District, the com-
mittee placed in nomination the name of Dr. D.
W. Heusinkveld, Cincinnati, to succeed himself"
for a term of two years. There being no fur-
ther nominations, on motion duly made, seconded
and carried, the nominations were closed and the
Executive Secretary was instructed to cast the
unanimous ballot of the House of Delegates for
Dr. Heusinkveld. This was done and Dr. Heu-
sinkveld was declared officially elected to The
Council for the years 1950 and 1951.
Third District
As Councilor for the Third District, the com-
mittee placed in nomination the name of Dr. J.
Craig Bowman, Upper Sandusky, to succeed
himself for a term of two years. There being-
no further nominations, on motion duly made,
seconded and carried, the nominations were
closed and the Executive Secretary was instructed
to cast the unanimous ballot of the House of
Delegates for Dr. Bowman. This was done and
Dr. Bowman was declared officially elected to
The Council for the years 1950 and 1951.
Fifth District
As Councilor for the Ffth District, Dr. Charles
L. Hudson, Cleveland, was nominated to suc-
ceed Dr. Fred W. Dixon, Cleveland, who re-
tired automatically from The Council due to the
fact that he had served three consecutive terms
682
The Ohio State Medical Journal ’
and who had been elected president-elect. There
“being no further nominations, on motion duly
made, seconded and carried, the nominations
were closed and the Executive Secretary was in-
structed to cast the unanimous ballot of the
House of Delegates for Dr. Hudson. This w*as
■done and Dr. Hudson was declared officially
elected to The Council for the years 1950 and
1951.
Seventh District
As Councilor for the Seventh District, the
committee placed in nomination the name of
Dr. R. J. Foster, New Philadelphia, to succeed
himself for a term of two years. There being no
further nominations, on motion duly made, sec-
onded and carried, the nominations were closed
and the Executive Secretary was instructed to
cast the unanimous ballot of the House of
Delegates for Dr. Foster. This was done and
Dr. Foster was declared officially elected to
The Council for the years 1950 and 1951.
Ninth District
As Councilor for the Ninth District, the com-
mittee placed in nomination the name of Dr. J.
P. McAfee, Portsmouth, to succeed himself for
a term of two years. There being no further
nominations, on motion duly made, seconded and
carried, the nominations were closed and the
Executive Secretary was instructed to cast the
unanimous ballot of the House of Delegates for
Dr. McAfee. This was done and Dr. McAfee was
declared officially elected to The Council for the
years 1950 and 1951.
Eleventh District
As Councilor for the Eleventh District, the
committee placed in nomination the name of
Dr. John S. Hattery, Mansfield, to succeed him-
self for a term of two years. There being no
further nominations, on motion duly made, sec-
onded and carried, the nominations were closed
and the Executive Secretary was instructed to
cast the unanimous ballot of the House of Dele-
gates for Dr. Hattery. This was done and
Dr. Hattery was declared officially elected to
The Council for the years 1950 and 1951.
A. M. A. DELEGATES ELECTED
The committee then presented nominations
for the offices of delegate and alternate to the
American Medical Association to be filled at this
year’s meeting, such delegates and alternates
to take office January 1, 1951, and to serve for
a term of two years, namely, 1951 and 1952.
The names of Dr. Edgar P. McNamee, Cleve-
land, and Dr. Herbert B. Wright, Cleveland, as
delegate and alternate, respectively, to serve for
a term of two years, starting January 1, 1951,
were placed in nomination. There being no fur-
ther nominations, on motion duly made, seconded
and carried, the nominations were closed and
the Executive Secretary was instructed to cast
the unanimous ballot of the House of Delegates
for Dr. McNamee and Dr. Wright. This was done
and they were declared duly elected delegate and
alternate to the American Medical Association
for two years, starting January 1, 1951.
The names of Dr. Carl A. Lincke, Carrollton,
and Dr. Herbert M. Platter, Columbus, as dele-
gate and alternate, respectively, to serve for
a term of two years, starting January 1, 1951,
were placed in nomination. There being no
further nominations, on motion duly made, sec-
onded and carried, the nominations were closed
and the Executive Secretary was instructed to
cast the unanimous ballot of the House of
Delegates for Dr. Lincke and Dr. Platter. This
was done and they were declared duly elected
delegate and alternate to the American Medical
Association for two years, starting January 1,
1951.
The names of Dr. George A. Woodhouse,
Pleasant Hill, and Dr. Roy S. Binkley, Dayton,
as delegate and alternate, respectively, to serve
for a term of two years, starting January 1,
1951, were placed in nomination. There being
no further nominations, on motion duly made,
seconded and carried, the nominations were
closed and the Executive Secretary was instructed
to cast the unanimous ballot of the House of
Delegates for Dr. Woodhouse and Dr. Binkley.
This was done and they were declared duly
elected delegate and alternate to the American
Medical Association for two years, starting
January 1, 1951.
The names of Dr. Wm. M. Skipp, Youngstown,
and Dr. C. E. Hufford, Toledo, as delegate and
alternate, respectively, to serve for a term of
two years, starting January 1, 1951, were placed
in nomination. There being no further nomina-
tions, on motion duly made, seconded and
carried, the nominations were closed and the
Executive Secretary was instructed to cast the
unanimous ballot of the House of Delegates for
Dr. Skipp and Dr. Hufford. This was done and
they were declared duly elected delegate and
alternate to the American Medical Association
for two years, starting January 1, 1951.
The Nominating Committee pointed out to
the House of Delegates that the delegates and
alternates just elected are incumbent delegates
and alternates to the A. M. A. and that they
would serve as such for the balance of 1950,
starting their new terms officially January 1, 1951.
DR. SWARTZ INSTALLED
President Lincke then installed Dr. E. O.
Swartz as President of the Association, present-
ing him with the official gavel of the Associa-
tion. Following a brief talk, Dr. Swartz sub-
mitted the following appointments to the stand-
ing committees of the Association:
Committee on Public Relations and Economics
— Dr. John A. Fraser, East Liverpool, for a
term of five years. Dr. Herbert B. Wright,
jor July, 1950
683
Cleveland, a member of the committee, to serve
as chairman for the ensuing year.
Committee on Education — Dr. J. L. Webb,
Nelsonville, for a term of five years. Dr. Charles
S. Higley, Cleveland, to serve as a member of
the committee for the years 1950, 1951 and
1952, inclusive, filling the unexpired term of Dr.
Edwin P. Jordan, Cleveland, resigned. Dr.
Carl A. Wilzbach, Cincinnati, a member of the
committee, to serve as chairman for the ensu-
ing year.
Judicial and Professional Relations Committee
— Dr. Neil Millikin, Hamilton, for a term of
five years. Dr. John A. Caldwell, Cincinnati,
a member of the committee, to serve as chair-
man for the ensuing year.
Committee on Scientific Work — Dr. Robert M.
Zollinger, Columbus, for a term of five years.
Dr. Martin W. Diethelm, Toledo, a member of
the committee, to serve as chairman for the
ensuing year.
On motion duly made, seconded and carried,
the foregoing committee appointments were con-
firmed by the House of Delegates.
VOTE OF THANKS
Under the order of new business Dr. Wm. M.
Skipp, Youngstown, moved that a vote of
thanks be extended to the Cleveland Academy of
Medicine, members of the Cleveland committees
on arrangements, Hotel Cleveland, the manage-
ment of the Public Auditorium, the press and
radio, the Committee on Scientific Work, the
'Committee on Scientific Exhibits, and all others
who had played a part in making the 1950
Annual Meeting the largest and one of the
best in the history of the Association. This
motion was adopted by a unanimous vote.
There being no further business, the House
of Delegates adjourned sine die.
Attest: Charles S. Nelson,
Executive Secretary.
Health Services for Civilians With
Military Forces Unified
Responsibility for the health program for
civilian employees of the military forces has
been assigned by Secretary of Defense Louis
Johnson to the Surgeons General of the Army,
Navy and Air Force, with each directing the
program in his respective department under the
over-all administrative, technical and profes-
sional control of Ohio’s Dr. Richard L. Meiling,
director of Medical Services, Office of the Secre-
tary of Defense.
The order, effective July 1, 1950, replaces the
former programs in which responsibility was
scattered among several agencies of the Depart-
ment of Defense, including the Surgeons Gen-
eral. Applicable to all Department of Defense
installations, the order consolidates and unifies
this health service.
A. M. A. Directory Now
Being Distributed
After three years of work, the 18th edition of
the A. M. A. directory has been completed and
copies are now being shipped to subscribers.
The edition, the first since 1942, was compiled
under extreme difficulties, and Editor Frank
V. Cargill says that “it was only with the
cooperation of the medical profession and allied
organizations that it was possible to produce a
directory of this scope.”
The long interval of eight years between the
new directory and the previous one made it
necessary to set new type on the entire book.
The loss of experienced clerical help during
the war, labor conditions and printing difficulties
also contributed to the delay.
The new directory contains 2,913 pages, and
lists information on 219,677 physicians in the
United States, its dependencies, and Canada. It
also lists American graduates and licentiates
located temporarily abroad. Since the 1942
directory, thousands of changes of address have
been made; 51,984 names have been added, and
28,242 names dropped from the book on ac-
count of death or for other reasons.
In the 1942 directory, the total number of
physicians listed in the United States was
180,496; in the 1950 edition, the number is
201,277, or a gain of 20,781, an average yearly
gain of 2,598 during the last eight years.
The Pacific States show the largest in-
crease in physicians, the Atlantic and Great
Lakes States a moderate increase and the West
Central States the greatest losses. California
leads in the number gained, with 16,668 physi-
cians in 1950 as compared with 12,365 in 1942, a
gain of 4,303. New York state shows a gain of
2,284, Texas a gain of 772, Pennsylvania 704,
Florida 634 and Massachusetts 603.
For the first time, postal zone numbers ap-
pear after the residence and office addresses of
physicians in cities where they are required by
the Post Office Department. A new feature
is the inclusion of data on the World Medical
Association.
The directory costs $25. Orders may be
placed by writing to Frank V. Cargill, Directory
Department, American Medical Association, 525
North Dearborn St., Chicago 10.
For every person who now dies of pneumonia
or influenza, five would have died if the mor-
tality rate of only 20 years ago had continued,
Metropolitan Life Insurance Company reports.
The Southwestern Chapter of the Ohio Aca-
demy of General Practice had as speakers Dr.
Othilda Krug and Dr. Eli A. Miller, both of
Cincinnati, who spoke respectively on “Mar-
riage Counseling” and “Controlled Fertility.”
684
The Ohio State Medical Journal
HOUSE OF DELEGATES
ROLL CALL— 1950 MEETING
County
Delegate
First
Session
Second
Session
ADAMS
FIRST DISTRICT
S. J. Ellison
Present
Present
BROWN
W. L. Faul
BUTLER
Neil Millikin
C. T. Atkinson
Present
Present
CLERMONT
A. A. Gruber
Present
CLINTON
E. K. Yantes
Present
Present
HAMILTON
Joseph Lindner
Present
Present
E. C. Elsey
Present
Present
John W. Hauser
Present
Daniel V. Jones
Present
Present
William F. Hunting
Present
Present
Kent E. Martin
Present
Present
James Mithoefer
Present
Present
J. Edwin Reed
Present
Present
Robert S. Green
Present
HIGHLAND
J. Martin Byers
Present
Present
WARREN
0. L. Layman
—
Present
CHAMPAIGN
SECOND DISTRICT
D. C. Houser
Present
Present
CLARK
S. C. Yinger
Present
R. M. Turner
Present
Present
E. W. Schilke
Present
DARKE
J. E. Gillette
Present
GREENE
H. C. Messenger
Present
Present
MIAMI
G. A. Woodhouse
Present
Present
MONTGOMERY
R. S. Binkley
Present
Present
A. W. Carley
Present
Present
R. D. Dooley
Present
Present
T. L. Light
Present
Present
PREBLE
E. P. Trittschuh
SHELBY
H. E. Crimm
Present
ALLEN
THIRD DISTRICT
F. P. Berlin
Present
Present
AUGLAIZE
C. W. Berry
Present
CRAWFORD
John S. Kiess
Present
HANCOCK
Frank M. Wiseley
Present
Present
HARDIN
Floyd M. Elliott
Present
LOGAN
Warren F. Mills
Present
Present
MARION
Robert T. Gray
Present
MERCER
SENECA
L. M. Otis
R. F. Machamer
Present
VAN WERT
R. E. Shell
Present
Present
WYANDOT
DEFIANCE
FOURTH DISTRICT
D. J. Slosser
Present
Present
FULTON
HENRY
E. M. Murbach
B. L. Johnson
Present
LUCAS
A. L. Bershon
Present
Present
0. E. Todd
Present
Present
E. E. Lyon
Present
Present
R. Kuebbeler
Present
Present
R. A. Diethelm
Present
Present
OTTAWA
C. R. Wood
Present
Present
PAULDING
R. H. Mouser
PUTNAM
W. B. Recker
Present
Present
SANDUSKY
J. Gedert
Present
Present
WILLIAMS
H. R. Mayberry
Present
Present
WOOD
Paul F. Orr
Present
Present
ASHTABULA
FIFTH DISTRICT
M. R. Martin
Present
P. J. Collander
Present
CUYAHOGA
H. B. Wright
Present
Present
D. A. Chambers
Present
Present
J. H. Budd
Present
Present
D. C. Darrah
Present
Present
C. L. Hudson
Present
Present
J. T. Ledman
Present
Present
J. E. Brown
Present
Present
George A. Tischler
Present
Present
F. L. Browning
Present
Present
L. H. Dembo
Present
Present
C. S. Higley
Present
Present
E. A. Marshall
Present
Present
H. A. Crawford
Present
Present
J. M. Rossen
Present
Present
I. M. Hinnant
Present
J. W. Conwell
Present
Present
GEAUGA
Phillip P. Pease
Present
Present
LAKE
Morris G. Carmody
Present
Present
First
Second
County
Delegate
SIXTH DISTRICT
Session
Session
COLUMBIANA
J. A. Fraser
Present
Present
MAHONING
V. L. Goodwin
Present
Present
C. A. Gustafson
.
Present
Wm. M. Skipp
Present
Present
PORTAGE
Robert M. Dumm
Present
Present
STARK
John E. Dougherty
Present
Present
C. C. Couch
Present
Present
R. K. Ramsayer
Present
Present
SUMMIT
Kurt Weidenthal
Present
Present
W. T. Bucher
Present
Present
C. A. Raymond
Present
Present
E. W. Burgner
Present
Present
TRUMBULL
S. J. Shapiro
SEVENTH DISTRICT
Present
Present
BELMONT
Harvey H. Murphy
Present
David Danenberg
Present
CARROLL
W. G. Lyle
Present
Present
COSHOCTON
E. J. Booth
HARRISON
Carl F. Goll
Present
Present
JEFFERSON
MONROE
John Gallagher
A. R. Burkhart
—
—
TUSCARAWAS
J. S. Adler
EIGHTH DISTRICT
Present
Present
ATHENS
Beatrice Postle
Present
M. H. Mitchell
Present
FAIRFIELD
W. D. Monger
Present
GUERNSEY
Robert A. Ringer
Present
Present
LICKING
George A. Gressle
Present
Present
MORGAN
Henry Bachman
MUSKINGUM
George C. M alley
Present
Present
NOBLE
Edward G. Ditch
PERRY
WASHINGTON
Donald S. Williams
NINTH DISTRICT
GALLIA
Charles E. Holzer, Jr.
HOCKING
M. H. Cherrington
Present
JACKSON
John L. Frazer
LAWRENCE
Newton Spears
Present
Present
MEIGS
Roger P. Daniels
Present
PIKE
R. M. Andre
Present
Present
SCIOTO
0. D. Tatje
Present
L. R. Chaboudy
Present
VINTON
H. D. Chamberlain
TENTH DISTRICT
Present
Present
DELAWARE
George J. Parker
FAYETTE
J. E. Rose
Present
FRANKLIN
George F. Collins
Present
Present
Phillip T. Knies
Present
Present
Reuben B. Hoover
Present
Gilman D. Kirk
Robert E. S. Young
Present
Present
Present
Thomas Curran
Present
C. C. Sherburne
Present
Present
KNOX
Henry T. Lapp
Present
Present
MADISON
Wm. T. Bacon
MORROW
J. P. Ingmire
Present
Present
PICKAWAY
E. L. Montgomery
ROSS
E. H. Artman
Present
Present
UNION
F. C. Calloway
ELEVENTH DISTRICT
Present
Present
ASHLAND
R. J. Ferguson
Present
Present
ERIE
Ross M. Knoble
Present
Present
HOLMES
N. P. Stauffer
Present
Present
HURON
Owen J. Nicholson
Present
Present
LORAIN
Leonard A. Stack
Present
Present
Russell Arnold
Present
Present
MEDINA
Wm. E. Dwyer
Present
Present
RICHLAND
P. A. Blackstone
Present
Present
WAYNE
Lyman A. Adair
OFFICERS
Present
—
President
Carl A. Lincke
Present
Present
President-Elect
E. 0. Swartz
Present
Present
Past-President
A. A. Brindley
Present
Present
Treasurer
H. P. Worstell ,
COUNCILORS
Present
Present
District
First
D. W. Heusinkveld
Present
Present
Second
Merrill D. Prugh
Present
Present
Third
J. Craig Bowman
Fourth
Carll S. Mundy
Present
Present
Fifth
Fred W. Dixon
Present
Present
Sixth
Paul A. Davis
Present
Present
Seventh
R. J. Foster
Present
Present
Eighth
Chester P. Swett
Present
Present
Ninth
J. P. McAfee
Present
Present
Tenth
H. M. Clodfelter
Present
Present
Eleventh
John S. Hattery
Present
Present
Totals
118
118
for July, 1950
6 85
Disability Compensation . . .
House of Delegates Resolution Opposes State Plan for Compulsory
Non-Occupational Sickness Benefits; Favors \ oluntary Protection
THE most important question of policy
considered by the House of Delegates
at the recent Annual Meeting of the
Ohio State Medical Association was that per-
taining to compulsory temporary disability com-
pensation.
A resolution prepared by The Council op-
posing compulsory temporary disability insur-
ance was presented to the House of Delegates.
The resolution was revised by the Reference
Committee on Resolutions and reported back to
the House, with a recommendation that it be
adopted.
The House of Delegates approved without a
dissenting vote, the report of the Reference
Committee.
Following is the text of the Reference Com-
mittee’s report, including the resolution and
statement of policy on the question:
TEXT OF REPORT
“Resolution I was presented on behalf of The
Council. This resolution recommends that the
House of Delegates shall approve and adopt
an official statement of policy regarding com-
pulsory temporary disability compensation,
which statement of policy is incorporated in
the resolution.
“The intent of this resolution is to provide
representatives of the Ohio State Medical Asso-
ciation with information and arguments which
they can use before legislative bodies in opposing
a compulsory state plan of non-occupational sick-
ness and accident benefits. Your Reference Com-
mittee held two long sessions for the purpose
of discussing this important proposal. It recom-
mends the adoption of the resolution and state-
ment of policy with certain amendments. The
resolution and the amended statement read as
follows:
“Resolved, That the House of Delegates of
the Ohio State Medical Association, consisting
of official representatives of Ohio’s 88 County
Medical Societies, in annual session in Cleveland,
Ohio, May 16, 17 and 18, 1950, herewith ap-
proves and adopts the following statement as
the official policy of the Ohio State Medical
Association on compulsory temporary disability
compensation.
“When the 99th Ohio General Assembly con-
venes in 1951, it may be requested to enact legis-
lation, establishing in Ohio a compulsory state
plan of non-occupational sickness and accident
benefits.
“During the past year a special commission
created by act of the last General Assembly has
been holding hearings on this question, prepara-
tory to compiling a report, with recommenda-
tions, to the next General Assembly.
“This question should be of vital concern, not
only to members of the medical profession, but
to all citizens of Ohio.
“Serious and far-reaching economic, social and
political implications are involved.
“In addition, a state-controlled program ta
compensate a worker for loss of earnings for
non-occupational injuries and illnesses — in other
words, cash sickness compensation — would be ac-
companied by innumerable medical administrative
problems, affecting the practice of medicine and
patient-physician relationships.
VOLUNTARY SYSTEM FAVORED
“The medical profession of Ohio endorses the-
principle that every worker should voluntarily
protect himself and members of his family
against the hazards of non-occupational illness
and injury.
“Moreover, the medical profession is in agree-
ment with the principle that public assistance,
including medical and hospital services, should
be provided on a state or local basis for those-
in need, regardless of the cause.
“On the other hand, the medical profession
of Ohio is opposed to any system of compulsory
disability insurance. It believes that it is neither
necessary nor advisable, and submits the follow-
ing specific arguments in support of this opinion:
OPINION SUBSTANTIATED
“Available data indicate that a high percentage
of workers are covered at present for the hazards
previously referred to. Such coverage is pro-
vided through private insurance contracts where
employers are paying all, or part of the cost;
or under mutual benefit plans operated by
groups of employees; or by employees or em-
ployers jointly. It is a fact also that many
employers continue to pay their workers their
salary when absent from work due to sickness.
Coverage can be secured without difficulty by
workers not already covered and at a cost within
their means.
“Great progress is being made by private in-
surance carriers in efforts to meet the needs
of the average working man for protection of
this kind. Benefits have been broadened; more
complete coverage is being offered; costs have
been lowered. Records show that private in-
surance companies which are competing with
686
The Ohio State Medical Journal
state cash disability funds in California and
New Jersey are offering broader protection and
providing better claims service for the same
premium cost than the state-operated fund.
“It would be exceedingly difficult, if not im-
possible, to make coverage under a state-wide
compulsory system flexible or elastic enough to
meet the varying needs of individual workers.
Likewise, such a system would probably be un-
able to gear itself to varying economic and so-
cial conditions.
DECRY FURTHER REGIMENTATION
“A compulsory program would require a high
degree of governmental regulation and regimen-
tation, rigid controls and considerable red-tape,
bookkeeping, paper work, etc., affecting insured
workers, employers, physicians, and others par-
ticipating in the program.
“Administration of a compulsory program
■would necessitate great expansion of some ex-
isting state agency or the creation of a new
agency. Many new employees would have to be
added to the state payroll. This additional
overhead obviously would add considerably to
the state budget.
“Compulsory disability insurance would inject
The government still further into the relation-
ship between physician and patient. This situ-
ation is now acute because of the expansion of
government-controlled medical and health activ-
ities. Additional impairment of the physician-
patient relationship would constitute a real
•danger which must not be overlooked.
“Obviously, it would be impossible to eliminate
politics and political pressures from the admin-
istration of a compulsory program. Any system
wTiich is subject to political manipulation, regu-
lated by a paternalistic government, and which
develops in the insured individual the feeling
that he has an inherent right to demand such
benefits, is wide open to abuse, malingering,
dishonesty and collusion. A compulsory disability
program cannot be an exception to this rule.
POLITICAL CONSIDERATION
“Under a state disability program, subject
to political pressures, benefits would be con-
tinuously expanded and liberalized without re-
gard for actuarial principles. This would mean
that deficits would have to be met from the
state treasury, necessitating additional general
taxes or special taxes. The only alternative
would be increases in the premiums levied on
workers and employers. This would add to the
problems and maladjustments which already
exist in our present economy of high taxes, high
prices and inflation.
“Any state which adopts a compulsory dis-
ability insurance program is setting up the pat-
tern for transfer to the Federal Government.
Concentration of power, control and regimen-
tation in the hands of the Federal Government,
which has taken over many activities which
could be handled better and more economically
on a state or local basis, has created a dangerous
situation.
STEP TO FEDERAL CONTROL
“Those who believe that establishment of a
compulsory disability plan on a state basis
will prevent the formation of a Federal system
are naive, to say the least. They do not
realize how easy it would be for the Federal
Government to take over after a relatively few
key states have adopted such a plan. This is
the plan of those in power in Washington who
are exerting pressure day after day for com-
plete Federalization of all social insurance, wel-
fare and health plans, and other governmental
activities.
“Conversion of any compulsory non-occupational
disability compensation program into a full-
fledged compulsory health or sickness insurance
scheme is relatively easy — in fact inevitable.
Compulsory health insurance plans now operat-
ing in other nations started with a compulsory
disability compensation program. When it be-
comes necessary to apply controls or to expand
benefits, the inevitable trend is to regulate the
professions and to add service benefits — medical,
hospital, nursing, and dental care of claimants.
This adds up to an over-all compulsory medical
care system. Witness what has happened in
California, where hospitalization is now covered
under the state disability law. Witness the pres-
sure which has been exerted in Rhode Island and
New Jersey for similar service benefits — even
in New York where the disability law will not
even become effective until July 1, 1950. Com-
pulsory disability compensation is the back-door
entrance to general compulsory health insur-
ance under government regulation and control.
We are opposed to that.
“The time has come to call a halt to the
present trend which is encouraging the sur-
render of individual initiative, destroying ambi-
tion and responsibility, and threatening our na-
tional economy with bankruptcy.”
American College of Physicians
Announces 1951 Meeting
The American College of Physicians will con-
duct its 32nd Annual Session at St. Louis, Mo.,
April 9-13, inclusive, 1951. Dr. Ralph Kinsella
of St. Louis is the general chairman and will
be responsible for local arrangements and for
the program of Clinics and Panel Discussions.
Dr. William S. Middleton, president of the
College, Madison, Wis., will be in charge of the
program of Morning Lectures and Afternoon
General Sessions.
The 1952 Annual Session of the College will
be held at Cleveland, Ohio, April 21-25, 1952.
for July, 1950
687
A Half-Century of Progress . . .
President of Association Reviews Some High Lights of the Past 50
Years and Makes Pertinent Comments About the Future of Practice
By CARL A. LINCKE, M. D.
(Presented to the House of Delegates, May 16, 1950, at Cleveland, Ohio)
IT is indeed a privilege and a pleasure to be
president of the Ohio State Medical Associa-
tion, and especially at this time — the midway
mark of the Twentieth Century. Since this is
the mid-century meeting of the Association, I
think it would be appropriate to review some of
the high spots of the progress of the past 50
years and to make a few comments about the
future.
The past half-century has produced the great-
est advancement in the science of medicine
since the dawn of history. Permit me to enu-
merate a few high lights for the record.
In the field of sanitation, the outhouse has
been brought inside, pure water substituted for
contaminated wells and springs in a large part
of the nation, and refrigeration has become a
household necessity.
Public health administration, a vital part of
the practice of medicine, has advanced from
practically no organization to an efficient spe-
cialty, dealing with epidemic and contagious
disease control, health education, collection of
vital statistics, et cetera.
Great advances have been made in pathological
research and in laboratory techniques, giving
us new information about the cause of diseases
and providing us with exact diagnostic methods.
Progress in therapeutics and pharmacology
has given us antibiotics, serums, chemicals and
other drugs which were unheard of at the turn
of the century and efficient ways of using them.
PROGRESS IN SURGERY
Surgery has progressed from the kitchen-
table technique under chloroform, or possibly no
anesthesia, to the skillful methods used by to-
day’s surgeon. This, also, is true in the other
specialties.
Hospital care has kept pace, dispelling the
fear of hospitalization which prevailed in the
minds of so many persons 50 years ago.
Scientific inventions and advancements bene-
fiting the entire world have done much for the
doctor and his patients. Take electricity as an
example. It has supplied us with an energy
that has made possible new methods of diagnosis
and treatment.
Another example is the automobile. It and
good roads have taken the place of the horse and
buggy and the mud, landmarks still quite
fresh in the minds of many physicians still in
practice.
Still another example is the progress made in
dissemination of news and information — by the
press, telephone, radio and television.
A marked change has occurred in the at-
titude of the public toward medical and health
matters. Not so many years ago the public
paid little, or no, attention to such matters.
About the only organizations, other than medical
societies, taking an interest in advancing the
art and science of medicine, medical education
and public health education were the large phil-
anthropic agencies, such as the Rockefeller
Foundation.
Today, millions of people are taking a keen
interest in these subjects. This is shown by the
presence of many different organizations in the
field of medical care and health education, such
as organizations which are interesting them-
selves in crippled children, poliomyelitis, cancer,
heart disease, arthritis, tuberculosis, diabetes,
epilepsy, venereal diseases, and many others.
Programs to provide insurance protection have
grown and multiplied by leaps and bounds as
witnessed by our Workmen’s Compensation sys-
tem, voluntary hospitalization and medical care
insurance plans, accident and disability cover-
age, and the like.
ASSOCIATION HAS GROWN
While these things have been taking place,
our own organization has grown and been ex-
panded to meet the demands and needs of the
times. It is a far cry from the loosely knit
organization of county societies which existed at
the turn of the century to our Ohio State Medi-
cal Association of today.
It has not been many years since the Asso-
ciation employed its first executive secretary and
established a permanent full-time office — in 1915
to be exact. The first executive secretary had
one stenographer to assist him. His office was
in dingy quarters. The budget for his activities
was a mere pittance compared to our present
annual budget of $140,000. Now our office oc-
cupies half of the top floor of a downtown office
building in Columbus. We employ 12 persons on
688
The Ohio State Medical Journal
a full-time basis and several others on a part-
time basis.
Speaking of employees, I wish to take this
opportunity to thank all of the employees of
our Columbus office for their faithful services
and interest, and to mention especially our
Executive Secretary, Chuck Nelson, and his
assistant, Scotty Saville, for their interest and
work beyond the call of duty.
Our organization is in the category of big
business, gentlemen — the business of providing
a service program to preserve, protect and pro-
mote medicine and public health in the American
Way. Also, I should point out that we also
are in the insurance business. We own and
control Ohio Medical Indemnity, the fifth largest
voluntary prepayment medical care plan in the
United States, which is now providing coverage
against the costs of many illnesses and disabil-
ities for more than 700,000 Ohioans, and which
is shoving a steady growth each month.
Now, let us focus our attention on some of
the important events of the past year. It has
been a busy year. I am happy to report that
many things have been accomplished.
Developing better public relations has been
one of the major activities of our Association.
We all know that the foundation of good pub-
lic relations is conscientious service to our pa-
tients in our daily practice, plus vigorous pro-
motion of activities and services to improve
the health of the public as a whole.
Our efforts to get our members to realize
the need for improvement of their relationship,
professionally and personally, with their pa-
tients is beginning to bear fruit. Our chal-
lenge to the profession to “do right by the
people” is not going unheeded. The activities
of our committees, such as the Committee on
Rural Health and the Committee on School
Health, to cite two outstanding examples, have
demonstrated to the public that we are sincere
in our efforts to carry out our basic purposes.
WINNING FRIENDS
As a result, more and more people are be-
coming our allies in our battle to preserve the
freedom of the medical profession and to main-
tain high medical and health standards.
Our long-range approach to the job of win-
ning friends and acquainting them with what
we believe to be sound views on health matters
is beginning to pay dividends. The job has
just started. We must improve and expand our
efforts during the coming year.
The record shows that our Association, through
its Public Relations Department, with the help
of the county medical societies and many in-
dividual physicians, has done a tremendous job
in a tangible way during the past 12 months in
the field of public relations. Various media —
the press, radio, platform and literature — have
been used successfully to get our message
to the people.
Our Public Relations Department has co-
operated fully with the American Medical Asso-
ciation in its National Education Campaign.
During the past year more than three mil-
lion pieces of literature have been distributed
from our Columbus office to physicians for their
office waiting rooms, drugstores, insurance
agents, hundreds of lay organizations, groups,
clubs, etc.
All of the university, college and high school
libraries in Ohio, numbering nearly 2,000, have
been supplied with a comprehensive package
of material, describing the advantages of volun-
tary health insurance and the dangers of com-
pulsory health insurance. The package also
contains information on other subjects related
to the economic and social aspects of the prac-
tice of medicine, as well as valuable health
education data. Similar packets have been
sent to hundreds of participants in discussion
groups.
Local medical societies were assisted in secur-
ing scripts and platters for radio broadcasts.
Our State Speakers’ Bureau has furnished
speakers for many state and district public
meetings, supplementing the fine job by most
of the county medical societies in supplying
speakers for local gatherings.
After receiving material from our Associa-
tion reviewing the issue, nearly 500 Ohio or-
ganizations, including veterans organizations,
civic groups, business and professional organ-
izations, women’s clubs, et cetera, have adopted
resolutions opposing the enactment of compulsory
health insurance. These actions have been
called to the attention of the Ohio members of
the Congress.
We have sponsored exhibits at the State
Fair and at the annual conventions of the
Ohio Congress of Parents and Teachers, Ohio
Welfare Conference, Ohio Society for Crippled
Children, Ohio Society of Medical Technologists,
and similar groups. Also, our exhibits have
been used at a number of county fairs under the
sponsorship of the County Medical Society of the
Woman’s Auxiliary.
COMMITTEES ACTIVE
We can be proud of the work of our state
committees. They have worked hard and have
done a splendid job during the past year.
One of the most active committees is the
Committee on Rural Health. It established the
Ohio Rural Medical Scholarship and I am happy
to report that the first recipient, Mr. C. Craig
Wright, is progressing well with his studies at
Ohio State University College of Medicine. A
second scholarship will be awarded this summer.
This committee has promoted the formation of
for July, 1950
689
local community health councils. It has co-
operated with the Ohio Rural Health Council.
In the near future it will present to the deans
of the Ohio medical schools a plan for a series
of lectures for junior and senior medical stu-
dents on practice in small communities and in
rural areas.
The major activity of the Committee on
School Health during the past year was a state-
wide conference of school health committees of
the County Medical Societies with school ad-
ministrators, teachers and health officials. It
is preparing material for local school health
committees to guide them in working with school
officials on school health problems.
The Committee on Cancer has organized teams
which have been made available for programs
at county medical society meetings. This idea
has been popular. In fact, it has gone over so
well that the Committee on Education is con-
sidering the formation of teams to present pro-
grams at local medical meetings on other sub-
jects. The Committee on Cancer also has served
in an advisory capacity to the Ohio Department
of Health and Ohio Branch of the American
Cancer Society which are carrying on cancer
control and educational programs in the state.
A Committee on Chronic Illness has been ap-
pointed to study this problem and to make
recommendations which can be used as the basis
for a sound program of medical and institutional
care for these unfortunates.
Earlier in my remarks I referred to Ohio Medi-
cal Indemnity. Our prepayment medical care
plan has made great progress during the past
year. A year ago it had about 500,000 persons
covered. Today its enrollment exceeds 700,000.
Many of the indemnities in the schedule have
been increased. New procedures have been
added. A rider to cover medical cases in the
hospital is now being offered in several areas.
After experience has been gained, this kind of
coverage will be offered in all communities in
which Ohio Medical is operating. The possibility
and feasibility of adding coverage for X-ray
and anesthesia services are being studied. A
number of community enrollments have been
held with considerable success. More will be
held during the coming year. Experiments in
enrolling small groups and individuals have been
conducted in one area. If the results are favor-
able, coverage will be offered to small groups
and individuals in other parts of the state.
50-YEAR AWARDS
Last fall we started a program of presenting
gold emblems and certificates to physicians who
had been in practice for at least 50 years. This
idea, initiated by Past-President Rutledge, has
been accepted with great enthusiasm. Nearly
400 awards have been presented by members
of The Council at County Medical Society meet-
ings. These ceremonies have received wide-
spread publicity and built up fine public relations
in the various communities. There is no doubt
but what this will become an annual fall
activity.
Our annual conference for County Medical
Society officers and committeemen was a big
success and beneficial to all who attended, I
am sure. During the past year we sponsored
an important state-wide conference for officers
and committeemen of the local woman’s auxil-
iaries and the state auxiliary. At both con-
ferences the discussions high lighted the jobs
ahead, the importance of the coming elections,
public relations, et cetera.
Our Ohio State Medical Journal has continued
to improve. The OSMAgram is becoming more
and more popular and useful. The Placement
Service at our Columbus Office has supplied
physicians for a large number of small com-
munities.
I wish to thank the officers, Councilors and the
members of all of our committees for their un-
tiring efforts and for the parts which they have
played in making the record of the Associa-
tion during the past year one of marked progress.
What of the future? Here are a few things
which we must keep in mind in order to keep
our over-all program in high gear.
Our County Medical Societies must have top-
notch leadership. The destiny of the State
Association rests in the hands of the County
Medical Societies. The local societies will not
be able to fulfill their obligations and meet their
responsibilities unless they have alert, aggres-
sive leaders at the helm.
I am sure you will agree that our public rela-
tions program must be improved and expanded.
We have come a long way but we still have
a long road to travel. This is not a one-man
nor a one-society job. Its success will depend
on mobilization of the resources of the State
Association, those of the 88 county medical
societies, and the active interest and cooperation
of all members.
POOR CITIZEN— POOR DOCTOR
Another objective of major importance — I
might say immediate importance — is to get every
member of the Association actively interested in
political, civic and community affairs. In this
year 1950 I cannot over-emphasize how impor-
tant it is for each physician and all members
of his family to actively participate in political
affairs, especially in the activities leading up
to the General Election next November 7. The
physician who is a poor citizen is, in my opinion,
a poor doctor.
Moreover, we will have to step up our legis-
lative activities as the chips may be down during
the next session of Congress and during the
690
The Ohio State Medical Journal
next regular session of the Ohio General As-
sembly, starting next January. We must be
prepared to take a firm stand on all medical
and health bills — supporting those which are in
line with sound principles and policies; opposing
those which, in our belief, would be detrimental
to public health and to medical standards.
High priority should be given to extending the
fine work which has been done by the Committee
on Rural Health and the Committee on School
Health. Each County Medical Society should
have similar local committees and should give
them real support.
We should continue to give our active and
financial support to the Ohio Committee on
Public Health which is carrying on an impor-
tant educational program to improve our state
and local public health departments. Our local
societies can do much, if they will, to create
public interest in the matter of improving local
health departments and providing them with
adequate local funds for operation expenses.
EXPANDING SERVICE
As the problems increase, it will become in-
creasingly . necessary for the State Association
to provide more help and assistance to the
County Medical Societies on such matters as
providing speakers for meetings, clinical pro-
grams and field personnel from our Columbus
Office. If additional field services are to be
supplied from Golumbus, it will be necessary
to employ additional personnel. This should be
given serious consideration.
Needless to say, our entire membership should
give its active support to Ohio Medical Indemnity.
We should strive to boost its enrollment to at
least one million by the end of another year.
We should make every possible effort to expand
our contract both as to scope of coverage and
in the amounts of the benefits. This is our best
answer to those who think a compulsory govern-
mental program is the only solution.
Efforts should be made to expand our contacts
with governmental agencies and voluntary or-
ganizations interested in medical and health
questions. By doing so we will be able to
render our members greater service. At the
same time we will be in a position to take a
leading part in determining the policies and
activities of these agencies.
These are just a few of the goals which we
should have in mind as we start another Asso-
ciation year. By working hard to turn our
aims into achievements and by serving our
patients to the best of our ability, we will be
carrying on the basic purposes of our organ-
ization. In doing so we will win additional re-
spect and prestige for our Association and our
profession. This offers a real challenge. Let’s
meet it!
Survey of College
Health Services
The Bureau of Medical Economic Research
of the A. M. A. is conducting a survey of the
university and college health services for the
academic year 1949-1950 to bring up to date the
1936 study, “University and College Student
Health Services.”
The purpose of the present survey is to
determine what health services are being ren-
dered by the college directly or by community
physicians and hospitals through the college
health service offices, and how these services are
being financed.
A 12-page schedule is being sent to 1,150
colleges and universities to obtain data for
faculty members, nonacademic employes and
students. Insurance contracts with Blue Cross
and Blue Shield plans and insurance companies,
which have been made by some universities and
colleges in addition to, or instead of, other
methods of financing health services, are being
surveyed.
The health services available to the faculty
and nonacademic employes as well as to almost
three million college students is of great interest
and importance to American medicine, the
director of the Bureau stated.
New Chief of Tuberculosis Division
In Ohio Is Named
Dr. Arnold B. Kurlander who has been sta-
tioned in Ohio for approximately three and a
half years by the U. S. Public Health Service,
has been transferred to the Division of
Tuberculosis of the Public Health Service in
Washington, D. C.
Dr. John D. Porterfield, director of the Ohio
Department of Health, said that during Dr.
Kurlander’s stay in Ohio a completely new sys-
tem of central registration for tuberculosis cases
has been developed and a method of evaluating
the status of the tuberculosis program in each
health district evolved, which has been recog-
nized as a new contribution to the entire field
of tuberculosis control.
Replacing Dr. Kurlander as chief of the Di-
vision of Tuberculosis of the Ohio Department
of Health is Dr. Ralph E. Dwork. Dr. Dwork
received his medical degree after studying at
the Universities of Edinburgh and Glasgow,
Scotland, and later received the degree of Master
of Public Health at Columbia University. For
the last year he has been health officer in charge
of the Tremont and Fordham-Riverdale dis-
tricts of New York City.
An estimated 19,000,000 of the adult population
of the United States or about one out of five,
changed residence during the year ending in
April, 1949.
for July, 1950
691
• o •
Presenting
The New President-Elect and One New Councilor Elected at the
Recent Annual Meeting In Cleveland; Comments on Other Officers
THE President-Elect and one new Councilor were elected as officers of the Ohio
State Medical Association by the House of Delegates at the Annual Meeting in
Cleveland. Following are biographical sketches of these new officers, a sketch of
the incoming President, and a review of Councilors reelected.
Dr. Fred Willis Dixon of Cleveland is the President-Elect who will assume office as
President at the 1951 Annual Meeting in Cincinnati. In that office he continues as a
member of The Council on which he has served for the past six years. The Council
consists of the President, the President-Elect, the immediate Past-President, the
Treasurer and one Councilor for each of
the 11 Districts. The Council is the
interim governing body of the Associa-
tion between meetings of the House of
Delegates.
Dr. Dixon was born on a farm near
Mount Jackson, Pa., on November 18,
1888. After receiving his B. S. degree
from Geneva College, Beaver Falls, Pa.,
in 1912, he attended the University of
Pennsylvania School of Medicine from
which he received the degree of Doctor
of Medicine in 1917.
After completing an internship in City
Hospital, Youngstown, he was commis-
sioned in the Army Medical Corps and
served in that capacity during World
War I.
For approximately four years follow-
ing the war, he engaged in general prac-
tice in Leetonia before he began a
residency in the New York Eye and Ear
Infirmary. In 1925 he completed his
training in otolaryngology in Vienna.
For the past 25 years Dr. Dixon has
practiced in Cleveland.
Dr. Dixon is assistant professor, De-
partment of Otolaryngology, Western Re-
serve University SchooLof Medicine, and
visiting otolaryngologist at Lakeside Hospital and St. Alexis Hospital. He is a Fellow
of the American Medical Association, member of the American Academy of Otolaryn-
gology, American College of Surgeons, the American Laryngological Society, the
Rhinological and Otological Society, the American Broncho-Esophagological Associa-
tion (in an editorial capacity), and a fellow of the American Laryngological Asso-
ciation. In addition, he is the author of numerous medical publications.
Dr. Dixon was elected Councilor of the Fifth District at the 1944 Annual Meeting
to succeed Dr. Edgar P. McNamee of Cleveland. In 1946 and 1948 he was reelected
692
The Ohio State Medical Journal
to succeed himself. Before being elected
to that office, he served for five years as a
member of the Committee on Scientific
Work of the Association. He has since
served on several committees, among
which is the Committee on Auditing and
Appropriations.
INCOMING PRESIDENT
Dr. E. 0. Swartz, of Cincinnati, who was
formally installed as President of the Ohio State
Medical Association at the Annual Meeting in
Cleveland, comes into office with many years
of service in medical organization work.
He was born in Loudonville in Ashland County
on February 6, 1880, and received his prepara-
tory education at Portsmouth and in Warren
County. For his premedical training, he at-
tended Doane Academy
and Denison University,
Granville, where he re-
ceived his first college
degree. In 1905 he re-
ceived the degree of
Doctor of Medicine after
completing the course at
the Medical College of
Ohio, now the Univer-
sity of Cincinnati Col-
lege of Medicine.
Dr. Swartz was li-
censed the same year in
Ohio, and in 1907 was
licensed also by the Wisconsin State Board.
After serving as an intern and later as a resi-
dent in medicine at the Cincinnati General Hos-
pital, he engaged in general practice in Cincinnati
until 1917.
In that year he began a year of graduate
study in urology at Johns Hopkins Medical Col-
lege and was assistant in urology at The Brady
Urological Clinic, Johns Hopkins Hospital, from
1918 until 1921. During this time, under a
grant from the U. S. Department of the Interior
Hygiene Board, he collaborated in the production
and its presentation to the medical profession
of Mercurochrome.
From 1921 to the present time, Dr. Sw^artz
has continued his practice in Cincinnati, limiting
his work to genito-urinary surgery. He has
contributed many articles to medical literature.
Dr. Swartz served as president of the Cin-
cinnati Academy of Medicine for the term
1939-40. He served as Councilor for the First
District from 1943 until 1949, and is serving
as an alternate delegate to the American Medi-
cal Association. He has served on a number
of committees of the Association, among which
were the Committee on Public Relations and
Economics, the Committee on Industrial Health,
the Committee on Poor Relief, and the Auditing
and Appropriations Committee of which he was
chairman.
Dr. Swartz is assistant professor of surgery,
Department of Urology, University of Cincinnati
College of Medicine and is attending urologist at
Cincinnati General Hospital, Children’s Hospital,
Christ Hospital and Deaconess Hospital, and is
past-director and senior attending urologist at
Jewish Hospital and Bethesda Hospital.
He was a member of the Coordinating Com-
mittee of the Cincinnati Public Health Federa-
tion. Other affiliations include membership in
the American Urological Association, fellow-
ship in the American College of Surgeons and
recognition as a diplomate of the American
Board of Urology.
Civic and fraternal activities include mem-
berships in several Masonic orders including
the Consistory and Shrine, Nu Sigma Nu, the
Cincinnati Club, the University Club, the Travel
Club, Pelee Club, the Cincinnati Automobile
Club and the Baptist Church. Dr. and Mrs.
Swartz have one son, Dr. William T. Swartz.
FIFTH DISTRICT COUNCILOR
Dr. Charles L. Hudson of Cleveland was
elected by the House of Delegates as Councilor
for the Fifth District, succeeding Dr. Fred W.
Dixon, the new president-elect of the Association.
Dr. Hudson was born in Merrill, Michigan, on
August 5, 1904. He completed his preparatory
education at Saginaw High School and received
his AB degree from Alma College. He was
graduated as Doctor of Medicine from the Uni-
versity of Michigan in 1930.
He was intern and
assistant resident on the
medical service of Lake-
side Hospital, Cleveland,
following which for two
years he was a research
fellow at the University
of Pennsylvania under
Dr. A. N. Richards do-
ing research in kidney
physiology. He was next
chief medical resident
at University Hospitals,
Cleveland, and has been
associated with Univer-
sity Hospitals and Western Reserve University
since that time.
Dr. Hudson served as a Major in World War
II with the 36th General Hospital in North
Africa, Italy and France. He was separated
from active service as a Lieutenant Colonel.
He is a member of Nu Sigma Nu, Phi Kappa
Phi, Galens, Alpha Omega Alpha, American
Federation for Clinical Research, American
Medical Association, and is a diplomate of the
American Board of Internal Medicine. He is
C. L. HUDSON. M. D.
for July, 1950
693
Associate Director of Western Reserve Uni-
versity Student Health Service, senior clinical
instructor in Medicine at Western Reserve Uni-
versity and a member of the visiting staff of
University Hospitals and Crile Veterans Admin-
istration Hospital. He practices internal medi-
cine in Cleveland where he is a director of the
Academy of Medicine.
Dr. and Mrs. Hudson have three children and
live in Shaker Heights. His hobby is choral
singing with the Hermit Club of Cleveland.
PAST-PRESIDENT
Dr. Carl A. Lincke, Carrollton, as immediate
Past-President will continue to serve on The
Council for another year, succeeding Dr. A. A.
Brindley, Toledo, in that office.
COUNCILORS REELECTED
Councilors reelected for additional two-year
terms are:
Dr. David W. Heusinkveld, Cincinnati, Coun-
cilor of the First District. Dr. Heusinkveld was
elected to that office in 1949 to fill the one-year
unexpired term of Dr. Swartz.
Dr. J. Craig Bowman, Upper Sandusky, Coun-
J. C. BOWMAN, M. D.
D. W. HEUSINKVELD. M. D.
J. P. McAFEE, M. D.
R. J. FOSTER, M. D.
Ninth District. Dr. McAfee was elected to that
office in 1948.
Dr. John S. Hattery, Mansfield, Councilor of
the Eleventh District.
Dr. Hattery was elected
to that office in 1948.
J. S. HATTERY, M. D.
Councilors in the midst
of two-year terms are:
Dr. Merrill D. Prugh,
Dayton, Second District;
Dr. Carll S. Mundy, Tol-
edo, Fourth District; Dr.
Paul A. Davis, Akron,
Sixth District; Dr. Ches-
ter P. Swett, Lancaster,
Eighth District; and Dr.
H. M. Clodfelter, Colum-
bus, Tenth District.
Dr. H. P. Worstell, Columbus, was reelected
in 1949 for an additional three-year term as
treasurer.
MID-TERM OFFICERS
Legion Commander Adds Warning On
Left Turns to Communism
National Commander George N. Craig of the
American Legion said in an address in Chicago
recently that “compulsory health insurance —
political medicine — is bad medicine for America.”
“If some of the crackpot do-gooders should
have their way,” he said, “they eventually would
communize America. They tell us in honeyed
words that more concentrated government con-
trol of everything will do something for us.
They don’t tell us what it would do to us.”
The Legion chief spoke at the Silver Anniver-
sary banquet of the Chicago Accident and Health
Association. A group from the American Medi-
cal Association attended. Seated at the A. M. A.
table were: President Ernest E. Irons, Tom
Hendricks, Dr. Ernest B. Howard, Howard
Brower, Dr. J. J. Moore, John L. Bach, and
Walter McLaughlin and W. F. Mitchell of
Whitaker & Baxter.
Commander Craig said that on two different
occasions the American Legion had gone on
record as opposed to a compulsory sickness
insurance program.
“That,” he said, “should leave no doubt that
you and we stand on common ground — fighting
a common enemy — socialism, the advance guard
of communism.
cilor of the Third District. Dr. Bowman was
elected Councilor in 1946 and reelected in 1948.
Dr. R. J. Foster, New Philadelphia, Councilor
of the Seventh District. Dr. Foster was elected
to that office in 1948.
Dr. J. P. McAfee, Portsmouth, Councilor of the
“On the great American highway we have ap-
proached an intersection, at which is a bold
warning sign — No Left Turn.
“And too many of our people are mentally
indulging in the old wisecrack that they don’t
believe in signs.”
694
The Ohio State Medical Journal
• • •
Annual Meeting Review
Streamlined Scientific Program, Large Number of Exhibits, Banquet,
Other Features, Combine To Make Cleveland Session Most Successful
FOLLOWING the trend of postwar meetings
toward increasing attendance, the 1950 An-
nual Meeting of the Association in Cleve-
land set another all-time record. The previous
record attendance of 2,608 persons established
last year in Columbus was exceeded by 424.
The number of persons who registered was
3,032. A breakdown of the registration is given
on page 701 of this issue.
PROGRAM FEATURES
A streamlined scientific program was used at
the 1950 meeting — condensing into less than three
days 13 lectures, six discussion periods on Medi-
cal Topics of the Day, 14 Instructional Courses
and other features of medical educational value
to doctors.
All scientific sessions were well attended. The
general sessions drew as many as 400 and more
doctors per session. Between 250 and 300 was
perhaps an average. Instructional Courses,
where informality was the rule, were attended
by between 50 and 85 doctors per course. The
sessions on Medical Topics of the Day ranged
in attendance from approximately 100 to
approximately 240 doctors.
The general session on National Affairs at
which Dr. George F. Lull, secretary and general
manager of the A. M. A., spoke, and at which
a recording of an address by the Honorable Rob-
ert A. Taft was heard by the audience, was the
best attended of all meetings. The auditorium
which seats approximately 1,350 was filled almost
to capacity. Senator Taft had to cancel his
speaking engagement the morning of the session
because of the illness of Mrs. Taft.
THE COUNCIL AND HOUSE OF DELEGATES
The Council met in regular session on Monday,
May 15, on the eve of the Annual Meeting.
Proceedings of the business transacted at this
meeting are reported elsewhere in this issue.
A special meeting of The Council was called by
the Incoming President immediately after the
final meeting of the House of Delegates. Min-
utes of this meeting, which has to do principally
with appointments of committee members, is
contained in the Proceedings of The Council.
The House of Delegates held its first meeting
on Tuesday morning, May 16, with luncheon
at the Cleveland Hotel. The final meeting was
held in the same hotel on Thursday, May 18.
Proceedings of these meetings in which are
established policies of the Association are re-
corded in the article, Proceedings of the House
of Delegates, which will be found elsewhere in
this issue.
Election of officers, a function of the House
of Delegates, will be found in the minutes of the
House of Delegates, while biographical data
on the new officers will be found in a special
article beginning on page 692.
THE BANQUET
The annual banquet on Wednesday night,
in the midst of a concentrated scientific and busi-
ness program, furnished a refreshing evening
for members and their guests. The dinner, fol-
lowed by an evening of entertainment and danc-
ing, was held in the ballroom of the Hotel Cleve-
land. Approximately 500 persons enjoyed this
event. Entertainment wras in the form of a
variety show.
During the banquet Dr. A. A. Brindley, past-
president, presented Dr. Carl A. Lincke, retiring
president, with a replica of the official gavel used
during his year in office.
PUBLIC RELATIONS
In addition to notices sent out from the
Headquarters Office, the public press and radio
stations cooperated very well in furnishing the
public with information about the meeting and
its many activities. The Association’s Public
Relations Department through advance releases
and by special announcements as the meeting de-
veloped kept the public informed.
The meeting was especially well covered by
special medical and health reporters for the
local newspapers. Severino P. Severino of the
Cleveland News, Walter Lerch of the Cleveland
Press, and Mrs. Josephine Robertson of the
Cleveland Plain Dealer, each covered many fea-
tures of the meeting and wrote special articles.
Dr. George F. Lull, secretary and general man-
ager of the A. M. A., was interviewed on a tele-
vision news program over Station WNBK by
Edward Wallace, well-known Cleveland news
commentator and former foreign correspondent
for NBC. The subject of discussion was the
educational program of the medical profession
against compulsory health insurance and other
forms of socialized medicine.
Mr. George H. Saville, public relations director
for the Association, gave a daily roundup of the
program for rebroadcast over Station WJMO at
6:20 p. m. each day. Mr. Saville gave these
reports over the telephone to the studio where
they were recorded. The rebroadcasts formed
for July, 1950
695
Some of the High Spots at Annual Meeting
ttt.Sui, Ok<X>
1. Dr. Arthur T. Evans (left), one of the sponsors, exp’ains phases of the first prize scientific exhibit, “Translumbar
Arteriography.”
2. Dr. George F. Lull (left), secretary and general ma-sa^er of the A. M. A., and Dr. C. C. Sherburne, Columbus,
pause before the Association’s booth in a tour of the exhibit hall.
3. Dr. Fred W. Dixon (facing camera), shows specimens of his exhibit “Nasal Sinuses” which won second place.
4. Dr. Earl D. McCallister (right), secretary-treasurer of the Ohio Academy of General Practice, assisted by Mrs.
Ruth Hukill, discuss matters with a visiting doctor in the Academy’s booth.
5. Retiring President Carl A. Lincke passes the gavel to Incoming President E. O. Swartz.
6. This capacity crowd heard Dr. Lull as he spoke on “Your A. M. A. and Its Activities.”
696
The Ohio State Medical Journal
Camera Catches a Few of Many Activities
7. Dr. Karl P. Klassen (right) and Dr. Douglas R. Mor ~n (third from left) explain exhibit “The Surgical Manage-
ment of Intrathoracic Abnormalities of the Newborn,” which von third place.
8. Dr. Sherburne (right) escorts President-Elect Fred W. Dixon to the stand after his election by the House of
Delegates. At left is retiring president. Dr. Lincke.
9. Dr. Lincke is shown as he delivered the “President’s Address.”
10. This group from Toledo enjoy a social moment betwe ;n dances after Annual Banquet.
11. Mrs. Ora Winzenreid of the Columbus Headquarters Office, is showing a visitor campaign literature. Such
“ammunition” is always available through the Columbus Office.
12. This booth sponsored by the Toledo Academy of Medi ine shows what that Academy is doing to publicize its
emergency call service.
13. Dancing was enjoyed by many following the Banquet and special entertainment features.
for July, 1950
697
part of the program conducted by Bill Kennedy,
newscaster.
SCIENTIFIC EXHIBITS
One of the best arrays of scientific exhibits
ever seen at an Annual Meeting was on hand
for doctors. There was a total of 37 of these ex-
hibits, each representing a special project in
medical research developed by a doctor or team
of doctors.
Dr. Charles L. Hudson, Cleveland, chairman of
the subcommittee on scientific exhibits, was
highly commended in behalf of himself and his
committee for the untiring work exerted in ar-
ranging the educational feature.
AWARD WINNERS
Prize winning awards in the form of certifi-
cates of recognition for outstanding scientific
exhibits were made again this year, by an
anonymous committee appointed by the President.
The committee named a first, second and third
place exhibit and also gave honorable mention
to a fourth exhibit. The winning exhibits were:
First Place — The exhibit on “Translumbar
Arteriography,” sponsored by Dr. Parke G.
Smith, Dr. T. W. Rush and Dr. Arthur T. Evans,
all of the Division of Urology, University of
Cincinnati College of Medicine.
Second Place — The exhibit on “Nasal Sinuses,”
sponsored by Dr. Fred W. Dixon, Department of
Otolaryngology, Western Reserve University
School of Medicine, Cleveland.
Third Place — The exhibit on “The Surgical
Management of Intrathoracic Abnormalities of
the Newborn,” sponsored by Dr. Karl P. Klassen
and Dr. Douglas R. Morton, Department of Re-
search Surgery, Ohio State University College
of Medicine, Columbus.
Honorable Mention — The exhibit on “Fluoro-
scopic Spot-Film Technique in Cholecystography,”
sponsored by Dr. Mortimer Lubert and Dr.
George Krause, Department of Radiology, Mount
Sinai Hospital, Cleveland.
The winning exhibits were recognized by a
plaque placed in the respective booths and by
a certificate sent out from the Headquarters
Office.
There were 37 scientific exhibits at the meet-
ing, all of which drew a great deal of in-
terest from visiting doctors.
TECHNICAL EXHIBITS
A large and most interesting display of techni-
cal exhibits was presented. The commercial ex-
hibits were in the Main Arena of the Cleveland
Public Auditorium. Time was allowed between
scientific sessions for doctors to visit these ex-
hibits and gain much information on what is on
the market in the way of pharmaceuticals,
equipment, instruments and other supplies used
by the medical profession. The Auditorium was
an ideal place for the exhibits with ample room
for doctors to visit with representatives of the
supply houses.
HIGH LIGHTS AND SIDE LIGHTS
Dr. Herbert B. Wright, president of the Cleve-
land Academy of Medicine, representing the host
organization, officially opened the meeting of the
House of Delegates and welcomed visiting doc-
tors to Cleveland.
* * *
The Council adjourned to meet on Friday,
Saturday and Sunday, September 15-17, at the
Granville Inn. This extended meeting is sched-
uled to take care of a very heavy docket which
always accumulates over the summer months.
The Annual Meeting of the Woman’s Auxiliary
to the Ohio State Medical Association was held
at the Hotel Cleveland, concurrently with the
Association’s meeting. Officers and represen-
tatives of County Auxiliaries reported another
successful season. Complete report of the meet-
ing will be found elsewhere in this issue.
* * *
Dr. Harry V. Paryzek, general chairman of
the Cleveland Committee for the Annual Meet-
ing, was unable to be present at the meeting
because of illness.
* ❖ *
Dr. Carroll C. Dundon, chairman of the Com-
mittee on Halls and Meeting Places, among
other things arranged to have a reception com-
mittee at the door of each meeting place for
every meeting. These consisted of interns and
residents of local hospitals.
^ ^ ^
Dr. G. W. Crile, Jr., chairman of the Reception
Committee, arranged to have a member of the
committee meet and help entertain each guest
speaker on the program. This did much to make
the out-of-state speakers feel right at home
during their stay in Cleveland.
The entire regular staff of the Columbus
Headquarters Office was at the Annual Meeting
helping to attend the many behind-the-scenes
details which make such a large meeting run
smoothly. Registration was handled by the
staff with the help of personnel furnished by
the Cleveland Convention Bureau.
sj:
The Cleveland Academy of Medicine operated
an emergency call service for doctors attending
the meeting. Emergency calls were handled by
bulletin board announcements and page service.
:f: sfc
A public address system with loudspeakers
in the Main Area helped much in announcing
sessions, relaying emergency calls and giving
other announcements.
698
The Ohio State Medical Journal
National Affairs . . .
Senator Taft in Re-broadcast Address Knocks Proposals on Socialized
Medicine; Dr. Lull Tells What A. M. A. Is Doing On National Scene
DOCTORS who attended the Annual Meet-
ing had the opportunity of hearing the
Honorable Robert A. Taft’s sentiments on
Socialized Medicine even though the Senator was
unable to be present to deliver his scheduled
address because of pressing legislative matters
coupled with the sudden illness of his wife.
He was scheduled to speak on “Progress in
Medical Care.” Fortunately a recording of the
address Senator Taft had given the previous
evening over a nation-wide hookup was obtained
and was rebroadcast over the public address
system for listening doctors. Because Senator
Taft touched heavily upon the subject of so-
cialized medicine in his address, it was particu-
larly appropriate for the occasion.
Senator Taft’s talk was a challenging answer
to speeches made by the President on his tour
of the Nation. Mr. Taft had this to say about
the proposed national medical program:
SOCIALIZED MEDICINE
“Then we have the program of socialized and
nationalized medicine on which the President is
treading pretty lightly on this trip. But he
has heretofore endorsed it three times enthusi-
astically, and we can assume that if he ever gets
a Congress which will do his bidding and that
of the C. I. 0. - P. A. C. he will return to his first
love. He proposed that we levy for this purpose
another six billion dollars of taxes, set up a vast
Federal bureau to employ all the doctors and
all the hospitals in the United States to give
medical care to 150,000,000 people, including all
those who are perfectly able to pay for it
themselves.
“It would destroy, of course, the freedom of
the medical profession and supersede entirely the
tremendous system of community and charitable
health service which has given this country the
best health of any comparable country in the
world.
“Do you want a Congress that will go out
and spend that six billion dollars more?”
GOOSE STEP MEDICINE
Again Ohio’s Senior Senator warned what
would be in store if socialized medicine were
voted into existence. “Under the medical plan,
every family must be told by detailed regulation
just what kind of medical service it can get
and what it can’t get. Mr. Truman attacked
the Eightieth Congress because it refused to
give him power to fix prices and fix wages and
allocate and ration commodities, all the old
O. P. A. powers of wartime — ‘police state con-
trols,’ he called them himself . . .
“We believe that hardship and poverty can be
eliminated in America without extending Govern-
ment welfare service and regulation to the entire
population,” Senator Taft continued, “for such
universal free service can bankrupt the Govern-
ment wdiile it destroys the freedom and the char-
acter of the people to whom it is extended.
“If we hope to progress in the future as we
have in the past, we can only do so if we elect a
free Congress, one which will carry out on its
own independent initiative a program of progress
based on the principles of liberty and justice and
equality on which this nation was founded.”
REPUBLICAN PLATFORM
Senator Taft assured that a Republican
Congress will “back up Mr. Truman or any
other President in his foreign policy, as far
as they stand four square against the spread
of communism anywhere in the world. It
will welcome any efforts toward peace which
he deems to be practical by direct negotia-
tions with the Russian 'leaders. It will pro-
vide an all-powerful armed force for the
United States. It will insist on elimination
from Government, and particularly from the
State Department policy-making group, of every
man who thinks that communism has about it
any of the elements of true Americanism.”
In denouncing what he termed “the political
immorality” of the present administration, Sen-
ator Taft said: “What is the program as shown
by the speeches (of Mr. Truman) of this past
week? A part of it, of course, is just irrespon-
sible promising.”
DR. LULL
Dr. George F. Lull, secretary and general man-
ager of the A. M. A., keynoted the effect of the
medical profession’s educational program when
he said that Federal Security Administrator
Oscar Ewing and other promoters of the Na-
tional Compulsory Health Insurance program are
“worried as hell.”
The National Affairs program at which Dr.
Lull spoke and the rebroadcast of Senator Taft’s
address was heard, was attended by approxi-
mately 1,100 doctors. Dr. Lull spoke on the
subject, “Your A. M. A. and Its Activities.”
His conclusions on the apprehensions of
“Welfare Oscar,” as the speaker called him, were
based partly on experiences at a Jefferson Jubilee
celebration staged in Chicago by Democratic
for July, 1950
699
bigwigs. During this celebration, Administrator
Ewing staged what he called a panel discussion
on government health insurance. However, Dr.
Lull pointed out, this turned out to be nothing
more than a big rally by Democratic national
committeemen for socialized medicine.
Almost the entire session, Dr. Lull said, was
taken up with vicious and insulting attacks on
the A. M. A., although he and other represen-
tatives of the medical profession were not per-
mitted to answer the accusations.
Supporting speakers included Representative
Andrew J. Biemiller, Milwaukee; Nelson Cruik-
shank, director of the A. F. L. social insurance
activities; and Dr. Theodore M. Sanders of New
York; all well-known supporters of the admin-
istration’s welfare program.
“It was supposed to be an open panel,” Dr.
Lull said, “but the supporting speakers were
‘the same old crew.’
“I never saw such pain as there was on the
face of Dr. Paul R. Hawley (director of the
American College of Surgeons). It was absurd
to have to sit there and not be able to speak
for your cause.” Finally he and other represen-
tatives of the medical profession walked out, Dr.
Lull said.
“They tried to influence people to believe that
the country’s health is in a terrible state, but if
you read Mr. Ewing’s own statistics you will see
that this Nation has better health than any
other.” Oscar Ewing, the speaker said, is bitter
about the A. M. A. because it prevented him
from becoming a cabinet officer by defeating his
Reorganization Plan No. X.
OTHER ACTIVITIES
Dr. Lull pointed out that the educational pro-
gram to further voluntary health insurance and
combat government control of medicine is only
one phase of the A. M. A.’s many activities.
The speaker then reviewed some of the ac-
tivities, high lighting such projects as the peri-
odic examination of medical schools; expansion
of the Washington office; publication of the
Quarterly Cumulative Index, a vital factor in
medical research; publication of Today's Health
for the education of the lay public.
‘UNTIRING WORK’
As an example of the work in behalf of medi-
cine being carried on by the many councils, com-
mittees and bureaus of the A. M. A., Dr. Lull
commended the efforts of Ohio’s late Dr. Roscoe
G. Leland, for many years director of the Bureau
of Medical Economic Research. “Dr. Leland was
a casualty of the War,” Dr. Lull said, adding that
his untiring work and long hours during the
war constituted the underlying cause of his
untimely death.
At present, the speaker said, the Bureau of
Medical Economic Research is working with the
Brookings Institute in making a survey of medi-
cal services throughout the Nation. He predicted
that the results of the survey would show that
98 per cent of the accusations of the New Deal
administration about the shortage of medical
care are not true. The A. M. A. is aware that
there are shortages of medical care in some
places, Dr. Lull said, but, he added, it is also
true that in these same places there are equal
shortages of other economic factors that are
considered necessary to maintain standards of
living.
Dr. Lull warned about “fringe legislation.”
Now that the medical profession and the public
are alerted, he said, the advocates of socialized
medicine probably will not try to put over their
program in one package. But they will try to
put it over little by little. As an example he
pointed to the school health program which in
itself is a good thing. But, he pointed out, the
A. M. A. objects to the bill in its present form
because it provides for free medical examinations
to all children regardless of the ability of their
families to pay. That provision is a form of
socialized medicine, he said.
Regional Meeting, American
College of Physicians
On November 18, 1950, the American College
of Physicians North Central Regional Meeting
will be held in Madison, Wisconsin. Registra-
tion will begin at 8:00 a. m. and the meeting
will consist of a series of scientific papers
presented throughout the day. A scientific ex-
hibit of wide general interest is planned in
connection with the meeting.
It is to be especially noted that this post-
graduate instructional session is open to all in-
terested physicians whether or not they are
members of the American College of Physicians.
Members of the College are urged to bring along
their colleagues as guests.
Dr. Alexander Brunschwig, Memorial Hos-
pital, New York, was guest speaker at the
May 11 meeting of the Fort Steuben Academy of
Medicine. His subject was “Recent Advances
of Surgical Treatment for the Recurrent Cancer
of the Uterus After Radiation Treatment.” Dr.
Joseph A. Hepp, University of Pittsburgh,
opened discussion on Dr. Brunschwig’s paper.
The Cincinnati Medical Women’s Club, Branch
11, A. M. W. A., held its May 23 meeting at the
Hyde Park Country Club with seven senior
women medical students of the University of
Cincinnati College of Medicine as guests. Dr.
Mabel Gardner, Middletown, spoke on the sub-
ject, “Quo Vadis?” Twenty persons attended
the meeting.
700
The Ohio State Medical Journal
Annual Meeting Again Sets Record . . .
All-Time High in Total Attendance and Number of Members Present
Is Established at Cleveland; Names of Members Present Reported
AGAIN this year an all-time record for at-
tendance was set at the 1950 Annual Meet-
ing of the Ohio State Medical Association
held in Cleveland, May 16-18.
The record applied to number of members as
well as to total attendance. The total number
present was 3,032 with the following breakdown:
Members, 1,587; out-of-state physicians, 13; in-
terns, residents and Ohio guest physicians, 247;
medical students, 102; exhibitors, 376; Woman’s
Auxiliary, 293; miscellaneous guests, 414.
Following are registration figures for the
Annual Meetings held from 1919 through 1950;
also a breakdown of membership registration by
counties, and a list of names of members who
registered.
Registration, 1950 Annual Meeting by Counties
and Membership Data
County
Total Membership
Dec. 31, 1949 May 15,
Annual Meeting
1950 Registration
Adams ..
8
8
2
Allen
89
89
13
Ashland
26
26
9
Ashtabula
51
52
12
Athens
34
30
3
Auglaize
16
18
4
Belmont . ...
- 50
51
7
Brown
5
8
1
Butler
121
117
11
Carroll
9
9
5
Champaign
19
19
3
Clark
109
112
11
Clermont
26
26
3
Clinton
19
18
5
Columbiana
68
66
17
Coshocton
22
23
7
Crawford
32
32
12
Cuyahoga
1,657
1,597
588
Darke
23
26
3
Defiance
15
16
2
Delaware
19
20
2
Erie
42
48
13
Fairfield
42
45
9
Fayette
12
10
4
Franklin
658
655
99
Fulton
18
19
1
Gallia ....
21
19
2
Geauga
12
12
4
Greene
37
36
3
Guernsey
27
25
2
Hamilton
954
947
52
Hancock
38
37
8
Hardin -
28
26
2
Harrison
12
10
3
Henry
11
11
1
Highland
22
20
8
Hocking
11
11
4
Holmes .
9
9
6
Huron
25
24
12
Jackson
14
14
1
Jefferson .
57
58
4
Knox —
32
31
10
Lake
35
39
20
Lawrence _ ... — .
23
23
2
Licking
56
57
15
Logan
22
23
2
Lorain ...
126
119
57
Lucas
441
439
53
Madison __
13
13
1
Mahoning
239
231
39
Marion
49
46
10
Medina .
31
29
18
Meigs . . - — -
12
11
1
Mercer
18
15
2
Total Membership Annual Meeting
County Dec. 31, 1949 May 15, 1950 Registration
Miami
.. 44
44
13
Monroe
4
4
1
Montgomery
... 385
367
38
Morgan
7
6
1
Morrow
8
8
3
Muskingum .
54
52
8
Noble
3
3
Ottawa
18
17
4=
Paulding
10
9
I
Perry
14
13
1
Pickaway
... 16
15
2
Pike
_ 9
9
1
Portage
33
31
12
Preble
... 13
13
1
Putnam
19
15
2
Richland
... 98
95
24
Ross
44
43
11
Sandusky
... 41
43
10
Scioto
69
69
12
Seneca
... 42
42
9
Shelby
18
19
2
Stark
... 267
262
76
Summit ... .
... 352
343
95
Trumbull
._ 95
97
25
Tuscarawas
... 52
51
13
Union
14
13
7
Van Wert
_. 24
19
3
Vinton .
3
2
1
Warren
... 17
16
1
Washington
30
28
3
Wayne
... 46
51
6
Williams
16
17
2
Wood
... 34
33
9
Wyandot
15
14
2
Totals
. 7,479
7,338
1,587
Annual
Meeting Registration
For
1919-1950,
Inclusive
a»
Year
Place
Members
Out-of-St;
Physician
Guests
Technical
Exhibitor;
Total
1919
Columbus
1173
10
264
92
1539
1920
Toledo
860
17
105
80
1062
1921
Columbus
1275
28
104
96
1503
1922
Cincinnati .
1066
21
184
70
1341
1923
Dayton
1117
19
202
76
1414
1924
Cleveland
1301
13
180
109
1603
1925
Columbus
1204
17
361
107
1689
1926
Toledo
903
19
120
83
1125
1927
Columbus
1320
17
286
82
1705
1928
Cincinnati
916
27
92
80
1115
1929
Cleveland
1231
15
249
124
1619
1930
Columbus
1241
13
435
86
1775
1931
Toledo
826
13
198
50
1087
1932
Dayton ...
978
2
201
45
1226
1933
Akron
858
6
160
25
1049
1934
Columbus
1069
9
410
51
1539
1935
Cincinnati
973
17
197
84
1271
1936
Cleveland
1099
14
563
137
1813
1937
Dayton ....
1103
18
366
64
1551
1938
Columbus
1330
15
619
104
2068
1939
Toledo
1056
15
271
84
1426
1940
Cincinnati
1126
26
323
114
1589
1941
Cleveland — Joint Meeting with A. M. A.
1942
Columbus
1221
13
527
119
1880
1943
Columbus
544
13
160
717
1944
Columbus
830
20
441
130
1421
1945
No Meeting
1946
Columbus
1262
23
679
157
2121
1947
Cleveland
1502
23
561
328
2414
1948
Cincinnati
1362
43
768
214
2387
1949
Columbus
1533
36
809
230
2608
1950
Cleveland
1587
13
1056
376
3032
for July , 1950
701
Members of State Association
Registered . at 1950 Meeting
Adams County — S. J. Ellison, Hazel L. Sproull.
Allen County — Walter C. Beery, Margaret E.
Belt, F. P. Berlin, K. G. Hawver, Charles H.
Leech, W. B. Light, Walter A. Noble, J. S.
Novello, F. D. Rodabaugh, H. L. Stelzer, Roger
L. Tecklenberg, H. A. Thomas, Edward B. Young.
Ashland County — Eldred L. Clem, R. J. Fergu-
son, G. Delsher Fridline, Herman M. Gunn, Paul
Kellogg, Harold V. Marley, Glenn Paisley, L. G.
Sheets, Wayne C. Smith.
Ashtabula County — C. E. Case, P. J. Collander,
A. A. DeCato, J. Frank Docherty, H. R. Graves,
M. R. Martin, Wm. J. McCarthy, Adelbert M.
Mills, Clyde C. Roller, Lewis H. Roth, Robert E.
Stoops, Robert J. Zimmerman.
Athens County — M. H. Mitchell, Beatrice L.
Postle, C. N. Sanders.
Auglaize County — Clyde W. Berry, E. F. Heff-
ner, E. Y. Kuffner, Guy E. Noble.
Belmont County — L. D. Covert, David Danen-
berg, C. J. Holley, Peter Lancione, Lewis Liggett,
R. H. McCommon, H. H. Murphy.
Brown County — Glenn S. Lamkin.
Butler County — C. T. Atkinson, Fred Brosius,
Ross A. Hill, W. F. Hume, Wm. R. Jacobs, Henry
A. Long, H. S. Murat, Walter H. Roehll, Louis
H. Skimming, Clyde I. Stafford, P. B. Zollett.
Carroll County — Thomas J. Atchison, Glenn C.
Dowell, Carl A. Lincke, W. G. Lyle, Jos. D.
Stores.
Champaign County — Harold Carter, D. C.
Houser, Forrest E. Lowry.
Clark County — Frank Anzinger, Jr., George P.
Fitzgerald, Jr., E. P. Greenawalt, Howard H.
Ingling, Edward W. Keefer, John D. LeFevre,
W. H. Miller, Lillian M. Posch, E. W. Schilke,
Ray M. Turner, S. C. Yinger.
Clermont County — A. A. Gruber, Geo. E. Rock-
well, Charles M. Simmons.
Clinton County — H. R. Bath, Kelley Hale,
Arthur F. Lippert, Robert E. Suer, E. K. Yantes.
Columbiana County — Paul H. Beaver, Lea A.
Cobbs, John A. Frazer, Edith Gilmore, William
L. Gilmore, Milton M. Gottlieb, R. T. Holzbach,
Harold F. Hoprich, William J. Horger, L. W.
King, C. R. Kreutzer, C. J. Lehwald, Frank M.
Lindsay, E. C. Louthan, Samuel Rich, Ralph J.
Starbuck, Milton Wolpert.
Coshocton County — W. R. Agricola, J. C.
Briner, Floyd W. Craig, R. E. Hopkins, Paul S.
LaFollette, H. H. Schwindt, J. G. Smailes.
Crawford County — Jack W. Arnold, K. H.
Barth, D. D. Bibler, Mart L. Helfrich, M. M.
Horowitz, Carl J. Ide, John M. Kidd, John S.
Kiess, Bernard M. Mansfield, Theodore D. Saw-
yer, Malcolm E. Switzer, Donald R. Wenner.
Cuyahoga County — B. Abrams, Harold J.
Abrams, S. M. Adams, Wendell W. Adams, Fred
Adelstein, R. P. Albaugh, Frank 0. Albel, F. W.
Alexander, D. G. Allen, Maurice L. Allen, Hugh
Amos, Gilbert I. Anderson, Hugh R. Anderson,
John P. Anderson, F. W. Andreas, A. R. Andrisek,
Joseph G. Arday, Abraham Arons, Lawrence N.
Atlas.
R. V. Bachman, Daniel W. Badal, Arthur Baer,
N. S. Banker, Alfred K. Bard, Ha: old J. Barker,
A. M. Barkoukis, William R. Barney, Walter M.
Barth, Garry G. Bassett, J. D. Battle, Jr., Ed-
ward E. Bauman, G. I. Bauman, L. 0. Baum-
gardner, S. Baumoel, A. J. Beams, Claude S. Beck,
Charles S. Becker, Richard P. Bell, Jr., Richard
P. Bell, Robert V. Beltz, David G. Benjamin, A.
E. Bennett, Charles Bems.
S. L. Bernstein, J. J. Barry, James F. Berwald,
Irving Besserglick, Stacey A. Besst, Aretas E.
Biddinger, Harold B. Bilsky, C. A. Black, J.
Montgomery Black, Otto W. Blum, J. J. Boldizar,
Wm. H. Bond, T. H. Borland, W. F. Boukalik,
Robert E. Bowman, A. V. Boysen, Don D.
Brannan, E. J. Braun, Samuel Braun, Bernard
P. Bresin, Melvin Brody, A. S. Broglio, Joseph E.
Brown, Kent L. Brown, Francis L. Browning,
Herschel L. Browns, Carl N. Brudzynski, A. B.
Bruner, Jacob L. Bubis, John H. Budd, Simon
Bunin, A. T. Bunts, Charles W. Burhans, H. F.
Burkons, Arthur E. Burns.
A. Elizabeth Cannon, C. J. Carothers, Fred G.
Carter, Frank A. Catalano, Lewis Chalfin, Wilson
S. Chamberlain, David A. Chambers, L. L. Chand-
ler, Benjamin Chavinson, Paul Chrenka, H. E.
Christman, H. D. Clapp, Carroll J. Clark, Frank
H. Clark, Harold N. Cole, Jr., John W. Con-
well, T. H. Copeland, E. P. Coppedge, E. Peter
Coppedge, A. C. Corcoran, Samuel B. Cowen,
Reynold M. Crane, E. H. Crawfis, Henry A. Craw-
ford, George Crile, Jr., Paul C. Crone, Joseph
A. Crowley, Clyde L. Cummer, Earl D. Cumming,
H. G. Curtis.
James B. Daley, Donald C. Darrah, Homer T.
Daus, Leslie S. Dean, Robert S. Dean, Helmut M.
Dehn, Leon H. Dembo, E. B. Depp, Stanley N.
P. Deville, Ralph S. Dial, Robert J. Dial, R. H.
Dickinson, John H. Dingle, A. L. Dippel, Fred
W. Dixon, E. G. Dolch, Matt. T. Donahue, Ger-
trude C. Donnelly, V. H. Dredge, William Drey-
fuss, James R. Driver, William Dumeyer, Theo-
dore G. Duncan, Carroll C. Dundon, Walter W.
F. Dyckes, H. H. Dyson.
Milton T. Ebner, E. P. Edwards, Donald B.
Effler, Donald E. Eiber, Robert M. Eiben, Eduard
Eichner, M. L. Eigenfeld, I. H. Einsel, Thos.
H. Einsel, Oliver Eitzen, Richard A. Elmer,
Elizabeth T. Endicott, Walter A. Engel, Wm. J.
Engel, H. H. Englander, N. J. Epstein, A. Carl-
ton Ernstene, Ryan P. Estes, Armen G. Evans,
F. Graham Fallon, Warren C. Fargo, N. L.
Farnacy, Harold Feil, Stanley L. Feldman, Joseph
L. Fetterman, Sidney Feuer, J. A. Filak, Ralnh
J. Fintz, Ida E. Fleming, S. J. Foerstner, G. K.
Folger, J. J. Folin, S. T. Forsythe, Wm, E.
Forsythe, Ralph J. Frackelton, Jerome S. Frankel,
Alex N. Freed, Marvin S. Freeman, Ralph I.
Fried, Alvin B. Friedman, Clemont J. Friedman,
Louis M. Friedman, E. C. Froelich, R. M.
Fullerton.
Shelby G. Gamble, Francis J. Gannon, W.
James Gardner, J. B. Garlin, Chas. H. Garvin,
Curtis F. Garvin, James A. Gavin, F. V. Geiss,
Aladar Gelehrter, E. A. George, Thomas H.
George, Frank P. Geraci, M. C. Geraci, S. R.
Gerber, A. J. Gerteis, Marion N. Gibbons, Jack
Gilford, W. G. Gilger, Reuben Gittelsohn, R. A.
Glazer, Richard P. Glove, Donald M. Glover,
Leona V. Glover, George G. Goler, Harold K.
Goler, Charles F. Good, David H. Goodman, I.
J. Goodman, Joseph I. Goodman, Maurice B.
Gordon, Paul M. Gordon, C. Lee Graber, John
J. Grady, James Gray, Jos. H. Grossman, E. J.
Gunn, H. A. Gusman.
Rita G. Hain, D. E. Hale, James E. Hallisy,
John R. Hannan, John E. Hannibal, Paul G.
Hansen, J. R. Harff, D. M. Harlor, Edward 0.
Harper, H. J. Hartzell, John R. Haserick, H. R.
Hathaway, Joe F. Hattenbach, Harry Hauser,
W. E. Hauser, Robert B. Hauver, 0. L. Hawk,
702
The Ohio State Medical Journal
Shigeki Hayashi, Joseph M. Hayman, Jiv, John
B. Hazard, Patrick F. Healey, Hugo Hecht,
Morris I. Heller, Frank H. Hendricks, T. P.
Herrick, Dorothy Hicks, Charles S. Higley, W. E.
Hill, I. M. Hinnant, Martin Hirsch, George W.
Hobson, Helena Hoelscher, Stanley 0. Hoerr,
A. C. Hoffmeister, Charles A. Holan, Robert E.
Holmberg, Ralph J. Honzik, Howard H. Hopwood,
Arthur J. Horesh, Robert M. Hosier, Charles L.
Hudson, L. F. Huffman, William L. Huffman,
C. R. Hughes, W. C. Humphries,
Harris D. Iler, H. F. Inderlied, Chester R.
Jablonoski, C. C. Roe Jackson, John Jacob, R. E.
Jenkins, Nicholas J. Johnson, Albert L. Jones,
James G. Jones, Edwin P. Jordan, F. F. Jordan,
V. Jordan.
Samuel M. Kamellin, John J. Kamesis, T. J.
Kaminski, Michael L. Kandrac, Myron F. Kan-
ter, Joseph M. Kaplan, Bernard Katz, Sidney
Katz, W. R. Katzenmeyer, James S. Kaufman,
Anna L. Kaye, Anthony J. Kazlauckas, Daniel R.
Keating, Warren S. Kelley, M. R. Kellum, Fred
R. Kelly, Edwin P. Kennedy, Gerald T. Kent,
Frank J. Kern, Saul W. Kessler, C. L. Kiehn,
Charles E. Kinney, Robert C. Kirk, Joseph Klein,
Julius Klein, Zolton L. Klein, Henry E. Klein-
henz, Leonard A. Kleinman, B. S. Kline, J. C.
Kloepfer, Harold J. Knapp, P. J. Kmieck,
Richard S. Knowlton, Lewis V. Kogut, Paul M.
Kohn, Ernest Kohner, Harry C. Konys, Saul
Kottler, Joseph Kovacs, E. S. Kozikowski, George
R. Krause, Lester W. Krauss, William Kulka.
Middleton Lambright, Jr., John S. Landes, W.
B. Landesman, Charles L. Langsam, C. G. La
Rocco, Bernard B. Larsen, Elizabeth Workman-
Lash, G. R. Laube, Lawrence Lazarus, John H.
Lazzari, Jas. T.. Ledman, W. I. LeFevre, Albert
Legow, Benjamin Levine, Albert L. Lewin,
Leonard Lewin, Chas B. Lewis, Henry A. Lichtig,
Human S. Lieberman, Louis Lieberman, Samuel
C. Lindsay, Philip Robert Linsey, Harry A.
Lipson, William J. Loeb, McKinley London, A.
C. Long, David R. Long, David Lubin, H. Lupe-
son, R. Wenner Machamer.
A. Cameron MacNiel, D. Magid, Saul H. Mak-
man, E. W. Malong, Martin M. Mandel, Louis J.
Marcus, William W. Markley, R. H. Markwith,
Boris L. Marmolya, E. A. Marshall, Robert B.
Marshall, James F. Martin, John W. Martin, Val
J. Mastny, G. J. Mateja, Robert J. McCaffery,
Joseph E. McClelland, Jane P. McCollough, E.
P. McCullagh, F. Lambert McGannon, W. H.
McGaw, Raymond C. McKay, C. F. McKhann,
Melvin P. McKinley, E. P. McNamee, Joseph Mc-
Nerney, Floyd S. Meek, Jacob Meister, F. E.
Merritt, Roy B. Metz, E. J. Michalenko, Paul A.
Mielcarek, Charles B. Miller, Max Miller, Morton
L. Miller, Anthony J. Minelli, Dean H. Minnis,
Horace E. Mitchell, Joseph L. Modic, S. H. Mon-
son. Morris Montlack, Paul G. Moore. Clarence
J. Morell, Cecelia K. Morris, Harry D. Morris,
Felix Mottek, Paul Motto, Govan A. Myers.
E. P. Neary, Chas. F. Nelson, William E.
Neville, A. D. Nichol, John H. Nichols, Emilia M.
Nitsch, Frank D. Novy, C. R. Nuckolls, Robert
H. Nuss, Frank J. O’Dea, John A. O’Hale, Em-
mett O’Malley, Hugh A. O’Neill, Carl G. Opas-
kar, J. D. Osmond, Jr., John D. Osmond, M. L.
Pardee, Oscar Pan, Edward W. Parsons, A. J.
Pasterak, L. J. Perme, Clayton C. Perry, E. W.
Peters, Rose M. Petti, George W. Petznick,
Frances E. Pickett, Carlos E. Pitkin, York N.
Pitkin, Herman D. Pocock, Jr., John K. Potter,
Walter H. Pritchard, Chas. J. Prochaska.
F. J. Rack, Karl H. Radzow, S. F. Radzy-
minski, Cora J. Randall, Albert T. Ransone,
Arthur T. Rask, John E. Rauschkolb, Margaret
R. Read, Robert A. Reading, Faith Reed, Rudolph
S. Reich, Charles H. Reinacher, Barbara O.
Remetey, R. R. Renner, James L. Reycraft, Ed-
win D. Richards, Harry H. Robinson, Ruth A.
Robishaw, H. L. Rockwood, F. J. Roemer, Ben-
jamin Root, Fred A. Rose, Chas. S. Rosen, J. G.
Rosenbaum, H. 0. Rosenberger, H. Rosenthal,
Ralph S. Rosewater, Robert S. Rosner, J. M.
Rossen, Morton A. Roth, Guy A. Rowland, V. C.
Rowland, H. J. Rubin, George W. Ryall, J. M.
Ryan.
Maurice D. Sachs, George L. Sackett, Ernest
N. Salomon, John J. Sanate, John H. Sanders, B.
B. Sankey, John W. Schauer, Ralph A. Scherz,
Albert G. Schlink, H. A. Schlink, R. T. F.
Schmidt, A. Benedict Schneider, Jr., H. Charles
Schock, I. L. Schonberg, Edmund F. Schroeder,
A. H. Schumacher, Fred J. Schuster, Edward D.
Schwartz, S. A. Schwartz, Jos. Schwartzberg, R.
W. Scott, Abraham J. Segal, Walter S. Sellars,
William Shapero, Paul Shaughnessy, Thomas A.
Shehan, M. Hickey Shelly, Harry Sherman, Mar-
vin D. Shie, R. A. Shipley, Paul R. Siegel.
Samuel R. Siegel, Ezra I. Silver, Francis F.
Silver, William Sinclair, Jr., A. E. Sitkoski, Wil-
liam S. Skaryd, Jas. F. Slowey, G. V. Smith, John
Glen Smith, John J. Smith, William Eggers
Smith, Carl Snider, Frederick A. Snyder, S. A.
Sobul, W. M. Solomon, John A. Sommer, Samuel
Spector, Lorna M. Spenzer, D. M. Spicer, David
Sprague, Wess E. Sroub, S. K. Starcke, Viola
V. Startzman, Carl A. Stas, Robert M. Stecher,
Nicholas M. Steiner, L. J. Stericki, David B.
Steuer, John Stibran, R. E. Stifel, Gordon Stone,
Willard C. Stoner, G. M. Stroud, Sam G. Stub-
bins, James J. Sunseri, L. J. Svetlik, Chas. A.
Swan, Harold R. Swan.
Victor L. Tanno, Norman W. Thiessen, A. W.
Thomas, C. I. Thomas, Harold B. Thomas, R. T.
Thomson, John J. Thornton, V. L. Tichy, Harold
P. Timberlake, George A. Tischler, Bert A.
Tresiter, Frank M. Trump, Jacob B. Tuckerman,
J. E. Tuckerman, W. H. Tuckerman, Samuel N.
Ulevitch, Abraham Unger, Rena L. Urban, J. G.
Vande Velde, H. S. Van Ordstrand, Dean C.
Varney, Frank Vecchio, W. N. Vigor, Samuel
L. Vinci, John T. Vitkus.
J. E. Wallace, C. E. Ward, C. F. Ward, J. G.
Warner, Eugene J. Weber, H. C. Weinberg,
Wm. C. Weir, Rudolf Weiss, Beulah Wells, J. B.
Whelan, R. J. Whitacre, Charles A. White, Ben
Widzer, Bessie G. Wiesstien, Clifford M. Wilcox,
Theodore M. Wille, Guy, H. Williams, Jr., Guy
H. Williams, Theodore A. Willis, Edward E.
Woldman, Victor F. Woldman, Ernest Wolff,
Isabel J. Wolfstein, Harry E. Wolk, Ralph Wol-
paw, S. E. Wolpaw, Herbert B. Wright, L. Bur-
dett Wylie, S. Yamshon, Aaron B. Yasinow, J.
J. Young, Samuel A. Young, E. A. Yurick, N.
L. Zinner.
Darke County — J. E. Gillette, Peter H. Mulder,
Gilbert Sayle.
Defiance County — G. F. Moench, D. J. Slosser.
Delaware County — W. E. Borden, A. R. Cal-
lander.
Erie County — W. T. Fenker, Herbert F. Kesin-
ger, Ross M. Knoble, D. R. Lehrer, H. G. Lehrer,
H. W. Lehrer, Emil J. Meckstroth, Charles J.
Reichenbach, Dean Sheldon, W. P. Skirball,
Harold E. Snedden, H. L. Sowash, Paul N.
Squire.
Fairfield County — R. S. Bode, C. H. Hamilton,
George F. Jones, Victor N. Kistler, Wm. D.
for July , 1950
705
Monger, S. C. Sneeringer, Chester P. Swett,
Kenneth W. Taylor, Arthur B. Van Gundy.
Fayette County — Joseph M. Herbert, J. H.
Persinger, James E. Rose, M. H. Roszmann.
Franklin County — Louise P. Ainsworth, Marion
L. Ainsworth, Charles L. Anderson, K. H. Armen,
Shirley Armstrong, Calvin L. Baker, Allan C.
Barnes, E. H. Baxter, G. H. Bonnell, Jr., R. W.
Bonnell, B. J. Brief, H. E. Brown, John E. Brown,
Jr., Maurice G. Buckles, Lewis W. Cellio, H. M.
Clodfelter, George F. Collins, George Cooperrider,
John N. Cross, Thomas R. Curran, Robert F.
Daly, Horace B. Davidson, Francis W. Davis,
M. Deckert, C. J. DeLor, C. A. Doan, J. Quinn
Dorgan, Frederick C. Finke, T. R. Fletcher,
Morris J. Fox, Clarence M. Gallagher, John P.
Garvin, J. M. Gettrost, Grant 0. Graves, Paul
E. Grimm.
George J. Hamwi, Fred B. Hapke, Charles W.
Harding, Harold K. Harris, Gabriel C. Heller,
R. J. Henry, William H. R. Howard, Thomas
M. Hughes, Hugh B. Hull, W. D. Inglis, Jay
Jacoby, R. H. Jacques, Raymond L. Jennings,
O. W. Jepsen, H. W. Karrer, Gilman D. Kirk,
R. W. Kissane, Karl P. Klassen, E. G. Klopfer,
Phillip T. Knies, Frank L. Lally, Ruskin B.
Dawyer, H. E. LeFever, Norris E. Lenahan,
Milton Levitin, Bruce E. Lindsey, James W. Long,
Sydney N. Lord, Louis Mark, Charles W. Mat-
thews, Earl D. McCallister, Chas. W. McGavran,
Paul D. Meyer, W. H. Miller, Howard R. Mitchell,
Joseph L. Morton, G. I. Nelson.
Claude S. Perry, Paul Q. Peterson, H. M.
Platter, Alexander Pollack, W. L. Potts, Dale
E. Putnam, Thomas E. Rardin, William M.
Rhodes, Frank A. Riebel, Rush Robinson, Samuel
W. Robinson, Ruth H. St. John, Edward R.
Schumacher, Wendell P. Scott, Roy J. Secrest,
C. C. Sherburne, George P. Sims, William A.
Smith, Wm. P. Smith, Jr., Walter M. Stout, P.
B. Wiltberger, Charlotte Winnemore, H. P.
Worstell, H. D. Wright, Robert E. S. Young,
Richard W. Zollinger, Maurice L. Zox.
Fulton County — Cal S. Kellogg.
Gallia County — Norvil A. Martin, Homer B.
Thomas.
Geauga County — Alton W. Behm, Isa Teed-
Cramton, Phillip P. Pease, A. David Price.
Greene County — Ray W. Barry, Paul D. Espey,
H. C. Messenger.
Guernsey County — Robert A. Ringer, Reo M.
Swan.
Hamilton County — Edward J. Bender, Joseph
B. Bolin, A. L. Brown, Albert A. Brust, Richard
D. Bryant, John B. Chewning, H. F. Conwell, A.
Harry Crum, Charles Eha, Alfred J. Elkins, Ed-
ward C. Elsey, Walter G. Engel, Joseph P.
Evans, Howard D. Fabing, Archie Fine, J. J.
Flynn, Wm. E. Froshchauer, A. S. Gardiner,
Nicholas J. Giannestras, Robert S. Green, J.
Victor Greenebaum, Paul D. Grove, Samuel
Harris, Warren Hattendorf, John W. Hauser, J.
R. Hawkins, D. W. Heusinkveld, Benjamin Hoyer,
William F. Hunting, Daniel V. Jones.
Maurice Levine, Joseph Lindner, William H.
Lippert, Kent E. Martin, James Mithoefer,
Charles H. Moore, Roland E. Nieman, George F.
Patterson, Philip Piker, J. Edwin Reed, Robert
C. Rothenberg, Eugene L. Saenger, Moses
Salzer, W. T. Shriner, Vinton E. Siler, Robert
E. Slemmer, Parke G. Smith, H. A. Springer,
Cecil Striker, E. 0. Swartz, F. William Vockell,
Carl I. Wyler.
Hancock County — Donald R. Brumley, Harold
0. Crosby, R. Grant Janes, John H. Marshall,
H. L. Selo, Dan B. Spitler, Robert E. Traul,
Frank M. Wiseley.
Hardin County — Floyd M. Elliott, A. W. Sage.
Harrison County — C. F. Goll, G. E. Henderson,
D. L. Tippett.
Henry County — Bernard L. Johnson.
Highland County — J. Martin Byers, Robert G.
Claeys, Walter Felson, C. G. Foor, Lena Holla-
day, W. M. Hoyt, Leland D. McBride, W. H.
Willson.
Hocking County — M. H. Cherrington, R. C.
Jones, Walter B. Lacock, Owen F. Yaw.
Holmes County — Clyde Bahler, A. T. Cole, A.
J. Earney, Luther W. High, Owen F. Patterson,
N. P. Stauffer.
Huron County — Randolph A. Blackman, Jay D.
Bradish, Clyde J. Cranston, Harold A. Erlenbach,
R. C. Gill, W. H. Kauffman, A. H. Kimmel, W.
W. Lawrence, 0. J. Nicholson, W. R. Roasberry,
C. B. Thomas, Thomas H. Wells.
Jackson County — Elizabeth C. Innis.
Jefferson County — Irving Dreyer, Jacob Mervis,
Howard H. Minor, W. G. Snyder.
Knox County — John L. Baube, Robert L.
Eastman, Robert H. Hoecker, George B. Imhoff,
Henry T. Lapp, 0. W. Rapp, Gordon H. Pum-
phrey, Delbert C. Schmidt, Charles B. Tramont,
J. C.. Woodland.
Lake County — George F. Barnett, T. E. Byrne,
Morris G. Carmody, Frederick J. Dineen, G. W.
Hasse, Saul I. Krasne, Alfred C. Mahan, M. L.
Matteo, Richard W. McBurney, R. Keith Miles,
Warren Payne, Maynard A. Pike, James G.
Powell, Paul E. Reading, William J. Rucker, G.
Robert Smith, Howard Stephens, Rickard S.
Toomey, Jerome Wertheimer, W. H. Willis.
Lawrence County — Thomas E. Miller, George
N. Spears.
Licking County — A. S. Burton, Gerald A. Er-
hard, George A. Gressle, James B. Johnson, Jr.,
R. G. Mannino, Raymond C. Mauger, John Fleek
Miller, Thomas E. Morgan, James K. Nealon,
Arnold D. Piatt, Ralph E. Pickett, R. G. Plum-
mer, Dale E. Roth, Arthur J. Tronstein, Robert
S. Young.
Logan County — Warren F. Mills, Donald E.
Minch.
Lorain County — Valloyd Adair, John W.
Adrain, Russell M. Arnold, Theodore Berg, Alvin
L. Berman, Stanley J. Birkbeck, R. W. Bradshaw,
R. H. Browning, W. K. Brubaker, Bernhard
Chomet, Joseph Cicerrella, John M. Cook, R. A.
DeMarco, Joseph M. DeNardi, J. R. Dickason,
Robert J. Emslie, T. E. Finegan, Marion G.
Fisher, H. P. Frankie, Franz Gruen, Louis Hait,
John E. Hertner, L. Z. Hoffer, George A. Hoke,
M. E. Kishman, M. C. Kolczun, Frank A. Law-
rence, I. L. Levin, Alfred J. Loser.
Charles W. McQuire, Chas. R. Meek, Lawrence
C. Meredith, B. C. Myers, Geo. D. Nicholas,
Homer P. Nielsen, S. D. Nielsen, R. C. Novatney,
Augustine J. Novello, John E. Pettress, Anthony
Piraino, D. A. Russell, 0. H. Schettler, R. J.
Schork, R. L. Shilling, A. C. Siddall, Leonard A.
Stack, E. J. Stanton, James T. Stephen, Jeanne
H. Stephens, Joseph M. Strong, R. A. Styblo,
N. A. Tillman, L. H. Trufant, W. H. Turner,
Kenneth H. Willard, G. R. Wiseman, Sanford L.
Zieve.
Lucas County — Warren A. Baird, N. T. Barnes,
Paul L. Bell, Albert Bershon, A. A. Brindley, P.
704
The Ohio State Medical Journal
B. Brockway, John D. Burnett, I. R. Cohn, Rudolph
Diethelm, Andrew J. Extejt, Crawford L. Felker,
David C. Frick, David L. Friedman, Will Gar-
diner, E. B. Gillette, Wendell Green, Hazen L.
Hauman, J. M. Hertzberg, J. B. Hitsch, Richard
Hotz, C. E. Hufford, I. H. Kass, Gilbert D. Keil,
T. C. Kiess, Rollin Kuebbeler, George H. Lemon,
Edouard E. Lyon.
W. Frank Maxwell, Kenneth C. McCarthy,
C. W. McNamara, H. F. Mignerey, James E.
Miller, Norman B. Muhme, Carll S. Mundy,
Eugene A. Ockuly, Frederick P. Osgood, Willis
S. Peck, Joseph A. Radecki, J. B. Rayman, A. E.
Rhoden, Maurice A. Schnitker, Max T. Schnitker,
Bert Seligman, Gregor Sido, Edward J. Singer,
John W. Smythe, W. C. Suter, Oliver E. Todd,
Robert P. Ulrich, Earl F. Ward, Albert M. Weil-
bauer, Leo Weiss, Ralph L. Zucker.
Madison County — William T. Bacon.
Mahoning County — Hubert S. Banninga, Ben
S. Brown, W. H. Bunn, Kenneth E. Camp, Sidney
L. Davidow, W. H. Evans, A. J. Fisher, James
L. Fisher, Sidney Franklin, Horace K. Giffen, V.
L. Goodwin, C. A. Gustafson, John Heberding,
Herman H. Ipp, E. E. Kirkwood, F. G. Kravec,
P. H. Leimbach, David H. Levy, W. E. Maine,
Elmer T. McCune, H. P. McGregor, Wm. L. Mer-
mis, Frances A. Miller.
R. B. Poling, Morris S. Rosenblum, Raymond
J. Scheetz, Wm. M. Skipp, Ivan C. Smith, John
H. Smith, William R. Smith, M. H. Steinberg,
J. W. Tarnapowicz, Walter J. Tims, Oscar A.
Turner, J. Clair Vance, Clyde K. Walter, Durbin
T. Yoder, W. P. Young, M. S. Zervos.
Marion County — Milton F. Axthelm, D. W.
Brickley, Timothy N. Caris, R. L. Gettman,
Robert T. Gray, J. S. Greetham, B. D. Osborn,
Warren C. Sawyer, Jack F. Smyth, Martin M.
Weinbaum.
Medina County — 0. G. Austin, John L. Beach,
E. C; Bell, E. L. Crum, J. K. Durling, W. E.
Dwyer, R. F. Fasoli, Carl J. Ferber, William G.
Halley, J. L. Jones, Andrew J. Karson, T.
Victor Kolb, Paul F. Overs, H. T. Pease, Frank
C. Reutter, Morris Wilderom, Arthur F. Wolf,
Louis S. Zwick.
Meigs County — Roger P. Daniels.
Mercer County — John Chrispin, Rudolph G.
Schmidt.
Miami County — W. N. Adkins, John F. Beach-
ler, Jr., Berton M. Hogle, E. R. Irvin, Kenneth
F. Lowry, E. G. Puterbaugh, Roland A. Reich,
Harry E. Shilling, W. W. Trostel, Hugh Well-
meier, John M. Wilkins, G. A. Woodhouse, Ralph
D. Yates.
Monroe County — J. C. Pugh.
Montgomery County — Irwin H. Altenburg,
Sterling H. Ashmun, Robert C. Austin, R. K.
Bartholomew, Roy S. Binkley, A. V. Black, Rus-
sell N. Brown, Herbert L. Brumbaugh, Orville B.
Burke, A. W. Carley, E. F. Conlogue, Sydney
Dinkin, Roscius C. Doan, R. Dean Dooley, G. L.
Erbaugh, M. R. Haley, Wm. H. Hanning, Al-
bert Hirsheimer, Mason S. Jones, P. H. Kil-
bourne, Kenneth Kurtz, Jesse P. Kuperman,
Howard Lauer, T. L. Light, W. R. Love, V. H.
Mahan, Robert C. Markey, M. B. Menke. T. E.
Newell, Neal C. Perkins, Merrill D. Prugh, L.
Everett Seyler, E. W. Shank, Paul J. Shank,
Clyde B. Simson, E. W. Smith, W. B. Taggart
Robert E. Zipf. ’
Morgan County— Mary C. Gatewood.
Morrow County— F. M. Hartsook, Joseph P.
Ingmire, F. H. Sweeney.
Muskingum County — W. B. Devine, P. H. El-
liott, A. C. Lawrence, George C. Malley, James
McCormick, Flora M. Pedicord, W. W. Renner,
Earl B. Zurbrugg.
Ottawa County — H. 0. Beeman, Gordon R. Ley,
George A. Poe, Cyrus R. Wood.
Paulding County — D. E. Farling.
Perry County — 0. D. Ball.
Pickaway County — M. D. Gamble, W. F. Heine.
Pike County — R. M. Andre.
Portage County — Myrtle V. Collins-Dineen,
Robert Dumm, Edgar A. Knowlton, Walter W.
Lang, Edward T. Meacham, Ray T. Odell, M.
S. Owen, J. M. Painter, S. B. Peters, Max
Sternlieb, Myron W. Thomas, C. C. Voorhis.
Preble County — E. P. Trittschuh.
Putnam County — H. A. Neiswander, W. B.
Recker.
Richland County — Russell H. Barnes, W. M.
Bell, P. A. Blackstone, Wallace H. Buker, Charles
0. Butner, R. D. Campbell, Darrell B. Faust,
Robert L. Garber, Charles L. Hannum, J. S.
Hattery, F. J. Heringhaus, H. G. Knierim, E.
Mainzer, Lizabeth J. Mainzer, John F. McHugh,
Robert J. Peirce, W. W. Peirce, Carl M. Quick,
Stanley C. Schiller, Charles L. Shafer, P. 0.
Staker, J. L. Stevens, Harry Wain, Ralph C.
Wise.
Ross County — Edwin H. Artman, Richard L.
Counts, Harold Crumley, John W. Franklin, L.
T. Franklin, R. P. Giesler, W. E. Kramer, A. E.
Merkle, Robert E. Swank, Adolph Wolff, G.
Howard Wood.
Sandusky County — C. M. Cooper, Chester G.
Egger, R. Allen Eyestone, C. L. Fox, John J.
Gedert, John W. Monahan, Allen P. Newman,
L. A. Pokerr, Anthony C. Rini, Richard R.
Wilson.
Scioto County — George D. Blume, Walter A.
Braunlin, Louis R. Chaboudy, Clyde W. Everett,
Wm. J. Hartlage, L. B. Hatch, A. P. Hunt, Ralph
W. Lewis, Elizabeth Long, J. P. McAfee, Oral
D. Tatje, Charles S. Vinson.
Seneca County — Henry Lyman Abbott, W. R.
Funderburg, Paul J. Leahy, E. F. Ley, Wilbur W.
Lucas, R. F. Machamer, D. J. Mariea, F. H.
Pennell, R. E. Schriner.
Shelby County — H. Eugene Crimm, John H.
Kerrigan.
Stark County — L. E. Anderson, Walter H.
Angerman, J. E. Aten, William D. Baker, Hiram
J. Bazzoli, F. P. Bennett, H. H. Bowman, A. E.
Boyles, H. H. Brueckner, Joseph J. Brumbaugh,
Roy H. Clunk, Cleon C. Couch, Florian P.
Cuthbert, John E. Dougherty, F. J. Ebstein, Wil-
liam E. Elliott, D. T. Feiman, S. J. Feingold,
L. L. Frick, Verl Z. Garster, Frank 0. Good-
nough, R. E. Hall, I. B. Hamilton, Ronald M.
Harner, Jack G. G. Hendershot, Mark G. Herbst,
Arthur G. Hyde, John Dueber Joliet, Douglass
S. King, George L. King, Wm. T. Krichbaum,
C. A. LaMont, Loyal E. Leavenworth, Karl L.
Lehmiller, Joseph J. Leven.
W. B. Malloy, John L. Maple, Joseph W.
Mason, Auren W. McConkey, Wm. A. McCrea,
J. C. McDonald, James A. McNalley, R. E.
Meacham, Ray R. Mosely, Myrl D. Musgrave,
Howard S. Myers, Keith C. Noble, Atlee R. 01m-
stead, C. 0. Paradis, Otto L. Plaut, J. Edwin
Purdy, R. K. Ramsayer, R. L. Rutledge, Raymond
for July, 1.95.0.-.;
705
T. Saxen, Frank M. Sayre, John R. Seesholtz,
William J. Slasor, L, M. Snively, John M.
Thomas, G. Otho Thompson, R. L. Thompson,
John Mt Tondra, G. D. Underwood, John J.
Underwood.
John M. Van Dyke, J. B. Walker, C. A. Wat-
son, Harry L. Weaver, Homer V. Weaver, Louis
L. Weiss, George N. Wenger, G. M. Wilcoxon,
Albert Wild, J. S. Williams, O. G. Wilson, R. E.
Wirtz.
Summit County — Paul R. Adams, Harry Anker,
P. Z. Arapakis, John Bakos, Roy Barnwell, C.
M. L. Beatty, Harry S. Berlesky, E. R. Blower,
Frank H. Bly, M. F. Bossart, John L. Brick-
wede, John D. Brumbaugh, Wendell T. Bucher,
Earl W. Burgner, Ernest J. Burrows, James T.
Cunningham, D. D. Daniels, P. A. Davis, Wil-
liam Davis, Philip B. DeMaine, Arthur Dobkin,
Frank V. Dunderman, W. H. Falor, George A.
Ferguson, A. W. Friend, Theodore V. Gerlinger,
Arnold V. Gold, Nathan G. Gordon, R. A. Gregg,
Kenneth F. Hausfeld, Sydney J. Havre, Joseph
D. Hayden, John F. Henderson, Carrie A. Herr-
ing, E. F. Hurteau.
Wendell E. James, Uffe T. Jensen, N. A.
Johnson, Roy F. Jolley, Morris Kalmon, Warren
P. Kilway, James G. Kramer, Theodore A.
Krutky, Donald E. Leonard, H. G. ,Lieberman,
C. N. Long, George A. Lucas, J. A. Masaryk,
C. T. McCormish, R. G. McCready, D. M. Mc-
Donald, L. B. Mehl, S. J. Michaels, Samuel Mil-
ler, Margaret H. Moore, H. E. Muller, B. E.
Neiswander, Carl C. Nohe.
George A. Palmer, G. K. Parke, Thayer L.
Parry, Edgar C. Pickard, Dallas Pond, George
G. Proskauer, Cecil A. Raymond, Fred K. Read,
W. R. Rechsteiner, Eleanor J. Rector, L. E.
Rector, J. G. Repasky. David J. Roberts, Fowler
B. Roberts, Wm. B. Rogers, J. Paul Sauvageot,
H. Senne, H. Vern Sharp, Louis Sheinin, Hazel
P. Simms, Robert B. Smith, E. J. Snyder, B. 0.
Sours, N. Tsaloff, Thomas E. Van Sickle, Ed-
ward L. Voke, Frank M. Warner, Karl D. Way,
Kurt Weidenthal, G. R. Wellwood, M. It. Werner,
R. E. Wetzel, Cloyd F. Wharton, Robert E. Wil-
liams, Louis A. Witzeman, H. E. Woodbury, A.
S. Zervos.
Trumbull County — Allen W. Beale, L. A. Blum,
S. A. Brown, Maynard A. Buck, J. H. Caldwell,
E. G. Caskey, Morton J. Crow, Amanto P.
D’Amore, Paul C. Gauchat, Joseph W. Kohn,
Marie B. Krupko, Paul E. Krupko, E. G. Kyle,
F. LaCamera, Chas. W. Mathias, D. R. Mathie,
R. H. McCaughtry, Henry J. Meister, Clyde W.
Muter, Paul E. Noonan, Joseph A. Ralston,
Bernard M. Schneider, S. J. Shapiro, Aubrey L.
Sparks, Robert J. Willoughby.
Tuscarawas County — James S. Adler, Jay W.
Calhoon, Clark M. Dougherty, P. T. Doughten,
D. H. Downey, Henry Engel, M. W. Everhard,
R. J. Foster, Robert B. Hines, W. E. Hudson,
M. William Johnson, Harold F. Wherley, S. H.
Winston.
Union County — Walter R. Burt, Fred Callaway*
P. D. Longbrake, Malcolm Maclvor, Evert J.
Marsh, James M. Snider, Paul R. Zaugg.
Van Wert County — J. R. Jarvis, Roy E. Shell,
H. D. Underwood.
Vinton County — H. D. Chamberlain.
Warren County — Orville L. Layman.
Washington County — F. E. Eddy, G. E. Huston,
M. S. Muskat.
Wayne County — Lyman A. Adair, E. R. Alex-
ander, Robert A. Anderson, Bernard M. Foster,
H. J. Mitchell, Vincent C. Ward.
Williams County — H. R. Mayberry, Paul G.
Meckstroth.
Wood County — Daniel R. Barr, Irvin B. Kievit,
H. W. Mannhardt, Floyd A. Nassif, Francis J.
Nemcik, Paul F. Orr, Roger A. Peatee, L. S.
Pugh, William S. Rothe.
Wyandot County — T. A. Ferguson, F. M. Smith.
Report Increase of 2,266 in
Physician Population
The net increase in the number of physicians
in the United States and its territories and
possessions in 1949 was 2,266, according to the
48th Annual Medical Licensure Report of the
American Medical Association’s Council on Medi-
cal Education and Hospitals.
The report, presented by Dr. Donald G. And-
erson, secretary of the council, and his assist-
ant, Mrs. Anne Tipner, both of Chicago, ap-
pears in the June 3 Journal of the American
Medical Association.
These official figures indicate that last year
5,866 physicians were licensed for the first time,
and thus represent the gross additions to the
profession for that year. In 1949 there were
3,600 deaths of physicians reported to the of-
fices of the American Medical Association.
During the year there were 12,181 licenses
to practice medicine issued by the medical ex-
amining boards of the 48 states, the District
of Columbia and the territories and possessions.
Ohio licensed 568.
During 1949 there were 5,963 applicants for
medical licensure by written examination, of
whom 5,219 passed. The candidates examined
represented 70 approved medical schools in the
United States, nine approved medical schools
of Canada, six United States medical schools
now extinct, 124 faculties of medicine and two
licensing corporations of other countries, six un-
approved medical schools in the United States
and 10 schools of osteopathy.
Among the 4,675 graduates of approved medi-
cal schools in the United States, only 3.2 per
cent failed. Of the 737 graduates of faculties
of medicine located in countries other than the
United States and Canada, 56.7 per cent failed
and of the 114 graduates of schools of osteopathy,
42.1 per cent failed. Among the 282 graduates
of unapproved medical schools in the United
States, 34.7 per cent failed.
Following a study by officers appointed by
Ohio’s Dr. Richard L. Meiling, director of medi-
cal services, Office of the Secretary of Defense,
terms designating military hospitals in the
various branches of the armed forces are being
standardized. Secretary of Defense Louis John-
son issued a directive to that effect.
706
The Ohio State Medical Journal
Auxiliary Annual Meeting . . .
Tenth Anniversary Is Celebrated With Fifty-Nine Organized Groups
In, State; Officers and Directors Are Named, Committees Appointed
THE annual meeting of the Woman’s Aux-
iliary to the Ohio State Medical Association,
held in Cleveland May 16, 17 and 18, was
not only the usual, important convention; it was
the occasion of the group’s tenth anniversary.
That tenth anniversary bore witness to a decade
of phenomenal growth — in the number of
counties organized, in the scope of the activities,
in the ever-increasing degree of usefulness to
the medical profession.
The Hotel Cleveland provided the spacious,
attractive background for the celebration and
three-day program. The Cuyahoga County
Auxiliary was the efficient hostess, handling a
big job smoothly, courteously and enthusiasti-
cally, under the expert, guiding hands of Mrs.
Farrell Gallagher and Mrs. D. M. Keating,
convention co-chairmen. Total registration of
auxiliary members at the convention numbered
294.
PROGRAM DETAILS— TUESDAY
Mrs. C. W. Kirkland, state president, called
the pre-convention Board meeting together at
9:30 a. m. The officers and chairmen of com-
mittees presented their annual reports. At
twelve o’clock noon, the luncheon for the Board
of Directors was held.
The formal opening note of the convention
was sounded at 1:30 in the afternoon when the
House of Delegates of the Auxiliary convened,
with Mrs. Kirkland presiding. Dr. LeRoy
Lawther of the Lakewood Presbyterian Church
gave the invocation. Mrs. John L. Stevens
presented the pledge of loyalty. Dr. Herbert
B. Wright, president of the Cleveland Academy
of Medicine, in a gracious address, welcomed the
Auxiliary members to Cleveland. The response
was given by Mrs. George Wilcoxon, president
of the Stark County Auxiliary.
In presenting her report for the year, Mrs.
Kirkland, the president, stressed the importance
of unceasing vigilance in the fight against so-
cialized medicine; she expressed appreciation
and gratitude for the fine cooperation and help
that she had received throughout her year. With
great pride, she announced that the State of
Ohio has 59 organized county auxiliaries. Re-
ports of the other officers and chairmen followed
that of Mrs. Kirkland.
The session adjourned at 4:00 p. m. to allow
for “sight-seeing time” in Cleveland.
PROGRAM DETAILS— WEDNESDAY
The second session of the House of Delegates
was called to order by Mrs. Kirkland at 9:30
a. m. Reports of committee chairmen not given
the preceding day were presented. There was
the first reading of the Nominating Committee,
and the first reading of recommendations of the
Board. A challenging and inspiring portion of
the program was the brief but comprehensive
reports of the district directors and the county
presidents, many of which were eloquent tributes
to the local groups throughout the state for
well-rounded, helpful, worth-while activities.
In special recognition of the 14 new Auxiliaries
organized this past year, a simple but impres-
sive little ceremony was held by Mrs. Kirkland.
She welcomed the president of each new group,
and as each one came forward in acknowledg-
ment, Mrs. George Cooperrider, president-elect,
made the presentation of a scarlet carnation, the
flower of the State of Ohio.
MEMORIAL SERVICE
At 12:00 o’clock noon, a quietly beautiful “In
Memoriam” service was conducted by Mrs. Paul
Woodward, vice-president, assisted by Mrs. E.
Benjamin Gillette, past-president, and Mrs. Wil-
coxon. The opening prayer, set to music and
sung by Mrs. Wilcoxon, preceded the ceremonial
lighting of 12 tall white tapers by Mrs. Gil-
lette. Each such taper represented a member
who had died this past year. The poem of one
such member, Mrs. Oliver P. Coe, internationally
acclaimed poet, was read by Mrs. Woodward.
Another of Mrs. Coe’s works which had been
set to music provided a fitting “last touch” as
the significant words of “At the sound of your
key in the door” was softly and movingly sung
by Mrs. Wilcoxon.
PRESIDENT’S LUNCHEON
The President’s luncheon on Wednesday hon-
ored Mrs. Kirkland and Dr. Carl A. Lincke, presi-
dent of the Ohio State Medical Association.
Mrs. Daniels, president - elect of West Vir-
ginia, was introduced as was Dr. E. O. Swartz,
incoming President of the Ohio State Medical
Association, and the three members of the Ad-
visory Board — Dr. H. M. Clodfelter, Dr. Paul
A. Davis and Dr. Chester P. Swett.
The guest speaker, Dr. George F. Lull, secre-
tary and general manager of the American Medi-
cal Association, gave a forceful talk that urged
the doctors’ wives to “keep your husbands edu-
cated . . . educate the younger people . . . put
more emphasis on the positive side — that is,
on the voluntary health insurance side . . . talk
for July, 1950
707
to groups who do not think the way we do . . .
organize Speakers’ Bureaus . .
Dr. Clodfelter presented awards to the four
winners in the To-Day’s Health contest, which
awards were furnished this year by the Ohio
State Medical Association. Lorain County Aux-
iliary, winner in Group I, also won a first
prize of $40 in the To-Day’s Health contest
sponsored by the American Medical Association.
Knox County Auxiliary, winner in Group II of
the state contest, also won an Honorable Mention
in the national contest. Marion County Aux-
iliary came off with top state honors in Group III,
also winning Honorable Mention in the national
contest. Stark County Auxiliary topped Group
IV in the state contest.
Following the luncheon program, there was a
short intermission, after which the round table
discussion was held, with its “Questions and
Answers” period with state officers and chairmen.
PROGRAM DETAILS— THURSDAY
The third session of the House of Delegates
got under way at 9:30 a. m., with the presen-
tation of unfinished reports of district directors
and county auxiliary presidents. Unfinished
business was next on the agenda, followed by
new business and acceptance of the budget. The
House of Delegates adopted the Board’s recom-
mendation that the nurses’ loan scholarship
fund be made available to either student or
graduate nurses. Thirty-five delegates to the
national auxiliary convention in San Francisco
were elected. Winners in the Credits and Awards
contest were announced, first place going to
Ottawa County Auxilary, and second place to
Fairfield County Auxilary.
The report of the nominating committee was
presented by Mrs. E. Benjamin Gillette, chairman.
NEW OFFICERS AND DIRECTORS
The new officers and directors elected to of-
fice include: president, Mrs. George W. Cooper-
rider, Columbus; president-elect, Mrs. Farrell
Gallagher, Lakewood; vice-president, Mrs. E. P.
Greenawalt, Springfield; recording secretary,
Mrs. Ross Knoble, Sandusky; corresponding
secretary, Mrs. Oscar Jepsen, Canal Winchester;
treasurer, Mrs. A. Paul Hancuff, Toledo; past-
president, Mrs. C. W. Kirkland, Bellaire.
Directors: Mrs. Azel Ames, Jr., Hamilton;
Mrs. Harold Messenger, Xenia; Mrs. Harold K.
Mouser, Marion; Mrs. Wendell Green, Toledo;
Mrs. S. C. Lind, Lakewood; Mrs. Robert Lom-
mon, Akron; Mrs. Carl Goehring, Steubenville;
Mrs. D. Reed Jones, Cambridge; Mrs. George
Obrist, Portsmouth; Mrs. James Snyder, Marys-
ville; Mrs. C. E. Swanbeck, Huron.
Chairmen of Standing Committees: Legisla-
tion, Mrs. Paul Woodward, Cincinnati; Publicity,
Mrs. S. L. Meltzer, Portsmouth; Program, Mrs.
E. Benjamin Gillette, Toledo; Public Relations,
Mrs. N. M. Reiff, Washington Court House; His-
torian and Archives, Mrs. A. D. Cook, Dayton;
To-Day’s Health, Bulletin and Handbook, Mrs.
A. H. Kimmel, Norwalk.
Chairmen of Special Committees: Radio and
Visual Education, Mrs. W. R. Gibson, Oak Har-
bor; Credits and Awards, Mrs. Karl Ritter,
Lima; Nurses Loan Fund, Mrs. Lewis B. Stephan;
Convention Co-Chairmen, Mrs. Paul Woodward
and Mrs. William Lippert, Cincinnati; Editorial
Staff, The Ohio Medical Auxiliary News: Mrs.
S. L. Meltzer, Portsmouth, Editor; Mrs. Gerald
H. Castle, Cincinnati, Associate Editor; Mrs.
Clyde M. Fitch, Portsmouth, Associate Editor.
The impressive installation of officers was
conducted by Mrs. V. E. Holcombe of Charleston,
West Virginia, a past-president of the Woman’s
Auxiliary to the American Medical Association.
The convention adjourned after Mrs. Cooperrider
gave her vital and informative inaugural address
with its pledge of unceasing activity against
the threat of socialized medicine. Members
of the new Board were introduced.
LUNCHEON FOR NEW PRESIDENT
A luncheon honoring the new president, Mrs.
George W. Cooperrider, and her officers, was
held at 1:00 p. m., Thursday afternooon. Mrs.
Daniels and Mrs. Holcombe were guests of honor
at the luncheon. A feature of the luncheon hour
was the Fashion Show presented by the Higbee
Company of Cleveland. Music was provided by
Harry Walker and his orchestra.
A Post-Convention Board meeting followed the
luncheon. There are 3,511 paid-up auxiliary
members in Ohio, 654 of whom are new members
this year.
Ohio State Radiological Society
Holds Annual Meeting
The Ohio State Radiological Society at its
meeting in Cleveland elected Dr. Arnold D. Piatt,
Newark, president for the current year, to
succeed Dr. Edward L. Voke, of Akron. Dr.
Piatt was vice-president last year.
Other officers elected are Dr. Donald D.
Brannan, Cleveland, vice-presidept, and Dr. Ed-
mond C. Elsey, Cincinnati, secretary-treasurer.
The following executive officers were elected:
Dr. Huston F. Fulton, Columbus; Dr. Austin J.
Brogan, Dayton; Dr. W. S. Peck, Toledo; Dr.
Edward L. Voke, Akron; and Dr. Henry Snow,
Dayton.
The Society held its annual meeting on May 17
at the Statler Hotel in Cleveland, during the
Annual Meeting of the Ohio State Medical
Association. A scientific program was held from
9 a. m. until noon, followed by luncheon and the
business meeting.
708
The Ohio State Medical Journal
Are Doctors Citizens?
NOT LONG AGO, one of my patients — a fellow who alwaj^s has taken an
active interest in community affairs — asked me, jokingly: “Doctor, are doctors
citizens?”
The question puzzled me. Then, I discovered that he had been reading statistics
about the large number of professional and business men who have been slackers
when it comes to taking part in political affairs and voting. Of course, my friend
was trying to rib me. But, there is enough truth to his question to make physicians
sit up and take notice.
Apparently some people are not altogether sure of the answer to the question:
“Are doctors citizens?” Some political sources are trying to make the people
think that the doctor is different from other citizens; that he has a different sort of
civic obligation and a different sort of individual rights. Isn’t it about time for the
ph ysician to stand up and be counted; to stand up and let the public know that he
is a citizen and like other citizens has civic obligations and responsibilities?
The Congressional elections on November 7 — in fact, the political campaigns
which are now under way — will give the people of Ohio a good yardstick with which
to measure the citizenship of the medical profession of Ohio
Is it a citizenship that influences government; a citizenship that is informed
about candidates and political issues; a citizenship that means registration, working
for able candidates, and voting? Or is it a negative and passive citizenship? Are
doctors “too busy” to fight for their citizenship, for the preservation of medical
standards; for their professional freedom?
The answer is up to you, Doctor. The testing time is here. It is time for
doctors to prove that they are patriotic citizens, fully cognizant of their civic obliga-
tions and determined to live up to their great responsibilities.
Sincerely,
E. O. Swartz, M. D.,
President.
5.4 Per Cent of Persons Are
Disabled in U. S.
On an average weekday in February 1949
there were about 4,569,000 persons from 14 to
64 years of age in the civilian population of
the entire United States disabled by illness or
some condition that prevented them from doing
anything but occasional part-time work. This
does not include persons between these ages in
resident institutions or in the armed services.
A rough estimate for these two categories
brings the total up to 5,310,000, or 5.4 per cent
of the population between these ages. — National
Tuberculosis Association.
Houston Meeting Contract Signed
For A. M. A. Interim Session
The A. M. A. has signed a contract with the
City of Houston for the use of the Sam Houston
Coliseum and Music Hall in connection with the
Fifth Annual A. M. A. Clinical Session in that
city, December 4-7, 1951. The two places will
be used for the scientific sessions and the scien-
tific and technical exhibits.
The House of Delegates will hold its session
at the same time, in one of the larger hotels.
The A. M. A. Clinical Session this year will be
held in Denver, November 28-December 1.
for July, 1950
709
More Hill-Burton Hospitals Open . . .
Projects Now in Use at Washington C. H., Nelsonville and Wooster;
Others Will Be Ready Soon; 44 Construction Jobs Are Now Approved
TWO more Ohio hospitals constructed under
the Hill-Burton Law have been opened.
They are the Fayette County Memorial
Hospital at Washington C. H. and the Mount
Saint Mary Hospital, Nelsonville.
The Fayette County Memorial Hospital was
the first hospital project approved for assistance
in Ohio under Public Law 725, through which
the Federal government grants a percentage of
the construction cost. It is in one of 12 areas
in Ohio designated as priority A, which means
that the area was designated as having zero
percentage of acceptable hospital beds.
The hospital design and construction is unique
in many respects. It is a one-floor plan built
in the form of wing projections. In a recent
nation-wide competition on hospital design the
project received considerable publicity in Hos-
pitals, the journal of the American Hospital
Association.
One feature is inclusion of a modern public
center in a wing of the building. Under the
cooperative program, facilities of the hospital
will be availabe to the local health department
although administration will be entirely sepa-
rate from that of the hospital. The architects
are Inscho, Brand and Inscho, of Columbus.
The 46-bed hospital has facilities and equip-
ment to take care of approximately 25 additional
beds if the need arises. Total cost of construc-
tion and equipment was $630,000 of which the
Federal government contributed $210,000.
NELSONVILLE HOSPITAL
The Mount Saint Mary Hospital at Nelson-
ville is a four-floor plan with a capacity of ap-
proximately 80 beds. It was built at a cost
tentatively estimated at $1,260,000. The Federal
government is contributing one-third of the
construction and equipment cost.
This hospital designed by Louis F. Karls-
berger, Columbus architect, is considered one
of finest and most modern in its class. It, too,
includes space for the county health department
and if necessary a larger district office.
The Mount St. Mary Hospital is under ad-
ministration of the Sisters of St. Francis, Buffalo
Academy of the Sacred Heart.
OTHER PROJECTS
First of the new hospitals under the Hill-
Burton Law to open was the Wooster Community
Hospital, report of which was carried in the
March issue of The Journal.
Other projects recently approved for partici-
pation under the program and not previously
reported in The Journal are:
Galion City Hospital; 25-bed addition to in-
crease capacity of present hospital to approxi-
mately 60 beds; also new service facilities; ten-
tative estimate, $250,000, of which the Federal
government will contribute $50,000; should be
under construction by September.
Willard Municipal Hospital; remodeling proj-
ect now under way will increase present capacity
of 32 beds to approximately 55; expected to be
completed during this summer. The new proj-
ect under the Hill-Burton Law is for equipment
at a cost of $60,000 of which the Federal
government will contribute $20,000.
Mary Mount Hospital, Garfield Heights, Cleve-
land, a 234 bed hospital. Total estimated cost,
Photo Courtesy The Nelsonville Tribune
This view of the Mount St. Mary Hospital. Nelsonville, shows the four-floor project after its completion.
710
The Ohio State Medical Journal
Architect’s Sketch, Inscho, Brand & Inscho
This architect’s sketch of the Fayette County Memorial Hospital at Washington C. H. shows how a one-floor plan was
used to advantage.
$3,500,000. Federal government will share in
cost of equipment only to extent of $26,471.
Bellevue Hospital, Sandusky County; expansion
of present hospital to 55 to 60 beds; cost, $336,000
of which Federal share will be $112,000; still in
planning stage.
Providence Hospital, Sandusky; approximately
40-bed addition; estimated cost, $810,000 of
which Federal share will be $270,000.
Nurses’ Residence Project, Mercy Hospital,
Portsmouth; estimated cost, $367,800; Federal
contribution, $122,600.
St. Vincent’s Hospital, Toledo; equipment proj-
ect for new addition; estimated cost, $375,000
of which Federal government will contribute
$125,000.
Samaritan Hospital, Ashland; 35-bed addition;
estimated cost $529,500; Federal share, $176,500.
Federal grant-in-aid funds allowed under the
Public Law 725 (Hill - Burton Law) are admin-
istered in Ohio through the Hospital Facilities
Office of the Ohio Department of Health. An-
thony J. Borowski, Dr. P. H., is administrator.
Ohio completes its third year of participation
under the Hill-Burton Law on June 30 of this
year. The program is scheduled to continue
through June of 1955. Although many grants
are being made to larger hospitals and for ad-
ditions to existing hospitals, administrators
assure that projects in the high priority areas
are still on the top of the list for consideration.
Dr. Karsner Heads National Board
Of Medical Examiners
Dr. Howard T. Karsner, recently professor
of pathology at Western Reserve University
School of Medicine, and now medical research
advisor to the Surgeon General of the Navy,
Washington, D. C., has been elected president
of the National Board of Medical Examiners.
Other officers elected at the May 3 meeting in
Philadelphia are: Everett S. Elwood, executive
secretary and treasurer; Dr. J. S. Rodman,
medical secretary; and Dr. John P. Hubbard,
associate secretary.
The following new members were elected for
the regular term of six years: Dr. Chandler
McC. Brooks, professor of physiology and head
of the department at the State University Medi-
cal Center, New York (Long Island Medical
College), and Dr. Julian F. DuBois, secretary of
the Minnesota State Board of Medical Examiners.
The medical advisory committee to the Mont-
gomery County Chapter of the National Founda-
tion for Infantile Paralysis includes the following
doctors: Dr. Robert H. Wahl, chairman; Dr.
S. E. Flock, Dr. H. L. MacKinnon, Dr. G. L.
Parkin; Dr. Mason Jones, Dr. H. H. Pansing,
Dr. Bert Wiley and Dr. F. C. Sutton.
for July, 1950
711
• • •
A.M.A. Launches Ad Campaign
New Phase of National Education Campaign Approved by Board of Trustees;
Budget Set Up To Place Material in Newspapers, Magazines and on Radio
THE American Medical Association, by unani-
mous action of its Board of Trustees and
Campaign Coordinating Committee, has
given the final “go ahead” signal for a Nation-
wide advertising program which will include
three principal media — newspapers, magazines
and radio — as a new phase of its National Edu-
cation Campaign in behalf of Voluntary Health
Insurance and against socialized medicine.
Clem Whitaker and Leone Baxter, directors
of the A. M. A.’s National Education Campaign,
announced authorization of the advertising pro-
gram and stated that the ad campaign will be
launched in October.
A total advertising budget of $1,110,000 has
been approved by the A. M. A. Board of Trus-
tees, it was announced, with $560,000 allocated
to newspapers, $300,000 to radio and $250,000
to National magazines.
IN EVERY NEWSPAPER
The newspaper advertising schedule calls for
blanket-coverage of every bona fide daily and
Aveekly newspaper in the United States — ap-
proximately 11,000, in total — and the copy is
scheduled to run during the week of October 8.
Newspapers in the territories of Hawaii and
Alaska will be included in the schedule. The
space reservation will approximate 70 inches
(probably a 5x14) in all papers.
About 30 of the leading National magazines,
and a score of advertising trade publications,
will be included in the magazine ad program.
The radio advertising program calls for an
intensive “spot announcement” campaign, utiliz-
ing time on some 300 radio stations, covering
every State and Hawaii and Alaska.
The magazine and radio campaigns also are
scheduled for October.
TWOFOLD PURPOSE
“This is not an institutional advertising pro-
gram,” said the Whitaker & Baxter announce-
ment. “The American Medical Association is
embarking on a Nationwide advertising program
for two reasons. First, it is determined to aid
in every way possible in increasing the avail-
ability of good medical care to the American
people through the medium of Voluntary Health
Insurance. In that respect, the advertising copy
will be designed to make the American people
‘health insurance conscious’ and to encourage
the extension and development of prepaid medi-
cal and hospital care as a means of taking the
economic shock out of illness. Second, Ameri-
can medicine is determined to alert the American
people to the danger of socialized medicine and
to the threatening trend toward State Socialism
in this country.
INDIVIDUAL FREEDOM
“The ad copy, in part, will be designed to
sell a commodity, Voluntary Health Insurance,
but not any particular brand or plan. The in-
dividual will be encouraged to secure sound
coverage in the plan which he feels best suits
his individual needs. In its second aspect, the
ad copy will be used to mobilize public opinion
in support of a basic American ideal — the
principle of individual freedom, as opposed to
the alien philosophy of a Government-regimented
economy.”
It was announced that the following advertis-
ing agencies have been selected to handle the
buying of space and placement of copy:
Lockwood-Shackelford Company for newspaper
and magazine media, with Homer J. Buckley &
Associates, Inc., affiliated with them.
The Russell M. Seeds Company in the radio
held, with the Harry M. Frost Company asso-
ciated with them.
Life Underwriters’ Grants
Include Three in Ohio
The life insurance companies of the United
States and Canada will give $670,000 to medical
schools and other research centers during 1950
for the study of heart disease and the training
of research scientists. The awards were ap-
proved in May at the annual meeting of the
Life Insurance Medical Research Fund, and bring
to $3,200,000 the total amount of money given
out by the Fund since it was organized late in
1945.
Grants to institutions in aid of research on
diseases of the heart and arteries by the Life
Insurance Medical Research Fund include the
following in Ohio:
The Children’s Hospital Research Foundation,
Cincinnati, for research by Dr. George M. Guest
on the chemistry of the myocardium in diabetic
acidosis, $2,625.
University of Cincinnati College of Medicine,
for research by Dr. Eugene B. Ferris, Jr., on
hypertensive cardiovascular disease, $21,000.
Western Reserve University School of Medi-
cine, Cleveland, for research by Dr. Normand L.
Hoerr on the capillary circulation of intra-
abdominal organs, $9,450.
712
The Ohio State Medical Journal
• • •
Taft Raps Truman Plan
Reorganization Plan 27 Would Create Department of Health, Education
And Security, Relegating Health Needs to Whims of Welfare Personnel
SENATOR ROBERT A. TAFT of Ohio took
a lusty swing at President Truman’s latest
move to give more power and authority over
health and medical matters to Social Security
Administrator Oscar Ewing and elevate Ewing
to cabinet status in a statement released by
Taft on June 9, opposing Reorganization Plan
No. 27 submitted to the Congress by President
Truman.
On May 31 the President sent a reorganization
plan to Congress creating a Department of
Health, Education and Security, (Reorganization
Plan No. 27 of 1950). This plan would create a
Department of Health, Education and Security
with cabinet status.
Under the plan all functions of the Federal
Security Administrator will be transferred to the
Secretary. Also to be appointed would be an
Under Secretary of Health, Education and Se-
curity to be appointed by the President and
confirmed by the Senate, who would perform
such duties as the Secretary would prescribe.
An Administrator to the Assistant Secretary
would be appointed by the Secretary with the
approval of the President under classified Civil
Service.
Continued would be the offices of the Surgeon
General of the Public Health Service, Commis-
sioner of Education, and Commissioner of Social
Security, all of whom would serve subject to
requirements of the Secretary pursuant to law.
The Surgeon General would hold office for a
term of four years and may be appointed from
the commissioned regular corps of the Public
Health Service.
The Surgeon General and the Commissioners
of Education and Social Security would be ap-
pointed by the President subject to Senate con-
firmation.
To serve for an interim of sixty days the
President may designate and empower as acting
Secretary any person who is an officer of the
Federal Security Agency pending the regular
appointment and he shall have the title with the
prefix “Acting.”
LAST YEAR’S PLAN
Last year the President offered Reorganization
Plan No. 1 of 1949 providing for a Department
of Welfare. The provisions of that plan were
almost identical with the new plan except that
he substituted for Department of Welfare, the
title “Department of Health, Education and
Security.” In the latest plan express provisions
retain for the Surgeon General and Commissioner
far July, 1950. . - . ...»
of Education statutory authority and duties now
vested in them.
Under the law a constitutional majority of
either the House or the Senate may kill this
plan if they take appropriate action before the
expiration of sixty calendar days. In other
words this plan would become law if neither
House voted it down prior to July 31, providing
both Houses stay in session until that date.
TAFT’S STATEMENT
Following is the text of Senator Taft’s state-
ment in which he points out the bugs in the
Truman proposal.
“The Proposal to create a Department of
Health, Education and Security is designed to
carry out an idea that has been current for
quite a while. In fact, I once introduced a
Bill to establish a new' department. The dif-
ficulty is that Health, Education, and Security
are all different subjects. On the local level
in cities they are entirely separate departments.
The only respect in which they are grouped
together in the present Federal Security Ad-
ministration is that they all are matters in
which the Federal interest is secondary and
the matter of principal interest is aid to the
States.
“Last year a similar plan was presented,
and it was defeated in Congress. It was de-
feated because it did not conform to the Hoover
Plan. Hoover recommends setting up a De-
partment of Education and Security. But he
wants to put the Health Division in an entirely
separate medical administration. That’s been
the great issue. The welfare people, like Oscar
Ewing, want to run health as a kind of welfare
service.
“The doctors and others feel that medical care
and health is a special subject, which ought to
be dealt with by people expert in the health
field and not subject to welfare direction. Now,
the difficulty with this plan is the same as the
difficulty with the plan last year. It is true
that it separates these three functions into
separate departments under the secretary, but
the secretary has an assistant secretary, and
an under secretary, all of whom are likely to
be welfare people, and then it isn’t perfectly clear
that all the health functions have to be as-
signed to the Surgeon General of the Public
Health.
SAME OBJECTIONS
“It seems to be that the plan has all the
objections which the plan had last year; and,
713
therefore, I should think under the same cir-
cumstances it is likely to be defeated primarily
because it does not conform to the Hoover
Plan, and, I may say, apparently because Oscar
Ewing just would turn the Federal Security
Administration into a Government Department
and in turn make Oscar Ewing, instead of a
Federal Security Administrator, a secretary in
the Cabinet. There is a good deal of resent-
ment in Congress about that, too, which is likely
to raise more political objection, perhaps, to the
plans than the one based entirely on logic.”
Ohio physicians who feel that Reorganization
Plan No. 27 is not a sound proposal and should
be rejected, should write to Senator Taft, con-
gratulating him on his stand in opposition to
the plan and request him to work actively
against it. Letters also should be sent to
Senator John W. Bricker, suggesting that he also
vote to reject Plan No. 27.
Family Doctors Outnumber
Specialists Two To One
Nearly two out of every three physicians in
private practice in this country are family doc-
tors.
This is brought out by the American Medical
Association’s recent count of physicians in con-
nection with its publication of the 18th edition
of the American Medical Directory, according
to Frank V. Cargill, Chicago, directory editor.
The new directory shows that the physicians
of the United States are in the following classi-
fications: 72,550 are in general practice and
22,976 are in general practice but give some at-
tention to a specialty; 54,891 limit their prac-
tice to a specialty; 12,536 are in Federal govern-
ment service; 9,700 are retired or in fields not
related to medicine; 3,737 are in administrative,
editorial or other executive positions related
to medicine, and 24,887 are interns, resident
physicians or full time physicians in hospitals.
The previous directory, issued in 1942, listed
the number of physicians in the United States as
180,496. In the 1950 edition the number is
201,277, an increase of 20,781 and an average
yearly gain of 2,598 during the last eight years.
California leads in the number gained, with
16,668 physicians in 1950 as compared with 12,365
in 1942, an increase of 4,303. New York state
shows a gain of 2,284; Texas, 772; Pennsylvania,
704; Florida, 634; and Massachusetts, 603.
Among the 24 largest cities in the United
States, New York City (including Brooklyn)
is first in physician population with 17,915
physicians, an increase of 1,244 since 1942.
Chicago is second with 7,477, a gain of 294;
Philadelphia is third with 4,894, an increase of
649; Los Angeles is fourth with 4,183, a gain
of 811, and Boston is fifth with 3,388, a
gain of 454.
Two Changes Approved in Workmen’s
Compensation Fee Schedule
Upon suggestion of the Ohio State Medi-
cal Association, two changes in the Work-
men’s Compensation Fee Schedule have
been approved by the Ohio Industrial
Commission. They are: (1) An increase
in the minimum fee for X-ray reexamina-
tion of fingers and toes to $5, and (2)
reduction of the period of after-care cov-
ered by the flat fee in reconstructive sur-
gical procedure from six months to three
months.
Navy Makes Available Data on
Atomic Radiation Effects
The Navy’s experimental research data con-
cerning certain effects of atomic radiation upon
living tissue are being made available to civilian
physicians and medical officers of the armed
services and Federal agencies under a program
announced recently by Rear Admiral Clifford A.
Swanson, chief of the Navy Bureau of Medicine
and Surgery.
The commanding officer of each Naval hos-
pital has been instructed to arrange with the
local county medical society, commanding of-
ficers of Armed Forces reserve components and
Federal agencies in their areas for interested
physicians to join with Navy doctors in the
use of study material.
Future plans for supplying additional study
material will depend upon the degree of success
realized from use of the present material and
the measure of interest manifested by those in
a position to benefit from the offering.
1951, 1952 Annual Meetings
The House of Delegates voted to change the
meeting place of the 1952 Annual Meeting,
previously scheduled in Columbus, because ex-
perience during the 1949 meeting indicated that
facilities are not adequate there to take care of
such a large meeting. The 1952 meeting will
be held in Cleveland during the month of May.
The House then voted to hold the 1953 meeting
in Columbus, provided the new Columbus audi-
torium is completed by that time.
The 1951 Annual Meeting will be held in Cin-
cinnati, April 24, 25 and 26.
Notice was received of the death on May 12
in Atlanta, Ga., of Dr. George Hess, U. S. Pub-
lic Health Service medical officer. Dr. Hess
was at the U. S. Industrial Reformatory in
Chillicothe from 1931 through 1933.
714
The Ohio State Medical Journal"
"AMINOPHYLLIN shares the actions and uses of other
theophylline compounds, over which it has the ad-
vantage of greater solubility. It is useful as a
diuretic and myocardial stimulant for the relief of
pulmonary edema or paroxysmal dyspnea of con-
gestive heart failure Aminophyllin is also useful
in the control of Cheyne-Stokes respiration and for
the treatment of paroxysms of bronchial asthma or
status asthmaticus.”
Council on Pharmacy and Chemisfry: New and Non-
official Remedies, 1949, Xanthine Derivatives, Phila-
delphia, J. B. Lippincott Company, 1949, p. 323.
Searle AMINOPHYLLIN*
Oral . . •
Parenteral . • .
Rectal Dosage Forms
SEARLE
RESEARCH IN THE SERVICE OF MEDICINE
* Contains at least 80% of anhydrous theophylline.
/or July, 1950
715
• • •
Mahoning County Essay Contest
Three Winners Are Announced Out of 300 Entries on Voluntary System
Of Medical Care; Text of Winning Paper by Medical Student Is Given
MORE than 300 essays on the subject,
“Why We Should Preserve the Volun-
tary System of Medical Care in the
United States” were submitted by college stu-
dents of Mahoning County, it was revealed as
winners were announced recently by the spon-
soring organization, the Mahoning County Medi-
cal Society.
The contest was conducted by a committee
of the Society consisting of the following mem-
bers: Dr. C. F. Gustafson, chairman; Dr. E.
J. Reilly, Dr. W. M. Skipp, Dr. Stephen W.
Ondash, Dr. James Miller and Dr. H. E. Mathay.
The judges were Judge Elmer T. Phillips,
Mrs. Charles B. Cushaw, Jr., Roy M. Welch, Sr.,
Attorney David E. Jones and Mrs. J. C. Foutts.
The contest was open to all college students
of Mahoning County except children of physi-
cians.
Supplementing packages of material on so-
cialized medicine which had been furnished to
all public high school and college libraries in
Ohio by the Department of Public Relations of
the Ohio State Medical Association, additional
material was provided by the Department to the
Mahoning County Medical Society for distribu-
tion to contestants.
WINNERS
First prize winner in the contest was Ed-
ward M. Miller, Jr., 716 Glacier Heights Road,
Youngstown, a freshman in the Ohio State Uni-
versity College of Medicine. Miller graduated
from the Chaney High School in Youngstown in
1946, where he was president of the National
Honor Society, a member of the National For-
ensic League, and received the Bausch & Lomb
science award and the mathematics award. At
Ohio State, he is a member of Phi Eta Sigma,
Romophos, Bucket & Dipper, Sphinx, Alpha
Epsilon and Phi Beta Kappa. He received his
B. A. degree in 1948 and B. S. in 1949. As
first prize winner he received a $250 U. S.
Savings Bond.
Second prize winner is Henry W. Pierce, 254
Fairgreen Ave., Youngstown. He is a graduate
of Rayen School and a freshman at Hiram
College where he is working on his B. A. degree.
He also won first prize at Rayen School in the
essay contest conducted by the Youngstown Area
Heart Association, and he won the Edwin S.
Gregory award. Second prize was a $100 bond.
Third prize winner is Donald F. Rendinell,
1824 Coronado Ave., Youngstown. He is a
graduate of Rayen School, received his B. A.
degree at the University of Michigan, and served
in the U. S. Navy during the war as a lieutenant.
He received his M. S. degree in chemistry at
the University of Pennsylvania in 1947 and is
now completing his second year at Western Re-
serve University School of Medicine.
Honorable mention was given to Georgie
Geordan, 224 Porter St., N. E., Warren, and to
Wilson S. Hamilton, 546 Detroit Ave., Youngs-
town.
Following is the complete manuscript of the
first prize winning essay:
FIRST PRIZE WINNING ESSAY
“Why We Should Preserve the Voluntary System
of Medical Care in the United States”
By Edward M. Miller, Jr.
The very basis of our economic greatness is
our inalienable right to choose. And whether
that choice be one of vocation, religion, or per-
sonal physician, all are so interrelated that main-
taining any one strengthens the others, and for-
feiting any one undermines the others.
It is my purpose therefore to set forth here
how our freedom of choice is being challenged
by insidious attempts to foist state or political
medicine upon our unsuspecting citizenry and
why we should resolutely defend our present
system of personalized care under which America
has grown great and strong.
The American medical profession is the best
informed, the most highly skilled, the most
efficient, the most humanitarian of any country
in the world, without exception. In a genera-
tion, life expectancy has been increased twenty
years. Epidemics have been virtually eliminated.
Amazing strides in preventative-curative medi-
cine, surgery and psychiatry have been made.
Vast storehouses of knowledge have been com-
piled. Through individual initiative, backed by
private and public philanthropy, the Nation’s
health has kept pace with its economy.
This enviable record of progress — unmatched
elsewhere — has been achieved in a free and un-
fettered medical field. Why, then, should any-
one want to halt this advance — to substitute a
devious system of controls and compulsions,
regulated, not by local authorities who know
community conditions, but from Washington,
by medically inexperienced administrators, moti-
vated by political expediency and self-perpetuat-
ing in office?
For years, large groups of Marxian-schooled
propagandists have been working zealously
716
The Ohio State Medical Journal
CHRONIC ASTHMATIC
• Many chronic asthmatics have been restored to activity —
and maintained that condition — by controlling attacks
with Norisodrine powder inhalation.
Using the Aerohalor®, Abbott’s powder inhaler, and a
cartridge containing Norisodrine Powder, the patient
inhales three or four times and the bronchospasm usually
ends quickly. This take-it-with-you therapy is effective
against mild as well as severe forms of asthma.
Proved by clinical investigation1’2, Norisodrine is a
bronchodilator with relatively low toxicity. Few side-effects
result when the drug is properly administered and these
are usually minor. Before prescribing Norisodrine,
however, please write to Abbott Laboratories,
North Chicago, Illinois, for literature. This tells how to
establish individual dosage and precautions to be taken.
Norisodrine Sulfate powder 10% and 25% is supplied
~ in multiple-dose Aerohalor* Cartridges, with rubber
caps, three to an air-tight vial. The si ft ft
Aerohalor is prescribed separately. vXuuTMU
♦ Trade Mark for Abbott Sifter Cartridge
1. Krasno, L.R., Grossman, M.I., and Ivy.
A.C. (1949), The Inhalation of l-(3',4'-Di-
hydroxy phenyl )-2-Isopropylaminoethanol
(Norisodrine Sulfate Dust), J. Allergy,
20:111, March. 2. Krasno, L.R., Gross-
man, M., and Ivy, A.C. (1948), The In-
halation of Norisodrine Sulfate Dust,
Science, 108:476, Oct. 29.
NOTE
THE NAME
(Isopropylarterenol Sulfate, Abbott)
ALWAYS READY FOR USE WHEN THE NEED ARISES
for July, 1950
717
throughout America to disseminate their doc-
trine of so-called “free” medicine. Their efforts
are not based on sincere desire to better our
welfare. They seek rather to entrench them-
selves firmly in a vast system of power and
patronage, and thus weaken America’s financial
stability and threaten her dominance in world
affairs.
Such a change in our patient-physician rela-
tionship would be far-reaching, disastrous and
irrevocable! Besides being an encroachment of
our Constitutional liberties, it would inevitably
result in decreased medical efficiency, dwarf de-
velopment of self-reliance and personal achieve-
ment, attract lower type of students into medi-
cine, reduce patients to bureaucratic submission,
and cost the average family more than it now
spends for medical care.
Government - controlled Medicine has failed
abysmally in every country in which it has
been tried, including France, Germany, Russia,
England. Costs have been stupendous; patients
treated on “assembly-line” speed; doctors — badly
overworked by queued-up patients — compelled to
diagnose and treat in two to four minutes. Pa-
tients become “form numbers” instead of in-
dividuals. Enormous administrative costs cut
sharply into every tax dollar. Heavy abuses re-
duced each dollar’s service still further. Hos-
pitals, over-taxed, were unable to receive
emergency cases, or aged patients.
Is this what our people want? I think not.
When sickness strikes, they want to “ call a
Doctor” — Their Doctor — not wait hours in line
for a government appointee.
Then let us keep our Medical Profession
unbound that it may maintain responsible rela-
tionship between doctor and patient, better its
remarkable achievement record, and continue to
serve America competently! Under standingly !
Conscientiously !
Field Director for A. M. A. Rural
Health Committee Named
Mr. Aubrey D. Gates, Little Rock, Ark., is the
new field director of the A. M. A.’s Committee
on Rural Health which is headed by Dr. F. S.
Crockett, Lafayette, Ind. He has been a leave
of absence as associate director, cooperative ex-
tension work, College of Agriculture, University
of Arkansas. He formerly served as a member
of the advisory committee of the Committee on
Rural Health.
Mr. Gates recently spent considerable time in
Columbus studying the setup and program of
the Ohio State Medical Association’s Committee
on Rural Health. To help solve some of the
health problems in rural areas, he is working
closely with state medical societies, state rural
health chairmen, extension services, farm organ-
izations and other civic groups in the formation
of community health clinims, councils and local
improvement associations.
New Members of O. S. M. A.
Following are the names of new members of
the Ohio State Medical Association, since April 1,
1950. The list shows the county in which they
are affiliated, city in which they are practicing, or
temporary addresses in cases where physicians
are taking postgraduate work.
ASHTABULA COUNTY
Ernest F. Lindenmayer,
Ashtabula
CLARK COUNTY
Greer A. Allen, Spring-
field
CUYAHOGA COUNTY
Richard P. Bell, Jr.,
Cleveland
Arthur E. Burns, Cleve-
land
Charles M. Clark, Cleve-
land
John J. DeJak, Cleveland
Barry A. Friedman,
Cleveland
Herman K. Hellerstein,
Cleveland
John A. Hunter, Jr.,
Cleveland
William M. Jefferies,
Cleveland
Felix E. Karpinski, Jr.,
Cleveland
James S. Kaufman,
Cleveland
Howard D. Kohn, Cleve-
land
David R. Long, Cleveland
Joseph P. Martin, Cleve-
land
Albert F. Portmann,
Cleveland
Thomas P. Rab, Cleve-
land
Clark T. Randt, Cleve-
land
Morton Rosenthal, Cleve-
land
George W. Rowney, Cleve-
land
Hans J. Rubin, Cleveland
Hyde G. Sample, Jr.,
Cleveland
John P. Storaasli, Cleve-
land
Fred R. Tingwald, C. eve-
land
DARKE COUNTY
Wayne S. Ramsey, Green-
ville
FRANKLIN COUNTY
Drew J. Arnold, Colum-
bus
Floyd M. Beman, Wester-
ville
Robert S. Darrow, Co-
lumbus
Richard L. Fulton, Co-
lumbus
George P. Hummel, Co-
lumbus
Charles E. Johnston, Co-
lumbus
Joseph D. Kiener, Colum-
bus
Paul E. Leithart. Co-
lumbus
James W. Long, Columbus
Walter Lowenstein, Co-
lumbus
Robert Pickett, Columbus
John P. Riepenhoff, Co-
lumbus
Harry M. Sage, Jr., Co-
lumbus
John A. Scholl, Columbus
Roy E. Swenson, Worth-
ington
Richard C. Troutman,
Columbus
David H. Watkins, Colum-
bus
GUERNSEY COUNTY
Wm. W. Bryant, Seneca-
ville
HAMILTON COUNTY
Frank P. Cleveland, Cin-
cinnati
Forrest V. Cress, Cin-
cinnati
Albert A. Kattus, Jr.,
Baltimore, Maryland
Harvey C. Knowles, Jr.,
Cincinnati
Clarence J. Podore, Cin-
cinnati
Helen C. Sharp, Cincin-
nati
Herman Ulevitch, Cincin-
nati
HARDIN COUNTY
Robert F. Schultz,
Kenton
HARRISON COUNTY
Carl J. Nicosia, Bowers-
ton
HURON COUNTY'
Carl R. Swanbeck, Huron
LORAIN COUNTY
Lawrence C. Meredith,
Oberlin
LUCAS COUNTY
Jack M. Kenyon, Toledo
Robert D. Kiess, Toledo
Donald C. Wilson, Toledo
MAHONING COUNTY
E. R. McNeal, Youngstown
Jerome B. Stechschulte,
Youngstown
MEDINA COUNTY
Wm. G. Halley, Lodi
MIAMI COUNTY
Robert L. Sutton, Tipp
City
MONTGOMERY COUNTY
Malachi W. Sloan, II,
Dayton
SANDUSKY COUNTY
Carroll D. Miller, Fre-
mont
STARK COUNTY-
Theodore J. Dodd, Canton
Clovis A. Watson, Jr.,
Canton
SUMMIT COUNTY'
Reynolds P. Desman,
Akron
Joseph A. Masaryk,
Barberton
Benjamin Moorstein,
Akron
Ernst S. Pawel, Akron
TUSCARAWAS COUNTY
Philip T. Doughten. New
Philadelphia
718
The Ohio State Medical journal
from
to florida
in december
Pollens may invade the air as early as January in
California and last through December in Florida.
wherever hay fever may be
and whatever the pollens, a valued measure of symptomatic
relief can be expected in most patients with
Trimeton ,® one of the first of the more
potent antihistaminic compounds,
continues to be, as always, a reliable
means of making the hay fever sufferer
more comfortable. Because the
incidence of side effects is relatively
low, it is rarely necessary to
discontinue Trimeton.
(brand of prophenpyridamine)
Packaging: Trimeton Tablets
(prophenpyridamine) 25 mg.
Bottles of 100 and 1000 scored tablets.
Trimeton Maleate Elixir containing
7.5 mg. per teaspoonful is available
in bottles of 4 and 16 oz.
Patients taking Trimeton should be
informed of the nature of side effects
common to all antihistamines.
CORPORATION • BLOOMFIELD, NEW JERSEY
TRIMETON c-
Washington Roundup . . .
A Review of Developments on Proposed Medical and Health Legislation
Before the Congress, With Observations on Other Matters of Interest
WITH an all-important election period
approaching a deadline and legislators
anxious to wind up the 81st Congress,
observations and predictions as these columns
are written may indeed be ‘‘stale as yesterday’s
newspaper” by the time The Journal reaches its
readers.
The following items in brief are given, there-
fore, not as any final authority, but merely as
some observations on happenings as they de-
velop in Washington.
The American Medical Association’s Washing-
ton office is constantly flashing back to Chicago
and to the State Associations throughout the coun-
try information on matters that are or can de-
velop into vital issues for the medical profession.
* * *
An imposing group of educational associa-
tions now are throwing their support behind
legislation to remove the U. S. Office of Edu-
cation from the Federal Security Agency and
establish it as a separate agency. Six organiza-
tions, including the National Education Associa-
tion, have indorsed H. R. 8161, which would turn
over Federal education activities to a board and
a commissioner to be appointed by the board.
This is the first time this type of legislation
has had such wide support from educational
groups, some of which in the past have favored
a cabinet-rank department of Health, Edu-
cation and Welfare. This development means
important new allies for the medical profes-
sion in its opposition to any such grouping of
government activities.
^ ^ ^
The Brookings Institution’s comprehensive sur-
vey on the country’s health services — doctors,
hospitals, prepayment plans, public health fa-
cilities and other factors — which began late
last summer is reported approximately half
completed. At the beginning of the task it
was estimated that eight persons would be
sufficient for the project. However, 15 full-time
workers are now on it.
* * *
Under sponsorship of the Federal Security
Agency a Conference on Problems of the Aging
will be held in Washington August 13-15. Ad-
ministrator Oscar Ewing said that invitations
are being issued to individuals — not to associa-
tions as such. Approximately 1000 persons from
the government, industry, education, labor, and
the professions are expected. Mr. Ewing said that
government officials had no preconceived ideas
about future action but were scheduling the con-
ference merely in the hope that out of the
discussions will develop a more coordinated and
fruitful program. Washington observers report,
however, that an F. S. A. committee has been
working in this field for two years and reports
as follows: “One principle suggests itself at
the start, namely — the Federal government
should establish a clearing house for studies of
the problems for the aging population, with
broad authority for research and promotion in
this field.”
•}* ¥
The Veterans Administration has ruled that
any eligible veteran who starts his pre-medical
course by July 25, 1951, but is delayed in enter-
ing medical schools by factors beyond his con-
trol, will be considered eligible for medical school
benefits whenever he can gain admission. This
ruling is expected to solve the problem which
prompted introduction of H. R. 7235 which would
by law extend the educational time limit beyond
the July 25, 1951, deadline.
% %
With the Citizens Committee on the Hoover
Report coming out in opposition to the Presi-
dent’s Reorganization Plan No. 27 to create a
Department of Health, Education and Welfare,
another strong force is in the corner with
the medical profession. Senator Taft has de-
clared himself in opposition as reported in a
special article on page 713 of this issue.
% %
A bill that would provide for Federal re-
insurance of voluntary, non-profit medical and
hospital insurance associations against catas-
trophic illnesses has been introduced in the House
by Representative Charles A. Wolverton (R.-N.J.).
In general the bill follows the suggestions ad-
vanced by Harold Stassen. Under the proposed
bill (H. R. 8746) a Federal corporation would
assume 66-2/3 per cent of all risks in excess of
$1,000 per subscriber per year. Among limita-
tions is a specification that the individual would
be required to pay a token share of all costs.
?jc
A pamphlet on “Better Medical Care That You
Can Afford,” being distributed by the Demo-
cratic National Committee, is out-and-out prop-
aganda for President Truman’s health plan.
All the opposition that has been mustered
against the proposed national compulsory insur-
720
The Ohio State Medical Journal
\
-• ■ .
.—I
■ i ■
^ LONG BEFORE I
GOTTHE DOCTOR'S
report; I KNEW
CAMELS AGREED WITH
MY THROAT. THEY
SMOKE SO MILD—
AND THEY ARE SO
GOOD-TASTING !
hroat Specialists report on
30-day test of Camel smokers:
Not one
single case of
throat irritation
due to smoking
Camels!”
Yes, these were the findings of throat spe-
cialists after a total of 2,470 weekly exami-
nations of the throats of hundreds of men
and women who smoked Camels — and only
Camels — for 30 consecutive days.
R. J. Reynolds Tobacco Co.. Winston-Salem
N. C.
ACCORDING TO A NATIONWIDE SURVEY:
More Doctors Smoke Camels
THAN ANY OTHER CIGARETTE
Yes, doctors smoke for pleasure, too! In a nationwide survey, three independent research organi-
zations asked 113,597 doctors what cigarette they smoked. The brand named most was Camel.
for July, 1950
721
ance program is dismissed in these two sen-
tences: “Why do some people oppose it? Either
because of self-interest or because they don’t
understand it.”
In typical propaganda fashion, the pamphlet
glides smoothly over many questionable state-
ments. It states “you would choose your own
doctor” and “the doctor would choose his pa-
tients,” but it does not explain how that choice
would be exercised in areas where there are
shortages of doctors and few patients. It states
that “a worker would pay IV2 per cent of his
earnings under $400 per month.” It does not
explain that costs would mount as the program
developed, nor that the Treasury Department
would have to make up any deficit out of general
taxes.
* * *
The Armed Forces Epidemiology Board in an
official report maintains that the anti-histamines
are useless against true cases of comomn colds.
Persons suffering from allergies were eliminated
from the group tested. The report does not
go into the effectiveness of anti-histamines on
allergic persons who might believe they are suf-
fering from colds.
* * *
The Army announced that all reserves plan-
ning on summer field training must have their
immunization brought up to date. Similar an-
nouncements were expected from the Navy and
Air Force. Earlier plans to have all members
of the reserve and national guard check up on
their shots were abandoned at least temporarily,
apparently because such a move might heighten
war jitters.
^ ^ ^
Dr. Leonard A. Scheele, Surgeon General of
the U. S. Public Health Service, upon his return
in mid- June from the World Health Assembly
meeting in Geneva, urged that the United States
raise its contribution to the World Health Or-
ganization to $2,500,000. Dr. Scheele who has
carried on health projects in 76 countries said
that almost half the people of the world suffer
from preventable disease. He contends that such
illness contributes to the type of sub-marginal
society where communist propaganda can easily
take root. The two-and-a-half millions is the
amount set by W. H. O. despite the fact that
Congress set the ceiling at $1,910,000.
* * ❖
The Department of Agriculture (Federal) has
started a wholesale diabetes detection survey
of its 11,000 employees. If the test shows pos-
sible diabetes, the employee is sent to a private
physician.
:>’c ^ ^
Announcement has been made that the Defense
Department has waived the requirement that
Medical Corps reserve officers must accumulate
12 points before July 1 of this year in order to
retain their active status. The announcement is
not a statement of policy, but is intended as
an interim measure for those physicians who
have not had time for reserve activities during
the past year.
Ohio Academy of General Practice
Elects Officers at Annual Meet
Dr. Gordon Erbaugh, of Dayton, was named
president-elect of the Ohio Academy of General
Practice at its annual meeting in Cleveland,
May 16. He will be installed as president at
the 1951 annual meeting.
Dr. Earl D. McCallister, Columbus, was re-
elected secretary-treasurer.
Dr. Roscoe M. Knoble, Sandusky, was installed
as president for the present year, succeeding
Dr. Emery G. Kyle, of Newton Falls.
District members elected to the Board of
Directors are: Dr. Wallace C. Madden, Dayton,
District Number Two; Dr. Wayland B. Recker,
Leipsic, District Number Four; Dr. Earl W.
Burgner, Akron, District Number Six; Dr. Law-
rence H. Miller, Granville, District Number
Eight; and Dr. Perry B. Wiltberger, Columbus,
District Number Ten, reelected.
National delegates to the Annual Scientific
Assembly of the American Academy of General
Practice to be held in San Francisco in 1951
are Dr. Recker and Dr. Howard R. Mitchell,
Columbus. Alternates are Dr. Earl D. Van Horn,
Cincinnati, and Dr. Thomas Shehan, Cleveland.
Dr. Paul A. Davis, Akron, first national presi-
dent of the American Academy of General Prac-
tice, spoke to members relative to the Blue
Cross prepaid hospital care plan and informed
members of some of the serious conditions which
have developed which are of vital interest to
all physicians.
Dr. George F. Lull, Chicago, secretary and
general manager of the American Medical Asso-
ciation, spoke briefly about the setup of the
A. M. A. Mr. Charles S. Nelson, Executive
Secretary of the Ohio State Medical Association,
spoke briefly to the Academy.
The annual business meeting was attended
by 204 members out of a state membership of
834 members, the secretary reported. The secre-
tary further reported that the Academy’s booth
on the floor of the exhibit hall was a great
success despite the fact that the railroad strike
stopped shipment of a great deal of the material
from the national office.
The Army announced that a new type of
scrub typhus vaccine has been sent to Malaya
for testing by an Army Medical Department
team. Tests will be carried on to determine
the effectiveness of the vaccine against typhoid
fever as well as scrub typhus.
722
The Ohio State Medical Journal
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When pain, heartburn,
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tive means for prompt relief. Its
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side effects of atropine or bella-
donna. Thus, symptomatic relief of
many common disturbances of the stom-
ach or intestines can be achieved with
discrimination and safety. Mesopin is indicated for
the relief of gastrointestinal spasticity, such as py loro-
spasm, cardiospasm, spastic colon, and biliary spasm.
for July, 1950
723
Ohio Hospitals . . .
A. M. A. Annual Survey Shows That Utilization of Services in Ohio
And Other Institutions Increased Considerably for the Year 1949
ANEW high in the utilization of hospital serv-
ice in the United States was reached dur-
ing 1949, according to the annual presen-
tation of hospital data by the Council on Medical
Education and Hospitals of the A. M. A., re-
ported in The Journal of the A. M. A., May 6.
Patients admitted to hospitals registered by
the A. M. A., reached a total of 16,659,973, an
increase of 237,199 over the previous year. The
bed capacity of 1,439,030 showed an increase
of 15,510, while the average daily census of
1,224,951 was 6,797 more than were recorded
in 1948.
In Ohio there was a similar increase in
utilization of hospital services. Although the
total number of hospitals remained the same,
there was an increase of 566 in the number of
beds, an increase of 53 bassinets, 15,427 more
patients admitted and an increase in the aver-
age census of 766.
BIRTHS
In the last 20 years the number of hospital
births in the United States has increased from
621,867 to 2,820,791. The two million mark was
first exceeded in 1946, while the following year
set an all-time record of 2,837,139. The 1949
total is only 16,348 less than the record and
exceeds the 1948 total by 26,510. In Ohio there
were 171,533 births in hospitals in 1949.
OHIO HOSPITALS
The report shows the following hospital fac-
ities in Ohio:
Federal Hospitals 6; beds 5,073; patients ad-
mitted 19,965; average census 4,408.
State Hospitals 27; beds 33,216; bassinets 36;
patients admitted 28,560; average census 31,675.
County Hospitals 27; beds 4,139; bassinets
124; patients admitted 22,599; average census
3,510.
City Hospitals 18; beds 3,522; bassinets 360;
patients admitted 69,845; average census 2,844.
City-County Hospitals 1; beds 72; bassinets 22;
patients admitted 3,495; average census 70.
Total Governmental Hospitals (a summary of
the preceding) 79; beds 46,052; bassinets 542;
patients admitted 144,464; average census 42,507.
Church Related Hospitals (nonprofit) 47; beds
8,408; bassinets 1,449; patients admitted 299,694;
average census 6,965.
Nonprofit Association Hospitals 97; beds 10,718;
bassinets 1,951; patients admitted 369,192; aver-
age census 8,464.
Total Nonprofit (summary of preceding two
classifications) 144; beds 19,126; bassinets 3,400;
patients admitted 668,886; average census 15,429.
Individual and Partnership Hospitals 9; beds
350; bassinets 14; patients admitted 1,211; aver-
age census 260.
Corporation Hospitals (profit unrestricted) 8;
beds 551; bassinets 18; patients admitted 5,732;
average census 465.
Total Proprietary (summary of the preceding
two classifications) 17; beds 901; bassinets 32;
patients admitted 6,943; average census 725.
Total Nongovernmental (summary of the pre-
ceding nongovernmental) 161; beds 20,027; bas-
sinets 3,432; patients admitted 675,829; average
census 16,154.
Grand Total of all registered hospitals in
Ohio (summary of the preceding) 240; beds
66,079; bassinets 3,974; patients admitted 820,-
293; average census 58,661.
TYPE OF SERVICE
Following are the number of hospitals in
Ohio and number of beds according to type of
service offered: General, 148 with 24,069 beds;
nervous and mental, 28 with 34,298 beds; tuber-
culosis, 23 with 3,891 beds; maternity, 9 with
212 beds; industrial, 1 with 18 beds; children’s,
3 with 531 beds; orthopedic, 3 with 160 beds;
convalescent and rest, 7 with 327 beds; hospital
departments of institutions, 11 with 962 beds;
all other hospitals, 6 with 1,612 beds.
NURSING PERSONNEL
The A. M. A. report shows the following sta-
tistics in regard to professional nursing personnel
and schools of nursing education in Ohio: Stu-
dent nurses, 5,602; accredited schools of nursing,
61; schools offering affiliating courses only, 10
with 679 students; administrative nursing per-
sonnel, 372; full-time instructors, 320; supervisors
and assistant supervisors, 954; head nurses and
assistant head nurses, 1,453; general duty nurses
full-time, 5,164; general duty nurses part-time
1,447; nurses not classified, 177; total graduate
nurses, 9,887; private duty nurses, 1,659.
The report further shows the following infor-
mation on auxiliary nursing personnel and school
of practical, nursing; Schools of practical nurs-
ing, 5; practical nurse students, 56; practical
nurses employed, 781; attendants, 5,183; nurses’
aides, 4,784; ward maids, 1,092; orderlies, 964.
724
The Ohio State Medical Journal
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AND PHENYLMERCURIC ACETATE 0.02% IN SUITABLE JELLY OR CREAM BASES
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A CHOICE OF PHYSICIANS
HOLLAND- RANTOS COMPANY, INC • 145 HUDSON STREET, NEW YORK 13, N. Y.
MERLE L. YOUNGS
PRESIDENT
for July, 1950
725
T„ -w Otii yii/vyii Comments on Current Economic and Social
w 111 v_-r IJ-lil Questions and Professional Problems;
— — .. Suggestions Regarding Organized Activities
KNOCK-OUT DRIVE PLANNED BY THE A. M. A.
THROUGH ADVERTISING PROGRAM IN FALL
E^vLSEWHERE in this issue will be found a news article regarding a nation-
-wide advertising program which will be launched in the Fall by the American
Medical Association as a part of its National Education Campaign.
The A. M. A. Board of Trustees will win the commendation of many for con-
tinuing its policy of taking the initiative in the matter of telling the people what
the medical profession stands for, how voluntary methods can solve the medical and
health problems of the people, and about the dangers of government control of medi-
cine as well as all professions and business.
As the advertising campaign progresses, the cooperation and help of state and
local medical societies, individual physicians, allied professional groups and laymen
will be needed to make the program really click. Therefore, these groups and indi-
viduals should be ready to pitch in when the word goes out to them.
Following is a statement issued by
Whitaker & Baxter, public relations and its allies have proved to millions of people
agency which is handling details for the and.to thousands of publicly responsible organ-
. . _ _ . . , _ , . . _ . izations that the problems of medical service,
entire National Education Campaign, em- • care and cost can be solved under the voluntary
phasizing the major features of the ad- system, without Federal controls.
vertising program and its why’s and “The need now is to crystallize that general
wherefore’s * public sentiment into concrete public certainty.
“The need is to prove that if a General Elec-
“As publicly announced on May 29, the Board tion were called on the issue of Compulsory
of Trustees and Campaign Coordinating Com- Health Insurance, the people would vote “No!”
mittee decided unanimously to bring the efforts “The need is to show that Compulsory Health
of the National Education Campaign to a Insurance is discredited in the eyes of most
climax in October, with an advertising pro- Americans, and that the benefits of Voluntary
gram designed to crystallize public sentiment Health Insurance are more firmly established
on the issue of Voluntary versus Compulsory day by day.
Health Insurance. “The need is to build and solidify the con-
“We have been asked by the Board and the fidence of the public in the medical profession.
Committee to advise you of the main considera- “The need is to build the confidence of doc-
tions determining this course. Here are the tors in their own leadership, local, State and
major factors involved: National — and in their own ability to solve their
“In order to relieve the medical profession of problems. Doctors and their allies have done
any necessity for a continuing, exhaustive cam- a spectacular job of turning the tide which
paign for survival, it is imperative to find a would have destroyed the profession. In direct-
way to bring the issue of Government-controlled ing the National Campaign — whose success 18
medicine to a public conclusion. months ago looked pretty disheartening — the
The most desirable action possible, naturally, A. M. A. Board of Trustees and Coordinating
would be a vote in Congress — and that con- Committee have earned the sincere respect of
elusion we are thoroughly prepared for, and leaders in business and industry and other
would welcome. professions, for their forthright battle against
“However, the issue will not be permitted by the threat of socialism. On this basis, medi-
its sponsors to emerge in this Congress, and cine’s crusade has won recognition as a service
we are forced to find other means to solidify to the entire Nation.
medicine’s position. “For its effect on future political events af-
Medicine, in its National campaign, has won fecting the profession, the respect and esteem
the support of the greatest cross-section of medicine has won needs to be pointed out to the
public sentiment ever amassed on a contro- Nation at large. It needs to be crystallized into
versial public issue in this country. Medicine a firm foundation of strength, which medicine
726
The Ohio State Medical Journal
Jlu^ie^ fyine Galmeticl and Pe^i turned r
ai adue'iti&ed In p,ullicatio>n& o-f the
American Medical A Badalian,
aSie dii.t'iihuted in Ohio- bn:
CARL G. and DOROTHY SMITHSON, Divisional Distributors
252 S. CHESTERFIELD ROAD
PHONE: DOUGLAS 1240 COLUMBUS 9, OHIO
DOLORES ADAMS
181 Twelfth Ave.
Columbus 1, Ohio
Phone WAlnut 1654
ESTHER MESSERSMITH
Arbaugh Building
Salem, Ohio
Phone 7290
TILLIE CARR
P. O. Box 415
Steubenville, Ohio
Phone 24826
DISTRICT DISTRIBUTORS
ELVAH R. HUNT
519 Oak Street
Ironton, Ohio
Phone 927-R
ESTA REESE
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Gallipolis, Ohio
Phone: 986 W
ALICE SENSENBRENNER
313 E. Mound Street
Circleville, Ohio
Phone: 780 L
RUTH STIFF
240 N. Cherry St
Lancaster, Ohio
Phone: 1914 W
ANNABELLE O. RICHARDS
1341 Ridge Ave.
Steubenville, Ohio
Phone: 2-7643
ERMA TODD
559 Harding Road
Zanesville, Ohio
Phone 3895
VIRGINIA M. DAVIDSON
493 N. Walnut St.
Logan, Ohio
Phone: 5-2327
MAE THOMPSON
332 Eastern Ave.
Washington C.H., Ohio
Phone: 47941
ASSISTANT DISTRICT
LOUISE S. DAVIS
379 W. 8th Ave.
Columbus 1, Ohio
Phone UNiversity 1741
DISTRIBUTORS
VELDA KELTNER
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MABEL M. LAMP
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LEONA McARTOR
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Phone: 22050
LANA POLSTER VIRGINIA THOMPSON OPAL DUNCAN
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Columbus 3, Ohio Columbus 1, Ohio Columbus 4, Ohio
Phone FAirfax 1632 Phone: UNiversity 6277 Phone RAndolph 6669
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Post Office Box 125, CHAGRIN FALLS, OHIO
ANNE McVICKER
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DISTRICT DISTRIBUTORS
LA VERNE CARR POWELL
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DISTRIBUTORS
GLADYS SEWARD
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5921 OAKWOOD AVENUE
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MINN ETTA THOMAS
815 Keith Bldg.
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Phone: MAin 0360
DISTRICT DISTRIBUTORS
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Phone: KEnmore 2744
for July, 1950
727
well may need in the future. It needs to be
capitalized at its height — toward the nullification
©f the efforts of those who will continue to try
to discredit medicine.
“All these things and many more, the adver-
tising program is geared to accomplish. The
program above all else will strive constructively
to solidify the position and build the prestige of
the profession generally — and since the finality
of a Congressional vote is denied medicine at
this time — it is our intention to end this cam-
paign with the conclusiveness of the people’s
mandate we know we have.
We are aware this is a big order. We shall
do our utmost to fulfill it. We are aware that
irrespective of what is done, the program will
have some critics. The only way to avoid
criticism is to do nothing. And your Committee
and Board — fortunately for medicine — do not
advocate the dubious “safety” of inaction.”
EXCELLENT HUNCHES FOR
AUXILIARY PROGRAMS
Occasionally, a newly organized Woman’s
Auxiliary to a County Medical Society has found
itself a bit puzzled as to just what kind of a
year’s program it should provide for its mem-
bers— just what its responsibilities and activities
should be.
New auxiliaries organized in Ohio during the
next 12 months — in fact, auxiliaries now in ex-
istence— will be in a fortunate position. A
program committee of the State Auxiliary,
under the chairmanship of Mrs. E. B. Gillette,
Toledo, a former president of the state organiza-
tion, has just issued a bulletin to all local aux-
iliaries in which have been incorporated some
excellent suggestions for local auxiliary activ-
ities and programs.
Please note that the bulletin, the text of which
follows, points up how the auxiliary can assist
and cooperate with the local medical society
(in fact, some of the ideas offered would make
corking good programs for most of the County
Medical Societies):
“A Program Chairman should be carefully
selected in each County. She must work closely
with the President and the Board. Her ideas
for Programs may overlap those of other Com-
mittees, therefore, she must consult and co-
operate with other Auxiliary Chairmen.
“The plan for the Year’s Program must be
approved by the Auxiliary Board and the ad-
visor from the County Medical Society. It would
be well to ask the advisor for suggestions
before the program is completed.
“The component Auxiliaries vary in member-
ship from 7 to over 400. No set pattern can
be applied, but we hope that each County
Chairman may find the following suggestions
helpful in planning their Program for 1950 and
1951.
“1. Plan program early. Select some goal
to be achieved. Decide length of time for
meeting. Start and close meetings promptly.
“2. Form Speakers’ Bureau. List avail-
able speakers. Use these speakers for
Auxiliary programs and make them avail-
able to other groups.
“3. Encourage younger members and new
members to participate in program, or its
responsibilities if possible.
“4. Know the aims of the A. M. A. Study
its history, functions, work of various de-
partments, twelve (12) point plan, its con-
tribution to mankind, etc.
“5. Arrange program on pre-payment
medical care and hospital plans. Speakers —
representative of local or state plan or
local physician.
“6. Study Legislation, local, state and
national — which affects health and medi-
cine. Have report on legislation at each
meeting. Qualified Speakers: Members of
Medical Society, legal advisors or counsel.
“7. Public Health Meetings. Speaker —
health commissioner, mayor or other execu-
tives. Study local and state health facil-
ities available, school and rural problems.
Invite other Women’s Club members to this
meeting. This means good public relations.
“8. Program on Geriatrics: Speaker
from local nursing home, aid to the aged
department, county home. Discuss care and
facilities.
“9. Nurse Recruitment: Tea. Suggest help
to nursing schools, etc. Speaker: Hospital
superintendent, staff physician, County So-
ciety President or others interested.
“10. Study Groups (these are apart from
program) : Might report at meetings. Also
participants in health campaigns such as
cancer drive, polio, etc. Bring reports.
“11. Leave time on program to cooperate
with Medical Society in new projects. Be
informed on medicine’s aims. Tell others.
“12. All work and no play is not a good
program. Luncheon or tea meetings attract
members. A dinner dance given with the
Medical Society has proven popular.
“In making your program, consider home
needs first. Use as many of the above sug-
gestions as you wish. If we can be helpful at
any time, communicate with us.
“Let us work together so that the Women’s
Auxiliary may be a credit to its parent.”
CHECK YOUR WORKMEN’S
COMPENSATION FILES OFTEN
Physicians who do an appreciable amount of
industrial practice should check their files
routinely every six months for pending or in-
complete Workmen Compensation claims. Delay
in payment may be due to one or more of sev-
eral causes. Perhaps the employer has not filed
the claim. He may not have coverage. In-
formation may be missing or incomplete from
the employer, employee, or attending physician.
Signatures may have been omitted. If an X-ray
was taken, the film may not have been filed, and
payment of the bill of attending physician for
treatment therefore delayed. The employer may
be contesting the compensability of the claim.
Whatever may be the reason for the delay
in paying your bill, you are more likely to get
it straightened out by initiating the inquiry
early while the claim is still alive than by
728
The Ohio State Medical Journal
PICKER IN OHIO IS AT 10525 CARNEGIE AVENUE, CLEVELAND 6, OHIO (GArfield 1010)
There’s a Picker Sales Office and Service Depot near
you, staffed by capable men eager to serve you well.
Picker X-Ray Corp., 300 Fourth Avenue, N. Y. 10.
one
source
for July, 1950
729
waiting for a year or more (as some physicians
do).
After you’ve made your semi-annual inven-
tory of industrial cases, make a list of those for
which payment of your fee bill has been de-
layed six months or more. On such claims,
first call the employer for the number. If he
can’t furnish it, then he hasn’t filed the claim
with the Industrial Commission. When a claim
is received by the Commission, the employer
is immediately notified of its number. Your
’phone call may release the claim blank from
that pigeon-hole.
Your list of “pending” claims should in-
clude the claim number, if available; name of
employer; name of employee, date of injury.
Send the list to C. C. Grubbs, assistant super-
visor, Claims Section, State Industrial Commis-
sion, State Office Building, Columbus. You’ll get
a prompt explanation of what is holding up
payment of your bill. If you prefer, send the
list to the Headquarters Office of the State Medi-
cal Association, and a member of the staff will
follow through.
Of course, some of the delays in payment
of medical bills are the fault of the Industrial
Commission’s office. It is the responsibility of
that office to see that claims are properly and
promptly adjudicated and that claimants and
physicians are compensated in accordance with
the law and the regulations. At times, the
system used in handling approximately 25,000
claims each month short circuits; delays occur
or fee bills are misplaced. However, about 90
per cent of the claims and bills go through for
payment within a reasonable time. Efforts of
the Commission to straighten out cases which
have run into difficulty are limited by the volume
of the work and the perennial shortage of
personnel.
You can help the Commission’s staff by advis-
ing it promptly and periodically of cases in
which payment to you is delayed. Periodic ex-
amination of your files should be made so a
check can be made by the Commission and
the difficulty straightened out.
ACCIDENTAL DEATH RATE FOR
1949 REACHES ALL-TIME LOW
* It seems that we Americans lived less dan-
gerously during 1949 than in former years, ac-
cording to reports of accidental deaths. Metro-
politan Life reported that for 1949 the estimated
toll from accidents was 92,000 lives, a marked
decline from the 98,000 of 1948.
In fact, the 1949 figures will be the lowest for
any year of the past decade, and in relation to
population, mortality from accidents will be the
lowest on record for the Nation.
For the benefit of anyone who wishes to
philosophize on the recklessness of the present
generation, we might note that again accidents
in the home (33,000) accounted for more lives
than any other class. Accidents in the home
usually are caused by lack of forethought or fail-
ure to exercise ordinary precaution.
Motor vehicle fatalities fell somewhat below
the total of 32,000 recorded in 1948. In relation
to travel mileage, deaths from motor vehicle ac-
cidents, when all statistics are in, probably will
be the lowest ever experienced. Occupational
accidents also showed a sharp decline.
Undoubtedy the many safety education pro-
grams are having their effect on the lowering
of accidental deaths.
LIVES OF GREAT
MEN REMIND US
Many newspaper clippings have been coming
into the office of The Journal recently in con-
nection with awarding of 50-Year Pins. Many
of these contain biographical sketches or reports
of reminiscences of these oldsters in the profes-
sion.
One characteristic which perhaps predominates
in these sketches is that doctors, in spite of their
busy professional lives, usually are civic minded
to a marked degree. It is an exceptional bi-
ography which does not report the doctor as hav-
ing interests in some community enterprise — the
high school football team, the Elks Club, the
American Legion, board of education, public
health projects, the chamber of commerce, some
church, or any other of a hundred activities
which help the community to be a community.
A study of just how much time doctors con-
tribute to community affairs in addition to their
strictly professional work would be interesting.
Without question it would be high.
The doctor has his circle of patients who know
him intimately and who benefit most from his
store of ability. Taking part in these other activi-
ties helps the doctor to widen his field of influence
and to make more friends for himself and for
his colleagues in the medical profession.
IT WOULDN’T BE FREE
HERE, EITHER
Low-income Britons are beginning to discover
that the “welfare state” isn’t free after all, the
U. S. News and World Report observes.
It points out that actually, low-income tax-
payers (80 per cent of Britain’s families whose
incomes are under $1,400 a year) pay more in
taxes than they get back in welfare benefits.
They pay, on the average, about $9.50 in taxes
per family per week and they get back in wel-
fare benefits, about $8.00 per family per week.
Let those who think the proposal for a “give
away” state in the U. S. A. is free, take notice.
Which brings to mind the following definition
from some wit: “Federal aid: A system of mak-
ing money taken from the people look like a
gift when handed back.”
730
The Ohio State Medical Journal
Gefl
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for July, 1950
731
Do You Know?
• • •
Roger C. Crafts, Ph. D., is the new head of
the department of anatomy in the University
of Cincinnati College of Medicine. He has
been associate professor of anatomy at Boston
University School of Medicine. During the
war he was with the Office of Naval Research.
* * *
“Bronchiectasis and Tuberculous Bronchitis,”
was the subject discussed by Dr. Maurice G.
Buckles, Columbus, at the annual meeting of
the American Academy of Tuberculosis Physi-
cians, June 24, in San Francisco.
* *
Premium income of the accident and health
insurance industry was more than $1,171,600,000
in 1949, according to a preliminary estimate
of the Health and Accident Underwriters Con-
ference. This total is 16 per cent higher than
in 1948. The premium total in 1933 was ap-
proximately $175,000,000.
ifc sf:
The June 10 issue of the Journal of the
A. M. A. contains a complete report on post-
graduate courses for practicing physicians, com-
piled by the Council on Medical Education and
Hospitals. The listing is by specialty and
covers courses at medical schools for the period
July 1, 1950 -Jan. 15, 1951.
* * *
A resolution opposing compulsory health in-
surance was tabled at the recent biennial con-
vention of the American Nurses’ Association.
The Association’s new president is Mrs. Eliza-
beth K. Porter, assistant director and professor
of nursing, Western Reserve University, Cleve-
land.
% * *
Dr. Fowler B. Roberts, Akron, is the new
president-elect of the Ohio Orthopedic Society.
* * *
The Ohio State Medical Association’s schol-
arship for rural medical students was explained
in a recent broadcast over WRFD, Worthington,
the Ohio Farm Bureau radio station, by Hart
F. Page, secretary of the Committee on Rural
Health of the Association.
^ ^
Over 100 officers of local women’s organiza-
tions were guests of the Woman’s Aux-
iliary of the Lima and Allen County Academy
of Medicine at an afternoon meeting and tea
at Lima, April 27. George H. Saville, Direc-
tor of Public Relations, Ohio State Medical Asso-
ciation, spoke on the subject, “Uncle Sam, M. D.”
%
Unitarian Service, Inc., has named Dr. John
H. Dingle, Cleveland, professor of preventive
medicine, Western Reserve University School
of Medicine, a member of a medical mission to
go to Japan this summer to teach the latest
medical techniques to doctors whose scientific
progress was arrested during the war.
* * *
br. Richard L. Meiling, chief of medical
service, Office of Defense, has been awarded
the honorary degree of Doctor of Science by his
Alma Mater, Wittenberg College, Springfield.
* * *
Two Ohio physicians are members of the
Scientific Program committee for the 1951 meet-
ing of The American Academy of General Prac-
tice in San Francisco. They are Dr. Tom E.
Rardin, Columbus, vice-chairman, and Dr. Joseph
C. Lindner, Cincinnati.
* * *
A committee of the Medical College of Virginia
recently interviewed each of its 92 senior medi-
cal students to aid them in the choice of an intern-
ship. It was found that 53.26 per cent of the
students indicated an intention to enter general
practice.
>;c * *
Dr. Richard L. Meiling, Columbus physician,
now director of medical services, Office of the
Secretary of Defense, was named official ad-
viser to the U. S. Delegation at the World
Health Organization which met in Geneva,
Switzerland, in May. While in Europe Dr.
Meiling visited military medical installations in
the occupied areas and the medical facilities
of the U. S. Air Force in England.
* * *
Dr. Allan C. Barnes, Columbus, spoke on
“Use of Radioactive Cobalt in Treatment of
Carcinoma of Cervix,” at the meeting of the
American Gynecological Society, held at White
Sulphur Springs, W. Va., May 11-13.
^ ^ *1;
Dr. F. F. Reiser has retired as superintendent
of Columbus State School, after serving at the
institution for 43 years. His successor is Dr.
Roger Gove, former director of the Upper
Miami Valley Child Guidance Center, Piqua.
% sfc %
The scientific exhibit on “Translumbar Arteri-
ography” by Drs. Parke G. Smith, Thomas W.
Rush and Arthur T. Evans, Cincinnati, which
was awarded first prize at the annual Meeting
of the Ohio State Medical Association in Cleve-
land, May 15 - 18, also won the top award at
the meeting of the American Urological Asso-
ciation, May 29 - June 1, at Washington, D. C.
732
The Ohio State Medical Journal
for July, 1950
733
• • •
Buckeye News Notes
Chardon — Dr. and Mrs. Walter C. Corey were
honored at a banquet given “in recognition and
appreciation of untiring public service given
by the couple over a quarter century.” Dr.
Corey recently retired after 25 years as Geauga
County health commissioner and Mrs. Corey
after 25 years as secretary of the county health
board.
Cincinnati — Dr. Eugene B. Ferris, Jr., has been
elected president of the American Society for
Clinical Research and editor of the society’s
Journal of Clinical Investigation.
Cincinnati — Dr. Braxton F. Cann has been ap-
pointed to the Cincinnati Boxing and Wrestling
Commission.
Cleveland — Dr. Henry A. Zimmerman won the
award offered by the American College of Chest
Physicians for outstanding research in abnormal
lung conditions and was invited to address the
College at its annual meeting in San Francisco.
Columbus — Dr. Robert E. S. Young took part
in a discussion on the subject of “Socialized
Medicine” at a town meeting in the Hilltop area.
Columbus — Dr. Jonathan Forman, Editor of
The Journal, spoke on the subject of “Socialized
Medicine” at a meeting of the Columbus Life
Underwriters’ Association.
Dayton — Dr. Robert E. Boswell and Dr. John
T. Bickmore spoke before the Dayton Hearing
Society, where they discussed hearing defects
and their remedies.
East Liverpool — Dr. John A. Fraser spoke be-
fore the local Lions Club on the subject of cancer.
Grafton — Dr. Clifford S. Palmer, Massillon, im-
mediate past-governor of the Kiwanis Club,
spoke on the subject, “Aggressive Citizenship —
Safeguard of Freedom,” before some 200 Kiwan-
ians representing 15 clubs of the Sixth Division.
Greenfield — Dr. Phillip T. Knies, Columbus, ad-
dressed the Greenfield Rotary Club on the
subject, “Socialized Medicine.”
Greenfield — Dr. J. Martin Byers was elected
president of the Highland County Health Council.
Jefferson — Dr. Alfred P. Lindenmayer, of Ash-
tabula, is the new Ashtabula County Health
Commissioner. He succeeded Dr. Thomas E.
Patton, of Conneaut.
Lancaster — Dr. Wilford D. Nusbaum was gen-
eral chairman of the Lancaster Fairfield County
Sesquicentennial Celebration, June 4-11.
Mentor — Dr. Shelby G. Gamble, Cleveland,
spoke at the annual banquet of the Lake County
Chapter, National Foundation for Infantile
Paralysis, on the subject, “Interesting Side-
lights of Infantile Paralysis,”
Painesville — Dr. John W. Davis has been
named Lake County health commissioner to suc-
ceed Dr. W. H. Willis who resigned.
Shelby — Dr. Dwight M. Palmer spoke at the
annual meeting of the Women’s Guild of Shelby
Memorial Hospital on the subject, “Your Nerves
and How To Live With Them.”
St. Clairsville — Dr. J. B. Martin is acting Bel-
mont County health commissioner. Dr. Homer
S. West resigned as commissioner recently.
Toledo — Dr. Max T. Schnitker discussed “So-
cialized Medicine” before the Mercy Hospital
Alumnae Association.
Toledo — Dr. Roscoe J. Kennedy, Cleveland,
spoke on “Retrobulbar Neuritis” before the lo-
cal Eye, Ear, Nose and Throat Society.
Wapakoneta — Dr. Esta C. Yingling, of Lima,
spoke before the local Rotary Club on the subject
of “Socialized Medicine.”
Washington C. H. — Dr. Byers W. Shaw has
opened his practice here. He formerly was
resident surgeon at Lakeside Hospital.
Wilmington — Dr. Reyburn McClellan, Xenia,
spoke on “Hospital Management” at a meeting
of the Clinton County Registered Nurses Asso-
ciation.
Wooster — Dr. Lincoln L. Moore spoke on “So-
cialized Medicine” before the adult class of the
Methodist Church.
Wooster — Dr. Charles L. Hudson, Cleveland,
presented the medical profession’s point of view
on Socialized Medicine before the Wayne County
Community Forum.
Wooster — Dr. Ebert E. Judd addressed the
Wooster Branch of the Minute Women of Ohio
on the subject of “Socialized Medicine.”
Wooster — Wayne and Medina Counties will be
under one health commissioner starting July 1.
The boards announced appointment of Dr. Earl
E. Kleinschmidt as health commissioner. He
comes to Ohio from Oak Park, 111., with 11
years of public health experience. The district
includes the Wooster board which has long been
combined with the Wayne district.
Youngstown — Dr. John J. McDonough pre-
sented the medical profession’s viewpoint on
national health proposals in a panel discussion
before the Youngstown Business and Profes-
sional Women’s Club.
Zanesville — Dr. Margaret O’Neal, Muskingum
County health commissioner, addressed the Park-
inson P.-T. A.
734
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for July, 1950
735
In Memoriam
• • •
Daniel R. Barr, M. D., Grand Rapids, Ohio;
Toledo Medical College, 1911; aged 64; died
May 24; member of the Ohio State Medical
Association and a Fellow of the American
Medical Association. Dr. Barr began his prac-
tice in Grand Rapids upon completion of his
medical education. From 1915 until 1932 he
was medical director of research for the Taylor
Instrument Co., after which he resumed his prac-
tice in Grand Rapids. He is credited with valu-
able research in connection with the iron lung
and other medical equipment. In addition to
his professional work he was active in civic
and fraternal affairs. He was a member of the
Presbyterian Church, the Exchange Club and
several Masonic orders. He was chairman of
the Wood County Park Board, a member of the
board of directors of the Wood County Red
Cross and served on the executive committee of
the Wood County Democratic Committee. Dur-
ing World War I, he served overseas with the
Red Cross. His widow survives.
Richard A. Brown, M. D., Plain City; Starling
Medical College, Columbus, 1896; aged 77; died
May 27; former member of the Ohio State Medi-
cal Association and the American Medical Asso-
ciation through 1939. Dr. Brown was a trustee
of the Mercy Hospital, Columbus, with which
he had been affiliated since 1917. He was a
member of the Masonic Lodge. Surviving are
his widow, two sisters and a brother.
William F. Emery, M. D., Ashland; Western
Reserve University School of Medicine, 1897;
aged 78; died May 20; member of the Ohio
State Medical Association and a Fellow of the
American Medical Association through 1948;
president of the Ashland County Medical Society,
1932, and delegate of that Society, 1919, 1924,
1925 and 1929. Dr. Emery had practiced medi-
cine in Ashland County for 53 years. Re-
cently he was awarded the 50- Year Pin and
Certificate of the Ohio State Medical Associa-
tion. In additon to his professional services, he
was active in other phases of community activ-
ities; was a member of the Odd Fellows, a past-
president of Rotary Club and a member of the
Lutheran Church. He is survived by a son, Dr.
George M. Emery, also of Ashland.
John P. Farson, M. D., Columbus; Ohio Medical
University, Columbus, 1907; aged 67; died May
30; member of the Ohio State Medical Asso-
ciation and the American Medical Association.
Dr. Farson had practiced medicine in Colum-
bus for approximately 20 years before retiring
about eight years ago. Before coming to Co-
lumbus, he had practiced in Parkersburg, W. Va.
He was on the staffs of Mt. Carmel and Grant
Hospitals and for more than 20 years attended
children at St. Ann’s Hospital. He also was
an instructor in pediatrics at the Ohio State
University College of Medicine. A veteran
of World War I, he was a member of the
American Legion; and the Veterans of For-
eign Wars; he was a member also of the
Presbyterian Church and the Rotary Club. Sur-
viving are his widow; his stepmother, two
brothers and five sisters.
Robert Miller Fulwider, M. D., Hot Springs,
New Mexico; Ohio State University College of
Medicine, 1912; aged 63; died May 4; formerly
a member of the Ohio State Medical Association
and listed in the A. M. A. directory as a mem-
ber of the Colorado State Medical Society and
a Fellow of the American Medical Association.
Dr. Fulwider practiced in Zanesfield before
World War I.
Albert F. Green, M. D., Cleveland Heights;
Eclectic Medical College, Cincinnati, 1886; aged
89; died May 24. Dr. Green practiced his entire
career in Cleveland, retiring in 1937.
Dorrance S. James, M. D., Delaware; Univer-
sity of Cincinnati College of Medicine, 1924;
aged 50; died May 18 while visiting in North
Carolina; member of the Ohio State Medical
Association and the American Medical Associa-
tion; vice-president of the Delaware County
Medical Society, 1929; 1930, 1946 and 1948; pre-
sident, 1931, 1940, 1941 and 1947; delegate,
1925 and 1933. Dr. James began his practice in
Delaware 25 years ago. He was a veteran of
World War II, during which he was with the
Medical Corps. He was a member of the Ameri-
can Legion, several Masonic orders, the Elks
Lodge and was past-president of the Delaware
County Reserve Officers Association. Surviving
are his widow; also his parents, Dr. and Mrs.
J. K. James, of Delaware.
Lloyd L. Jones, M. D., Mexico City, Mexico;
Howard University College of Medicine, 1904;
aged 69; died June 7. Dr. Jones formerly prac-
ticed in Columbus. He was convicted on two
counts for abortion in 1946.
William Clyde Leeper, M. D., Chagrin Falls;
Illinois Medical College, 1905; aged 68; died
May 15; member of the Ohio State Medical
Association and the American Medical Associa-
tion through 1949. Dr. Leeper had been medical
referee for the Travelers Insurance Co. in
Cleveland for 25 years before retiring in 1949.
In addition to his medical work, he was en-
thusiastic about breeding of hunting dogs and
was the owner of Baron Gore, international
champion Irish setter. He was a founder and
active member of the Chagrin Valley Trails
7'-*6
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737
and Riding Club. Surviving are his widow, a
son and a sister.
John S. Lewis, Jr., M. D., Youngstown; Jef-
ferson Medical College of Philadelphia, 1914;
aged 59; died May 19 in a boat accident while
in Canada; member of the Ohio State Medical
Association and a Fellow of the American Medi-
cal Association through 1949; president of the
Mahoning County Medical Society, 1923, and
delegate in 1924; diplomate of the American
Board of Urology; member of the American
Urological Association. Dr. Lewis had prac-
ticed his profession in Youngstown continuously
since being released from the Medical Corps
after World War I. He was a past-president
of the University Club, a trustee of the Youngs-
town Country Club, a member of the Masonic
Lodge and the Baptist Church. Surviving are
his mother and two sisters.
E. U. Marquand, M. D., Coshocton; Ohio Medi-
cal University, Columbus, 1897; aged 82; died
May 4; member of the Ohio State Medical Asso-
ciation and the American Medical Association
through 1948; president of the Coshocton County
Medical Society in 1928. Dr. Marquand had prac-
ticed medicine in Coshocton for more than 50
years, about 25 years each in Conesville and
Coshocton. Recently he was awarded the 50-
Year Pin and Certificate of the Ohio State Medi-
cal Association. Activities included memberships
in the Methodist Church and Masonic Lodge.
Surviving are a son, Dr. Edgar A. Marquand, of
Berwick, Pa., and three sisters.
Charles J. McDevitt, M. D., Santa Barbara,
Calif.; University of Cincinnati College of Medi-
cine, 1911; aged 62; died May 27; member of
the Ohio State Medical Association and the
American Medical Association through 1946;
president of the Academy of Medicine of Cincin-
nati, 1936, and its delegate, 1941-43; diplomate
of the American Board of Urology; member of
the American Urological Association; fellow of
the American College of Surgeons. Dr. McDevitt
was a practicing physician in Cincinnati before
he retired because of ill health about four years
ago. Early in his career, Dr. McDevitt served
with the U. S. Public Health Service, going into
private practice during the middle 20’s. With the
outbreak of World War II, he went into the
Coast Guard as a medical officer. He was a
member of the Catholic Church. Surviving are
his widow, two daughters, three sons, two
sisters, and a brother, Dr. Lester McDevitt of
Cincinnati.
Howad C. Miller, M. D., Youngstown; Western
Reserve University School of Medicine, 1900;
aged 73; died May 14; member of the Ohio State
Medical Association and the American Medical
Association. Dr. Miller had practiced in Youngs-
town since 1901. In addition to his medical
activities, he was active in several Masonic
Orders and the Presbyterian Church. Surviving
are his widow, a son, a daughter and a sister.
James M. Pierce, M. D., Cincinnati; University
of Michigan Medical School, 1923; aged 53; died
May 24; member of the Ohio State Medical
Association and the American Medical Associa-
tion through 1947 ; diplomate of the American
Board of Obstetrics and Gynecology; Fellow of
the American College of Surgeons. Dr. Pierce
came to Cincinnati in 1931 from the University
of Michigan Medical School where he was asso-
ciate professor in the Department of Obstetrics
and Gynecology. In Cincinnati he was assistant
professor of obstetrics at the College of Medi-
cine. Dr. Pierce resigned his position and re-
tired from active practice in 1948 because of fail-
ing health.
Charles Saur, M. D., North Bend; Medical Col-
lege of Ohio, Cincinnati, 1901; aged 70; died
May 18. Dr. Saur had practiced in Norwood
for about 36 years before retiring in 1937.
Surviving are his widow, one daughter and one
son.
Howard Marcus Schriver, M. D., Cincinnati;
University of Cincinnati College of Medicine,
1943; aged 32; died June 11; member of the
Ohio State Medical Association and the Ameri-
can Medical Association. After completing his
internship at General Hospital, Cincinnati, in
1944, Dr. Schriver was commissioned in the
Navy Medical Corps where he held the rank of
lieutenant. He had never recovered from an
infection contracted while on duty in the Pacific
Theater in 1945. Affiliations in addition to
medical organizations included membership in
the Disabled Emergency Officers of the World
Wars. Surviving are his parents, Dr. and Mrs.
L. Howard Schriver, of Cincinnati, and a sister.
Frederick Alden Waltz, M. D., Columbus; Ohio
State University College of Medicine, 1942; aged
32; died May 24; member of the Ohio State
Medical Association and the American Medical
Association. Dr. Waltz was an instructor in
surgery at the O. S. U. College of Medicine and
visiting associate physician for the University
Student Health Service. He was a veteran of
World War II. Surviving are his widow, a son,
a daughter, his father and a brother.
James W. Young, M. D., Belief ontaine; Cleve-
land University of Medicine and Surgery, 1896;
aged 88; died May 26; member of the Ohio
State Medical Association and the American
Medical Association through 1929; president of
the Logan County Medical Society, 1925-26. Dr.
Young had practiced medicine in Logan County
for approximately 54 years. Recently he was
awarded the 50- Year Pin and Certificate of the
Ohio State Medical Association. Dr. Young at
one time operated a private hospital in Belle-
fontaine and was active in the founding of the
Mary Rutan Hospital in 1919. A daughter, two
sisters and a brother survive.
738
The Ohio State Medical Journal
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ment; witnessing operations; ward rounds; demonstra-
tion of cases; pathology; radiology; anatomy; operative
proctology on the cadaver.
PHYSICAL MEDICINE
Didactic lectures and active clinical application of all
present-day methods of physical therapy in internal
medicine, general and traumatic surgery, gynecology,
urology, dermatology, neurology and pediatrics. Special
demonstrations in minor electro-surgery, electrodiag-
nosis, fever therapy, hydrotherapy including colonic
therapy, light therapy.
RADIOLOGY
A comprehensive review of the physics and higher mathe-
matics involved, film interpretation, all standard general
roentgen diagnostic procedures, methods of application
and doses of radiation therapy, both X-ray and radium,
standard and special fluoroscopic procedures. A review
of dermatological lesions and tumors susceptible to
roentgen therapy is given, together with methods and
dosage calculation of treatments. Special attention is
given to the newer diagnostic methods associated with
the employment of contrast media such as bronchography
with Lipiodol, uterosalpingography, visualization of
cardiac chambers, pre-renal insufflation and myelography.
Discussions covering roentgen departmental management
are also included.
ANESTHESIA
A three months full time course covering general and
regional anesthesia, with special demonstrations in the
clinics and on the cadaver of caudal, spinal, field blocks,
etc. ; instruction in intravenous anesthesia, oxygen ther-
apy, resuscitation, aspiration bronchoscopy.)
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Activities of County Societies . . .
First District
(COUNCILOR : D. W. HEUSINKVELD, M. D„
CINCINNATI)
HAMILTON
More than forty physicians were honored by
the Academy of Medicine of Cincinnati at a
meeting on May 9, at which they were presented
50-Year Pins and Certificates of the Ohio State
Medical Association. Dr. David W. Heusinkveld,
Councilor of the First District, made the presen-
tations.
Those so honored are: Drs. Harry W. Behymer,
Albert J. Bell, Robert Carothers, Archibald I.
Carson, John B. Casello, Louis E. Cook, Harry
0. Cooper, James C. Erwin, Otto P. Geier.
Drs. Arthur E. Gillette, Samuel J. Goldberg,
Walter R. Griess, Thomas W. Hays, Daniel
Heyn, Frederick Kattenborn, Edward C. Juler,
Frank A. S. Kautz, E. M. Keefe, Edwin Khuon.
Drs. Frank E. Kugler, Sr., William C. Lang-
don, James T. McKibben, Edward W. Mitchell,
William Mithoefer, George W. Moore, Adolph F.
Morgenstem, Jacob B. Moses, Sr., William Muhl-
berg, Charles T. Pearce, Frank 0. Perry.
Drs. Frank L. Rattermann, Samuel Rothen-
berg, James W. Rowe, Louis C. Schrickel, Eben B.
Shewman, Henry Stanberry, Harry Y. A. Spar-
gur, William Teveluwe, John H. Thesing, Edward
H. Thompson, Henry W. Wiggers, William B.
Young, and Philip Zenner.
Dr. H. M. Platter, Columbus, secretary of the
State Medical Board, was guest speaker for the
occasion. A number of distinguished guests were
present for the special dinner meeting at the
Hotel Alms.
At the May 16 meeting, Dr. Cecil Striker was
chosen president-elect of the Academy. A total
of 475 votes were cast in the election of of-
ficers. Dr. Frank H. Mayfield, elected last year,
is the incoming president.
Dr. Esther C. Marting-Fabing was elected sec-
retary and Dr. Richard D. Bryant, treasurer.
Delegates and alternates were named as follows:
Dr. Joseph Lindner and Dr. Daniel C. Rivers,
three-year terms; Dr. Arthur W. Wendel, delegate
one-year term; Dr. J. Harold Kotte and Dr. Rob-
ert J. Tapke, alternates three year terms.
Dr. William B. Sherman, College of Physicians
and Surgeons, Columbia University, was guest
speaker at the May 16 meeting and spoke on the
subject, “Allergy and Non-Protein Drugs.”
WARREN
The regular monthly meeting of the Warren
County Medical Society was held on May 2
with luncheon at the Golden Lamb, Lebanon.
Dr. Frank Batsche presided.
Second District
(COUNCILOR: M. D. PRUGH, M. D., DAYTON)
CLARK
A movie showing effects of the atomic bomb
and treatment of casualties was shown at the
May 15 meeting of the Clark County Medical
Society. Speaker for the occasion was Dr. George
P. Fitzgerald, Jr., Springfield, who recently at-
tended a session in Washington on aspects of
atomic explosions.
At the final meeting of the season on June 1,
Dr. N. L. Burrell, Springfield, spoke on the
subject, “The Science of Having a Good Time.”
MIAMI
The Honorable Roscoe R. Walcutt, Columbus,
Republican Senate floor leader of the 98th
Ohio General Assembly, spoke on the subject,
“Legislator Prescribes for Doctor,” at the May 4
meeting of the Miami County Medical Society.
The dinner meeting was held at the Troy
Country Club with doctors’ wives and other
guests present.
MONTGOMERY
Hon. Roscoe R. Walcutt, Columbus, Republican
floor leader for the Ohio Senate, was guest
speaker at the June 7 meeting of the Mont-
gomery County Medical Society at the Biltmore
Hotel in Dayton. He discussed civic respon-
sibilities of doctors. A social hour was followed
by dinner and special entertainment.
Third District
(COUNCILOR: J. CRAIG BOWMAN, M. D.,
UPPER SANDUSKY)
MARION
Dr. John R. Haserick, Department of Derma-
tology, Cleveland Clinic, spoke at a meeting of
the Marion County Academy of Medicine on
May 10, where he discussed diagnosis and
treatment of common skin diseases.
Fourth District
(COUNCILOR: CARLL S. MUNDY, M. D., TOLEDO)
LUCAS
The program of the Academy of Medicine
of Toledo included the following features
during May:
General Meeting, May 5 — Preview of new
Academy building.
Section on Pathology, Experimental Medicine
and Bacteriology, May 12 — “Clinico-Pathologic
740
The Ohio State Medical Journal
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Correlation in Acute Hepatitis,” Dr. A. James
French, University Hospital, Ann Arbor, Mich.
General Practice Section — Did not meet because
of the Annual Meeting of the Association.
Medical Section, May 19 — Did not meet be-
cause of the Annual Meeting of the Association.
Surgical Section, May 26 — “An Experience in
Psychosomatic Medicine,” Dr. Herbert C. Modlin,
Menninger School of Psychiatry.
WILLIAMS
Fifty-Year Pins and Certificates of the Ohio
State Medical Association were presented to
seven doctors at a special dinner meeting of the
Williams County Medical Society at the Orchard
Hills Country Club on June 6.
Dr. Carll S. Mundy, Toledo, Councilor of the
Fourth District, made the presentations.
Those so honored are: Dr. Emery A. Bechtol,
Montpelier; Dr. Alfred G. Goll, Stryker; Dr.
James W. Long, Bryan; Dr. Orrin H. Nihart,
Edon; Dr. Horace L. Prouty, West Unity; Dr.
Harry W. Wertz, Montpelier; and Dr. Walter L.
Unger, Bryan.
WOOD
Dr. S. A. Avery, of Toledo, addressed the
Wood County Medical Society May 18 at its
regular dinner meeting at the Midway Restaur-
ant, Perrysburg. His subject was “Office
Urology.” Dr. Ray Whitehead presided.
Dr. Avery’s material was exceptionally well
organized and he discussed particularly the pro-
cedures adaptable to the routine of the General
Practitioner’s office. While in no case was scien-
tific accuracy sacrificed, techniques Were de-
scribed in a simple manner that would enable the
physician to diagnose and treat effectively a
large sector of genito urinary disease.
That the members enjoyed the paper greatly
was attested by the fact that nearly a. full hour
was given to questions and discussion after the
reading. Dr. Avery’s long experience as a
specialist in the field enabled him to reply
concisely to the questions.
A rising vote of thanks was given Dr. Avery.
Fifth District
(COUNCILOR: CHARLES L. HUDSON, M. D.,
CLEVELAND)
CUYAHOGA
The annual distinguished service award of
the Cleveland Academy of Medicine this year
went to Dr. Harry V. Paryzek. The citation,
read by Dr. D. M. Spicer, chairman of the
awards committee, at the May 19 meeting, called
the recipient “a physician whose' personality
has won him the respect, confidence and love of
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The Ohio State Medical Journal
his fellow practitioners, his patients and the
community in which his life has been such a
potent force.” The award was given in absentia,
since Dr. Paryzek was ill and unable to attend
the meeting.
Dr. Paryzek has rendered innumerable serv-
ices both to his county society and to the State
Association. He has been president of the
local society, its vice-president, a director for
six years and has been chairman or member of
a number of committees. He has been Councilor
of the Fifth District for two terms and in 1940
was named President-Elect of the Ohio State
Medical Association and subsequently became
President the following year. He also served
on a number of committees for the Association.
Fifty-Year Pins and Certificates of the Ohio
State Medical Association were presented in
person by Dr. Fred W. Dixon, acting in behalf
of the Association. Those present and awarded
in person are:
Drs. S. L. Bernstein, William E. Bruner, Ed-
win C. Froelich, John J. Friend, C. Lee Graber,
Mary C. Goodwin, W. H. Hyde, Max Kahn, Ben-
jamin B. Kimmel, Louis W. Ladd, Walter I.
LeFevre, Samuel C. Lindsay.
Drs. Alfred S. Maschke, Torald H. Sollmann,
David B. Steuer, H. B. Stotter, John S. Tierney,
Arthur C. Taylor, Samuel J. Webster, William
H. Weir, Norman C. Yarian.
The following physicians were awarded the
Pins and Certificates in absentia:
Drs. Frank P. Charvat, William E. Cleveland,
Herbert L. Davis, Roy C. Eddy, Frank J. Geib,
Bernard Levenberg, Charles F. Nelson, Frank
A. Oakley, Willis T. Parsons, Edwin H. Season
and George D. Upson.
The following physicians, approved to receive
the awards, are now deceased:
Drs. Thomas Burke, Ira B. Gordon, K. K.
Hastings, Frank C. Kopfstein, Paul H. Krebs,
and Archibald C. Nash.
Dr. Paul R. Hawley, director of the American
College of Surgeons, was principal speaker for
the occasion.
The Academy voted to establish a blood bank
in cooperation with the Cleveland Hospital Coun-
cil. The Academy made its decision after an
extensive survey of needs made by a committee
headed by Dr. Benjamin Kline and Dr. Francis
Bayless.
Dr. Charles S. Higley was elected president
of the Cleveland Academy of Medicine at the
May 26 meeting. Other officers elected are Dr.
Francis Bayless, vice-president, and Dr. J. D.
Osmond, Jr., secretary-treasurer (reelected).
LAKE
Dr. Howard L. Taylor, Cleveland, spoke before
the Lake County Medical Society at the May 9
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for July, 1950
743
meeting in Painesville on the topic, “Analgesia
and Anesthesia in Obstetrics.”
Dr. M?.rion E. Black, Cleveland, spoke before
the Medical Staff and Trustees of Lake County
Memorial Hospital, Painesville, on May 10. His
subject was “Present Trends in Obstetrics.” Dr.
Paul Reading was chairman of both meetings.
A medical answering bureau for all doctors
in Lake County is scheduled to be started
July 1, it was announced following the June 13
meeting of the Society. The participating doc-
tors will be covered 24 hours a day. Each phy-
sician will designate two of his colleagues to
cover for him in case he is not available for calls.
Dr. Thomas Byrne, vice-president, presided
at the meeting at the Painesville Hospital. Dr.
B. S. Park introduced Dr. Walter B. Lacock,
Columbus, chief of the Divsion of Chronic Dis-
eases of the Ohio Department of Health, who
spoke on “The Epidemiological Study of Can-
cer.”— F. J. Dineen, M. D., Public Relations
Chairman.
Sixth District
(COUNCILOR: PAUL A. DAVIS, M. D„ AKRON)
SUMMIT
Two doctors of the Henry Ford Hospital,
Detroit, Mich., conducted the scientific program
at the June 6 meeting of the Summit County
Medical Society held in the Nurses’ Home of
City Hospital.
Dr. Howard P. Doub, chief of the Department
of Radiology, spoke on “Roentgen Aspects of
Rheumatoid Arthritis and Ankylosis Arthritis
of the Spine”; Dr. Dwight C. Ensign, director
of the Arthritis Clinic, discussed, “Rheumatoid
Arthritis; Newer Aspects of Treatment.”
TRUMBULL
A joint meeting of the Trumbull County
Medical Society and the Auxiliary was held at
the Warner Hotel, Warren, on May 24. Dr. C.
R. Brown, Warren, gave a travelogue on a
recent trip to Central America including colored
moving pictures.
Seventh District
(COUNCILOR: R. J. FOSTER, M. D„ NEW
PHILADELPHIA)
BELMONT
Dr. Edward C. Jenkins, Delaware, was guest
speaker at the June 15 meeting of the Belmont
County Medical Society. His subject was “Medi-
cal and Surgical Management of Diaphragmatic
Hernia.” The meeting was a special event at
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The Ohio State Medical Journal
the Barnesville Memorial Park with a picnic
dinner followed by swimming and an evening
of entertainment. Members of the Auxiliary
took part in the meeting.
TUSCARAWAS
Dr. S. E. Kerr, Massillon, spoke before the
May 11 meeting of the Tuscarawas County
Medical Society in New Philadelphia on phases
of pathology. At a business session the county-
wide educational nursing program was approved.
Dr. W. E. Hudson, president, was in charge of
the meeting.
Eighth District
(COUNCILOR: CHESTER P. SWETT, M. D., LANCASTER)
GUERNSEY
The Guernsey County Medical Society met in
regular session at noon on April 20 at the Ber-
wick Hotel. Dr. Reo Swan, president, reported
that Mr. Garver of the Guernsey County Relief
Agency stated that his agency will reimburse
physicians for medical services according to the
fee schedule of the Division of Aid for the Aged.
Dr. Swan also stated that he would contact
Miss Margaret Brown of the Aid for Dependent
Children and Aid for the Blind County Agency
and would make arrangements for the Guernsey
County Medical Society members to provide
services for these beneficiaries, again according
to the fee schedule of the Division of Aid for the
Aged.
Dr. Earl E. Conaway was in charge of the scien-
tific program and presented a very interesting
and complete review of the status of B. C. G.
vaccination against tuberculosis. According to
his report, B. C. G. vaccine has proven effective
to a practical degree in mass immunization
against tuberculosis, either preventing or at-
tenuating tuberculosis infection in a significant
percentage of instances. His final thought was
that B. C. G. vaccinations may eventually be
used on a wide scale in the United States.
At the June 1 meeting, Dr. William W. Bryant
was admitted to membership in the Society by
unanimous vote.
Mr. Charles Moore, president of the Board
of Trustees of Guernsey Memorial Hospital, was
introduced and spoke regarding the proposed
building of a combined professional building and
nurses’ quarters. It was stressed by Mr. Moore
that it is the wish of the hospital trustees to
learn whether or not such a building would be
an asset to the Guernsey Memorial Hospital
and whether or not a sufficient number of doctors
would be interested in securing office space to
justify the construction of such a building. Mr.
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7 45
Moore stated that if such a building were con-
structed it would be owned and operated by
the hospital and that any doctor or dentist
would be eligible to secure office space therein.
Post cards were distributed to all members re-
questing that they express their opinions regard-
ing the proposal.
The scientific program was in charge of Dr.
Robert Ringer, delegate to the Ohio State Medi-
cal Association. Dr. Ringer gave an interest-
ing and comprehensive report of the Annual
Meeting held in Cleveland, May 16-18, cover-
ing not only high lights of the House of Dele-
gates’ sessions, but also several of the scientific
papers. Much thought and discussion was
devoted to (1) socialized medicine, and (2) the
proposed Ohio law which would provide com-
pulsory temporary disability insurance for non-
occupational illness and injuries.
Scientific papers reviewed by Dr. Ringer in-
cluded those on “Obstetrical Analgesia,” “Re-
suscitation of the Newborn,” and “Metabolic
Effects in Man of ACTH and Cortisone.”
Dr. Swan, who also attended the State meet-
ing, spoke on several of the interesting and edu-
cational features which he attended. — Gordon
Lawyer, M. D., secretary-treasurer.
MUSKINGUM
At the June 7 meeting of the Muskingum
County Academy of Medicine, Dr. Ward D.
Coffman, Chicago, described gynecological diag-
nostic procedures at the Chicago Lying-in Hos-
pital. Members of surrounding county societies
were guests at this meeting in Zanesville.
Ninth District
(COUNCILOR: J. PAUL McAFEE, M. D.,
PORTSMOUTH)
SCIOTO
Dr. Jonathan Forman, Columbus, Editor of
The Ohio State Medical Journal, spoke on the
subject, “Soils, Food, and Health,” at th,e
June 12 meeting of the Hempstead Academy of
Medicine. The meeting was held in the Nurses’
Recreation Hall, General Hospital, with a buffet
luncheon.
Eleventh District
(COUNCILOR: JOHN S. HATTERY, M. D„ MANSFIELD)
ERIE
Three doctors were honored for more than 50
years of medical service by the Erie County
Medical Society at a special meeting held in
the Providence Hospital, Sandusky. They were
each presented the 50-Year Pin and Certificate
of the Ohio State Medical Association. The
three honored doctors are: Dr. W. A. Crecelius
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The Ohio State Medical Journal
and Dr. Emily Blakeslee, both of Sandusky, and
Dr. William T. Sullivan of Kelleys Island.
Dr. John S. Hattery, Mansfield, Councilor of
the Eleventh District, made the presentations.
Dr. Herbert H. Johnson, Cleveland, was guest
speaker for the occasion. The meeting was held
on May 25 with members of the Auxiliary
present.
LORAIN
Dr. Harry R. Trattner, Cleveland, was guest
speaker at the June 13 dinner meeting of the
Lorain County Medical Society at the Lorain
Country Club. His subject was “Diseases of the
Prostate.”
MEDINA
Activities of the Medina County Medical So-
ciety included the following programs during
1950:
Jan. 19 — Lecture by Dr. J. E. Brown, Cleve-
land; subject, “Fractures of Lower Extremity.”
Feb. 16 — Lecture by Dr. R. F. Jukes, Akron
•Clinic; subject, “Management of Heart Failure.”
March 23 — Lecture by Dr. Robert E. Brubaker,
Akron Clinic; subject, “Pitfalls of Gall Bladder
Surgery.”
April 20 — Dr. J. E. Brown concluded a series
of interesting lectures on the “Treatment of
FTactures.” — Herbert F. Cowgill, M. D., Secy.
RICHLAND
Members of the Richland County Medical So-
ciety and the Medical Staff of Mansfield Gen-
eral Hospital met at the hospital on May 25
for a dinner meeting. A short business meeting
followed the dinner, after which the program
was presented.
The speaker was Dr. William D. Holden, pro-
fessor of surgery, Western Reserve University
School of Medicine. His subject was, “Prob-
lems in Diagnosis and Treatment of Peripheral
Vascular Diseases.” — C. 0. Butner, M. D., secre-
tary.
TO BE A GOOD CITIZEN, YOU MUST
BE REGISTERED TO VOTE
Woman’s Auxiliary . . .
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
President — Mrs. George W. Cooperrider, 1828 Bryden Road,
Columbus
President - Elect — Mrs. Farrell Gallagher, 1483 W. Clifton
Blvd., Lakewood
Vice-President — Mrs. E. P. Greenawalt, 1707 St. Paris Road,
Springfield
Recording - Secretary — Mrs. Ross Knoble, 219 - 44th St.,
Sandusky
Corresponding Secretary — Mrs. Oscar Jepsen, Canal Win-
chester
Treasurer — Mrs. A. Paul Hancuff, 3551 Maxwell Road,
Toledo 13
Past-President — Mrs. C. W. Kirkland, 4805 Guernsey Street,
Bellaire
ASHTABULA
Mrs. Paul Longaker was elected president of
the Woman’s Auxiliary to the Ashtabula County
Medical Society at a dinner meeting on May 16
held at the Hotel Ashtabula. There will be no
further meetings until fall. Also elected to of-
fice at the May meeting were: Mrs. John O’Bell
as president-elect; Mrs. E. N. Wright, vice-
president; Mrs. James Macaulay, secretary; and
Mrs. Richard Irving, treasurer.
ERIE
The Plum Brook Country Club was the scene
in April of “The Doctors’ Party” given by the
Erie County Auxiliary for members of the
County Medical Society. Program participants
were introduced by Mrs. E. J. Meckstroth, gen-
eral chairman. Musical selections were presented
by five members of the Sandusky High School
band. “The Clintonaires,” a quartet, sang a
group of harmony numbers. Principal speaker
of the evening was Lou Klewer, outdoor editor
of the Toledo Blade. Mr. Klewer, a country-
wide traveler, supplemented his vivid account of
a recent visit to Alaska with interesting and
scenic colored films.
Assisting Mrs. Meckstroth on the committee
were Mrs. W. F. Burger, Mrs. Herbert Kesinger,
Mrs. W. R. Liebschner, Mrs. Watson Parker and
Mrs. Ross Knoble.
The Erie County Auxiliary ended its 1949-50
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Catalogue on Request
G. H. MARQUARDT, M. D.
Medical Director
BARCLAY J. MacGREGOR
Registrar
29GenevaRd., Wheaton, Illinois (near Chicago)
for July, 1950
747
season on May 8 with a luncheon and installation
of officers at the Business Women’s Club. The
new officers, installed by the retiring president,
Mrs. Carl E. Swanbeck, included: Mrs. E. J.
Meckstroth, president; Mrs. H. W. Lehrer,
president-elect; Mrs. Paul N. Squire, vice-
president; Mrs. C. J. Reichenbach, secretary;
and Mrs. A. G. Groscost, treasurer. A musical
program was presented by the Almar Trio.
FAIRFIELD
The May meeting of the Auxiliary to the
Fairfield County Medical Society was a tea
given for the junior and senior girls of city and
county schools at the Nurses’ Home, Lancaster-
Fairfield Hospital. The tea is an annual event,
as part of the nurse-recruitment program. Mrs.
Galen Rodabaugh introduced the speaker, Miss
Florence Steel, who told the young women of
the requirements of a student nurse. Miss Steel
is nursing arts instructor at the local hospital.
Subsequently, a tour of the hospital was con-
ducted by student nurses for the girls, after
which tea was served. Mrs. Chester P. Swett
and Mrs. W. S. Jasper presided at the table.
Mrs. Rodabaugh was general chairman for the
event, with Mrs. Jasper and Mrs. C. F. Clark
as her assistant chairmen.
HURON
Mrs. William Kauffman was elected president
of the Huron County Auxiliary at its luncheon
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The Ohio State Medical Journal
meeting on May 12 at the home of Mrs. George
Linn. Chosen by the Auxiliary to serve with
Mrs. Kauffman were: Mrs. Clyde Cranston, presi-
dent-elect; Mrs. Walter Drury, vice-president;
Mrs. John Emery, secretary; and Mrs. C. H.
Edel, treasurer.
The group voted to sponsor a student nurse.
The scholarship will be given to the high school
student who rates in the upper third bracket
of her class at graduation. Mrs. C. E. Swan-
beck, district director, attended the May meet-
ing and addressed the auxiliary members.
KNOX
The Woman’s Auxiliary to the Knox County
Medical Society closed its meetings for the sea-
son with a luncheon at the Alcove on May 26.
Mrs. James F. Lee and Mrs. John C. Woodland
were hostesses.
Mrs. J. L. Baube presided at the business
session. Mrs. Charles Tramont reported on the
state convention at Cleveland, and Mrs. 0. W.
Kapp, To-Day’s Health chairman, announced that
the Knox County Auxiliary had won a prize of
ten dollars in the state-wide contest making first
place in the Group II classification.
Tentative plans were made for a display booth
on health at the Knox County Fair. Mrs.
Henry Lapp, chairman of the nominating com-
mittee, announced these officers for the coning
year: president, Mrs. C. E. Cassaday; president-
elect, Mrs. Alexander Mack; vice-president, Mrs.
I. S. Rian; secretary-treasurer, Mrs. Richard
Gomer.
LICKING
The Hotel Warden was the scene on May 23
of the dinner meeting of the Licking County
Auxiliary. Mrs. Roland Jones, president, presided
at the business session and presented an inter-
esting resume of the Cleveland convention.
Guest speaker was Miss Rosemary Kuster who,
two years ago, was awarded the nursing schol-
arship presented annually by the auxiliary.
Miss Kuster reviewed her work at the Good
Samaritan Hospital School of Nursing in
Cincinnati.
LOGAN
The Logan County Auxiliary concluded its
season’s program with a covered dish luncheon
May 23 at the home of Mrs. Warren Mills. Mrs.
Blair Webster conducted the business meeting.
Mrs. Mills reported on the state convention at
Cleveland. New officers chosen for the coming
year included: Mrs. C. K. Startzman, president;
Mrs. Hobart Mikesell, vice-president; Mrs. John
B. Traul, secretary; Mrs. John Maurer, treas-
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PICKAWAY
YOUR PATIENTS . . .
The Woman’s Auxiliary to the Pickaway
County Medical Society held its May meeting
at the home of Mrs. Walter Heine. A report of
the state convention at Cleveland was given, and
memberships on standing committees announced.
Plans were made for a covered dish luncheon to
be held in June.
RICHLAND
Mrs. H. G. Knierim was installed as president
of the Richland County Auxiliary at its annual
meeting on May 22 at the Women’s Club. Other
officers installed with Mrs. Knierim were: Mrs.
Charles Brown, Sr., president-elect; Mrs. A. H.
Voegele, vice-president; Mrs. Robert Pierce, rec-
ording secretary; Mrs. Sigmund Smedal, cor-
responding secretary; and Mrs. Milton Oakes,
treasurer.
Mrs. F. J. Heringhaus, the retiring president,
conducted the business session. Annual reports
and state reports were given, and a letter of
commendation was read from Dr. Harry Wain
for the Auxiliary’s participation in the well
baby clinic during the past year. Mrs. Robert
Crawford and Mrs. F. M. Wadsworth were named
as members of the citizens’ committee for the
council for the summer months.
The luncheon tables were attractive with ar-
rangements of lilacs and tulips. Mrs. Robert
Pierce and Mrs. Leonard Hautzenroeder served
as hostesses.
A. M. A. Distributes 1,912 Films
Ralph P. Creer, secretary of the A. M. A.
Committee on Medical Motion Pictures, reports
that a total of 1,912 films were shipped to various
medical groups during 1949 as compared with
1,750 in 1948. His report shows that 45 medical
societies used 177 films; 54 medical schools, 408
films; 36 veterans administration hospitals, 205
films; 190 civilian hospitals, 624 films; 10 service
hospitals, 53 films, and miscellaneous groups,
445 films.
The American Congress of Physical Medicine
will hold its 28th annual scientific and clinical
session August 28 - September 1, 1950, at the
Hotel Statler, Boston, Mass. All sessions will
be open to members of the medical profession
in good standing with the American Medical
Association. Further information may be ob-
tained by writing the Congress at 30 N. Michigan
Ave., Chicago 2, 111.
The annual convention of the National So-
ciety for Crippled Children and Adults will be
held October 26-28, 1950, at the Stevens Hotel,
Chicago. Further information may be obtained
from the Society at 11 S. LaSalle St., Chicago 3.
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Thoracic Surgery, one week, starting Oct. 9. Gall-
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weeks, starting Sept. 11.
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OBSTETRICS — Intensive Course, two weeks, starting
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MEDICINE — Intensive General Course, two weeks,
starting Oct. 2. Gastro-enterology, two weeks, start-
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The Ohio State Medical Journal
Dr. Wilzbach Named President of Ohio
Public Health Association
Dr. Carl A. Wilzbach, Cincinnati, chairman
of the Committee on Education of the Ohio
State Medical Association, and Cincinnati health
commissioner, became president of the recently-
organized Ohio Public Health Association at a
meeting of that organization in Columbus
May 11 and 12.
Dr. Wilzbach succeeded Dr. F. E. Mahla,
Toledo, health commissioner of Lucas County,
Dr. F. E. Mahla (right) is shown as he relinquished the
presidency of the Ohio Public Health Association to Dr.
Carl A. Wilzbach at the annual meeting in Columbus.
■who was chosen as president at a meeting in
October, 1949, during which the Association was
brought into existence as an outgrowth of the
Ohio Federation of Public Health Officials.
The Association chose Vera Glover, R. N., of
Cuyahoga County General Health District, as
president-elect, and Dr. Harry Wain, Mansfield,
Richland County health commissioner as dele-
gate to the American Public Health Association.
W. R. Haines, Sanitarian, Northwest District
Office, Ohio Department of Health, Bowling
Green, was reelected as secretary.
Dr. Jonathan Forman, Editor, The Ohio State
Medical Journal, spoke before the Health Com-
missioners’ section of the meeting on “Introduc-
tion of Asiatic Cholera into Ohio.” Other speak-
ers at the Association’s meeting included Dr.
Granville W. Larimore, director of public health
education, New York State Health Department;
Mr. Raymond Lenart, Extension Service Con-
sultant, the Ohio State University; Elizabeth
Lovell, M. P. H., director of public health edu-
cation, North Carolina State Board of Health;
Dr. Henry Eisenberg, medical officer in charge
of the Central Ohio Rapid Treatment Center;
Dr. John A. Prior, associate professor, Depart-
ments of Medicine and Preventive Medicine, Ohio
State University College of Medicine; and Dr.
Thomas E. Parran, dean, Graduate School of
Public Health, University of Pittsburgh.
Registration for the meeting was approxi-
mately 450. Members voted to present recog-
nition awards each year for outstanding work
in public health.
The Executive Committee of the A. M. A.
selected Dr. Austin Smith, editor of the
A. M. A. Joiu'nal, to serve in the Division of
Medical Sciences of the National Research Coun-
cil. He succeeds Dr. R. L. Sensenich, South
Bend, past-president of the A. M. A., who could
not succeed himself as a representative of the
council. Dr. Smith will serve a three-year term,
ending June 30, 1953.
A one-day seminar on heart and circulatory
diseases wTas held by the Southwestern Division
of the Ohio Academy of General Practice at the
Gibson Hotel in Cincinnati on May 14.
Dr. Maurice Levine, head of the Department
of Psychiatry, University of Cincinnati College
of Medicine, has been designated to head an
estimated 300 American psychiatrists who will
attend the first International Congress of Psy-
chiatry, Sept. 18-26, in Paris, France. He was
elected as president of the American delegation
by the delegates. At the Congress he will lead
a seminar on the development of American psy-
chiatry in the last 20 years.
RESTHAVEN
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For descriptive folder, call or write
M. YOUNG, Business Manager
Telephone FA. 2535 or FA. 4893
813 Bryden Road Columbus, Ohio
for July, 1950
751
Federal Income Tax Laws Unfair
To Professions, Says Economist
Present Federal income tax laws discriminate
against physicians and other professional men
and women, Frank G. Dickinson, Ph. D., Chicago,
economist and statistician of the American Medi-
cal Association points out.
Because a considerable portion of physicians’
lifetime earnings are “bunched” into a relatively
few peak earning years they pay more income
taxes than other persons who receive the same
lifetime incomes spread more evenly over a
greater number of years, Dr. Dickinson says in
an article in a recent issue of the Journal
of the A. M. A.
This discrimination in lesser degree applies to
a number of other professions, according to the
article.
“A physician undergoes a long training period
(the longest among the professions) during
which he foregoes income and incurs expenses
accumulating to approximately $35,000 at the
time of entering medical practice, at approxi-
mately age 28,” Dr. Dickinson says. “The work-
ing lifetime remaining after this prolonged
period is shortened.
“To pay off this investment in training in
annual installments, his annual gross earnings
would have to be at least $5,000 more than
those of a person whose earning period started
at age 18.
“Under the 1942 Federal Internal Revenue
Code, funds used by companies for the purpose
of providing employees with pensions or shares
in profit-sharing trusts are deductible from
gross receipts as business expenses and thus
are not a taxable part of the employer’s or
company’s income, if the particular plan is ap-
proved by the Bureau of Internal Revenue.
“Since the provisions are restricted to em-
ployees, professional men who can qualify as
employees — for example, company lawyers and
company physicians — can receive the benefits of
these pensions and profit-sharing trusts, while
those who conduct their professions as single
proprietorships or partnerships may not qualify
for these benefits.
“The Board of Trustees of the American Medi-
cal Association authorized its representatives
to record, at a meeting of the Association of the
Bar of the City of New York, its support, in
principle, of the proposal that the Internal
Revenue Code be amended to permit physicians
who practice as individual proprietors or part-
ners to declare as business expenses the costs
of pension programs for themselves, with
the proviso that there should be a reasonable
maximum pension.
“The American Medical Association believes
that such an amendment would appreciably re-
duce the present discrimination.”
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The Ohio State Medical Journal
Patients Who ‘Pay’ Get Service Under
‘Free’ British Medical System
The following letter which describes phases
of the British Medical system was relayed to
the Headquarters Office by a Columbus physi-
cian. It was written to a New Jersey doctor
by a former patient. As the doctor who for-
warded the letter remarked, “if the proof of
the pudding is in the eating thereof, the English
pudding seems to be a particularly unsavory
failure in this case.”
December 15, 1949
Dear Doctor . . .:
Today I read in the European Edition of the
Herald Tribune an article that so angered me
that it prompted this letter to you, as secretary
of the . . . Medical Association and, of course,
as the doctor who delivered our second baby on
April 15, 1946. . . .
Our family has been living in England for
over three months and my husband was here
an additional three months this summer. So far
we have had four different physicians attend
us personally and we have heard the comments
of numerous American and British friends on
their medical attention here. So when Mr. Oscar
Ewing comes to England for one week to study
“British problems in the fields of health, edu-
cation and social welfare,” talks with five doc-
tors, and then proceeds to say that “the British
service is a ‘terrific success’ as far as the pa-
tients are concerned” and that the “program
has been misrepresented by so many Americans
who should know better,” I feel personally
called upon to object.
Before coming over here, we were mildly, but
inactively, opposed to socialization of medical
care in the United States; but now we feel that
we should warn the voters at home of the
horrible consequences if they should accept such
a program. Here are some examples taken
from many instances that we know are true and
unexaggerated accounts of what happens in the
average English family.
First of all, to have a baby in a hospital
you must make all arrangements thirteen months
(sic) in advance. Someone might think that
this is necessary because of crowded conditions,
but if you pay as a private patient, as an
American friend of mine did, you may get a
room almost immediately. My friend reported
that during her stay in the hospital the attend-
ing doctor left the actual delivery of all babies
to a nurse, including one breech and one pre-
mature delivery. She could not help concluding
that the only reason he personally delivered
her baby was that she was paying as a private
patient. When the government pays the bill,
there is little reason for the patient being sat-
isfied and no recourse if he is not.
A British executive we know has been wear-
ing cracked glasses with adhesive tape holding
one lens together. He explained that after
waiting weeks for an eye examination, he was
given a prescription for new glasses that would
be filled in six months. He knew that he was
paying indirectly for these glasses and didn’t
want to buy a pair privately thereby paying
twice. He could have bought a new pair pri-
vately within two weeks.
When we Americans want dental care in Eng-
land, we call up for an appointment as a pri-
vate patient and see the dentist within a week’s
time; but an Englishman waits five to six months
under the medical plan. Incidentally, I have
yet to hear of a foreigner taking advantage of
the free medical attention which he could get
here.
A British lady told me recently that she ought
to have a large growth on her lip removed, be-
cause it was irritating as well as unsightly.
She was reluctant to go to a surgeon as a pa-
tient under the so-called plan, because she knew
that he would not do the job himself, but would
let one of his assistants do it. However, she
knew that she could receive his attention as a
private patient, and thus be assured of a good
job while paying for it.
Summing up the patient’s viewpoint, let me
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NEIL TRAINING SCHOOL
Registered by the American Medical Association
For Retarded and Exceptional
Children
Individual attention given to educational, emotional
and speech problems. Highly-trained teachers and
supervisors.
Suburban Estate Day and Boarding Pupils
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for July, 1950
753
say that he has little choice of doctors, no way
of getting medical supplies or attention when
they are needed, and no reason for satisfaction
from the doctor or the hospital treating him.
When he lets the government pay the bill, he
surrenders the innate power of his own purse.
I realize that this is a sketchy picture and
one that is purely from the patient’s viewpoint;
but I am sure that you know already the
mechanics of the British medical plan, and the
doctors’ side of the story. It occurred to me
that I had not read much in the A. M. A.’s
publicity campaign which gave the patient’s
reaction to socialized medicine, hence this
outburst.
Before we left the States, several doctors we
know asked us to let them know how we liked
the British medical plan. This letter answers
that question in part. We want to send to them
and to you our best wishes for a merry
Christmas and a happy New Year without so-
cialized medicine.
Sincerely,
Fifteen Million Veterans Benefit
Under GI Bill
June 22 was the sixth birthday of the GI
Bill, a law passed in 1944, to help World War II
veterans get back into the swing of civilian
living.
During the six years the act has been in
effect, a majority of the nation’s 15,300,000
World War II veterans have benefited by one or
more of its three major provisions.
Those provisions are education and training
at Government expense; Government-guaranteed
and insured loans for homes, farms and busi-
nesses, and a readjustment allowance program
to help tide veterans over during periods of
unemployment or slack self-employment.
Some 7,000,000 ex-servicemen and women, at
some time or another, have attended school or
trained on-the-job or on-the-farm under the
law’s educational provisions. This program so
far has cost more than $10 billion for tuition,
supplies and subsistence allowances.
Altogether, the veterans spent a total of
95,000,000 months in the classroom, at the
work bench and on the farm, or an average of
about 15 months of training per veteran.
Only four per cent of all veterans who have
been in training — or around 300,000 — have ex-
hausted their entitlement to further GI Bill
training.
Under the law, most veterans must start their
courses by July 25, 1951, if they want to con-
tinue on after that date. The final cut-off, for
most veterans, comes on July 25, 1956.
More than $11 billion of GI loans have been
obtained by 2,100,000 World War II veterans
during the six years of the GI Bill.
Ninety-two per cent of the veterans’ loans,
or 1,940,000, were for homes. Another 121,000
were for businesses, and the remaining 57,500
were for farms and farm equipment.
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American Meat Institute 660
Ames Company, Inc 658
Ann Arbor School, The 744
Ayerst, McKenna & Harrison, Ltd. 647
Battle Creek Sanitarium 745
Bell, Kathryn S., Inc. 750
Birtcher Corporation _. 743
Borden Company . 731
Bowen, Charles F., M. D. , 752
Camel Cigarettes _ 721
Cincinnati Sanitarium 654
Clinical and Pathological Laboratory 749
Columbus Orthopaedic Appliance Co 749
Continental Casualty Co 735
Cook County Graduate School of Medicine 750
Cordelia of Hollywood 737
Endo Products, Inc. 723
Fleet, C. B., Company, Inc. 657
Hanger, J. E., Inc. 752
Harding Sanitarium 655
Holland Rantos Co. 725
Ingleside Home, Inc . 741
Lederle Laboratories, Inc. 659
Lilly, Eli, and Company Insert Between
Pages 660 and 661
Luzier’s, Inc 727
McMillen Sanitarium 654
Mead Johnson & Company Back Cover
Medical Protective Company 746
Medico Press, The 742
Mercer Sanitarium, The 655
Miller, W. H.. M. D 748
Neil Training School 753
Nes tie’s Company, Inc... 741
New York Polyclinic Medical School... 739
Num Specialty Company 753
Oak Ridge Sanatorium 656
Parke, Davis & Company 756 and
Inside Back Cover
Picker X-Ray Corp. 729
Pogue, The Mary E., School.. 747
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Quincy X-Ray & Radium Laboratories 753
Radium Emanation Corporation 739
Resthaven 751
Rupp & Bowman Company 746
Sawyer Sanatorium 645
Schering Corporation 719
Searle, G. D., & Company 715
Stoneman Press 748
Wendt-Bristol Company 744
Wickhaven Sanitarium _.. 655
Windsor Hospital 655
Winthrop-Stearns, Inc. — 649
Wyeth, Inc : 733
Zemmer Company 755
754
The Ohio State Medical Journal
“But, Doctor,
what's a meal without potatoes / TT
I’ve eaten spuds all my life . . •
don’t take them away from me!’9
And it takes a doctor with enduring patience to face such pleading every
day. It's a patience soon worn thin if the physician hasn't prescribed Efroxine
Hydrochloride.
Efroxine is a logical adjunct in the management of obesity. Efroxine offers
a number of advantages over other sympathomimetic amines:
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for August, 1950
763
*7<4e PUyiiciajth feo&k<eljj
By JONATHAN FORMAN, M. D.
Attorneys’ Textbook of Medicine, by Roscoe N.
Gray, M. D. ($35.00. Two Volumes. Third Edi-
tion. Matthew Bender & Company, Inc., Al-
bany, N. Y.). The author, who is Surgical Di-
rector of Aetna Casualty and Surety Company,
has revised the 1940 edition in order to include
the medical and surgical advancements which
have increased with unusual rapidity during
and after World War II. The section on men-
tality has been expanded, and new chapters
written on amnesia, apoplexy, epilepsy, and al-
cohol tests for drunkenness. Brain activity as
demonstrated by the electroencephalogram is
discussed. Chapters generally deal with the
cause, symptoms, diagnosis, and treatment of
the disorder involved, with an additional title
“Investigation” containing advice regarding the
legal manifestations. At the end of each chap-
ter are extensive bibliographical references.
The author points out that doctors and law-
yers hold key positions in the administration of
liability and compensation claims, and upon their
ability the jury or commission depends for a
clear understanding of the facts, both legal and
medical. Therein, lies the importance of this
text, not only to the attorney, but to the
physician.
The two volumes include 186 chapters and a
comprehensive index, each separately stitched,
and easily removable from the sturdy leather
binding if convenience indicates.
Dr. Gray’s Attorneys’ Textbook of Medicine
is extremely worth-while reading and is highly
recommended to all physicians in Ohio who are
particularly concerned with industrial insurance,
general disability and workmen’s compensation
cases.
Progress in Allergy, edited by Paul Kallos,
Halsingborg, Sweden. ($7.50. Volume II. S.
Karger, Basel, Switzerland, Interscience Pub-
lishers, Inc., New York City, Agents), again il-
lustrates the difficulties of producing a yearbook
on an international basis. It always seems to
be impossible to secure uniformity in the quality
of the various papers, and the most famous man
does not always set the standard. Nevertheless
this is a book well worth having. Others have
objected because authors have been permitted to
air their own particular hobbies. Your reviewer
can see no objection to this for if this objection
were followed to its logical conclusion, then our
medical literature would consist of one text in
each field assembled by a committee. There
would be no medical magazines and very little
program. In keeping with the history of allergy,
most of the contributors are Americans. Books
such as this seem to me to be the best methods
in which to get a look at the progress of a
specialty the world over. This is especially true
in a rapidly developing field such as allergy.
Black’s Medical Dictionary, by J. D. Comrie,
M. D., edited by W. A. R. Thomson, M. D. ($5.50.
Nineteenth Edition. The Macmillan Co., New
York City), lands somewhere between a techni-
cal dictionary of medicine and a guide to do-
mestic treatment of the more common ailments.
It gives information in intelligible language on
medical subjects of general interest. This edi-
tion incorporates recent advances in all branches
of medicine and discards out-of-date material.
The Common Form of Joint Dysfunction, by
William Kaufman, M. D., (E. L. Hildreth & Co.,
Brattleboro, Vermont), is a discussion of its in-
cidence and treatment. This is a monograph
recording the observations made in private prac-
tice over a period of years. Objective measure-
ment of impaired joint mobility is carefully
measured and recorded to show that it is corrected
or greatly relieved by adequate niacinamide
therapy and recurred in time when this treat-
ment was discontinued.
Length of Life, by Louis I. Dublin, Alfred J.
Lotka and Mortimer Spiegelman ($7.00. Ronald
Press, New York City), is a sound statistical
study by the chief of statistics for the Metro-
politan Life Insurance Company. The authors
trace and interpret the improvements in health
and longevity from the earliest times to the
present. The authors predict the addition of
another five years to life expectancy in the
United States by 1975.
Infection and Sepsis in Industrial Wounds of the
Hands, A Bacteriological Study of Aetiology
and Prophylaxis, by R. E. O. Williams and A. A.
Miles (Is 6d net. His Majesty’s Stationery Office,
London, England), is an official summary of
the British experiments and experiences from
1942 up to 1945 of war wounds.
The Diagnosis of Pancreatic Disease, by Louis
Bauman, M. D. ($5.00. J. B. Lippincott Co.,
Philadelphia), is a much needed monograph dis-
cussing the function tests and their application in
the diagnosis of disease of this organ. The au-
thor brings together twenty-five years of clinical
and teaching experience in the task of writing
this book.
Brain and Behaviour, by N. E. Ischlondsky,
M. D. ($7.00. C. V. Mosby Co., St. Louis, Mis-
7 64
The Ohio State Medical Journal
souri), is an experimental and clinical study of
induction as a fundamental mechanism of neuro-
psychic activity with consideration of the edu-
cational, mental-hygienic, and social implications.
A Short Practice of Surgery, by Hamilton
Baily, F.R.C.S.,' and R. J. McNeill Love, F.R.C.S.
($10.00. Eighth Edition. Williams & Wilkins
Co., Baltimore, Maryland), is written in the
concise yet precise manner of the British sur-
geons. The illustrations, 1,198 in number, of
which 280 are in color, are outstanding showing
how very small cuts can be used successfully if
they happen to illustrate a fact.
It Pays To Be Lazy, by Lester F. Miles,
Ph. D. ($2.50. Wilfred Funk, Inc., New York
City), shows you the easy way to get what you
want. The book is one long sermon about hav-
ing faith in yourself and your abilities and
finding the easy way out of any hindering feel-
ings of inferiority.
Oral Bacterial Infection: Diagnosis and Treat-
ment, by Lyon P. Strean, D. D. S., Ph. D. ($5.50.
Dental Items of Interest Publishing Co., New
York City), presents the author’s well-known
lecture in a form readily available for reference.
It covers the basic information in practical
fashion.
Patterns of Panic, by Joost A. M. Meerloo,
M. D. ($2.00. International Universities Press,
Inc., New York City), answers many questions
for those who have to do with fear and panic.
In this atomic age, it behooves every physician
to concern himself with the mental mobilization
of men. The author is a physician with con-
siderable experience in the field of warfare and
its impact upon the emotions of a people.
New Discoveries in Medicine: Their Effects on
Public Health, by Paul R. Hawley, M. D. ($2.50.
Columbia University Press, New York City),
are Bampton Lectures. The author is well
known to all of us for his work in Veterans
Administration, Blue Cross, and now with the
American College of Surgeons. The lectures
cover “Our Fabulous Blood,” “Modern Surgery
of the Heart and Lungs,” “Modern Prevention
and Treatment of Mental Disease,” and “The
Socio-Economic Aspects of Medical Care.” This
last chapter is particularly valuable at this
time coming as it does from a brilliant and ex-
perienced mind.
Freud: His Life and His Mind. A biography
by Helen Walker Puner ($1.49. Grosset &
Dunla-p, Inc., New York City), is just that.
Every physician should know well the life of
this man so that he may appraise for himself
the teachings of this man — who he was, what he
contributed — so that he may make up his own
mind as to whether or not this is another medical
cult based upon the ancient formula : One
master, one book, one cause, one cure.
Your Diet for Longer Life, by James A. Tobey,
Dr. P. H. ($3.50. Wilfred Funk, Inc., New York
City), records the information which the au-
thor gave out over the radio assisted by a
“fan mail” of 100,000 letters. It is a valuable
review in non-technical language of modern,
knowledge of food and nutrition.
Practical Neurological Diagnosis, by R. Glen
Spurling, M. D. ($5.00. Charles C. Thomas r
Publisher, Springfield, III.), deals especially"
with the problems of neurosurgery and is de-
signed for practitioners who wish to become more
proficient in this field by giving them the basic
principles.
Menstruation and Its Disorders, edited by Earl
T. Engle ($6.50. Charles C. Thomas, Publisher,
Springfield, III.), is actually the proceedings cf
the conference held under the auspices of the
National Committee on Maternal Health. Four-
teen authoritative essays are presented which
deal with this aspect of human fertility.
Living Through the Older Years, edited by
Clark Tibbitts ($2.00. University of Michigan
Press, Ann Arbor, Mich.), presents the pro-
ceedings of the Charles A. Fisher Memorial In-
stitute on Aging, in eleven lectures which
stick quite closely to the topic dealing with the
biologic, psychologic and social problem of the
aging.
Penicillin, under the general editorship of Sir
Alexander Fleming ($7.00. Second edition.
C. V. Mosby Co., St. Louis, Mo.), gives us the
practical application of this wonderful anti-
biotic. The book presents the 1946 text thor-
oughly revised, rewritten, and enlarged. An-
other book of reference that most physicians can
use handily and one every intern library should
have.
Consumption of Food in the Lmited States
1909-1948 (65 cents. U. S. Department of Agri-
culture Miscellaneous Publications No. 691,
Washington, D. C.), brings together for the first
time detailed information on the per capita
consumption of all major food commodities in
the United States, including the basic data on
supplies and distribution from which consump-
tion estimates are derived. An essential volume
for all who are interested in feeding America
from any angle whatsoever.
The 1949 Year Book of Dermatology and Syph-
ilology, edited by Marion B. Sulzberger, M. D.,
and Rudolph L. Baer, M. D. ($5.00. Year Book
Publishers, Inc., Chicago, III.), presents as al-
ways an outstanding first chapter for the edu-
cation of the general physician. This time, it
is acne and its management. It is a summary
that your reviewer just could not practice
without. It brings one up to date on Eczematous
Dermatitis, Allergic Skin, Drug Eruptions,
Fungus Infections.
for August, 1950
765
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JOHN J. GEDERT, M. D., Resident Physician M. M. RIDDLE, M. D., Eye, Ear, Nose ond Throat
766
The Ohio State Medical Journal
\
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association, a scientific society, non-profit corporation, with a definite
membership, for scientific and educational purposes.
Vol. 46 August, 1950 No. 8
Jonathan Forman, M. D., Editor
Charles S. Nelson, R. Gordon Moore,
Managing Editor — Bus. Mgr. Asst. Managing Editor
Chloromycetin Treatment of Typhoid Fever
JOHN A. PRIOR, M. D., C. T. KASMERSKY, M. D., and GEORGE HUMMEL, M. D.
The Authors
• Dr. Prior, Columbus, Ohio, is a graduate
of Ohio State University College of Medicine
1938; diplomate, American Board of Internal
Medicine; consultant to Tuberculosis Control
Division, United States Public Health Service
and to Communicable Disease Section, Ohio
Department of Health; member, American
Trudeau Society, American Federation for
Clinical Research, American College of Phy-
sicians; director. Contagious Disease Section,
University Hospital; and Associate Professor
of Medicine, Ohio State University.
• Dr. Kasmersky, Columbus, Ohio, is a
graduate of Ohio State University College of
Medicine, 1946; chief resident, Children’s
Hospital; and instructor in pediatrics, College
of Medicine, Ohio State University.
• Dr. Hummel, Columbus, Ohio, is a grad-
uate of Ohio State University College of
Medicine, 1944; chief resident in medicine, St.
Francis Hospital; and instructor in medicine,
College of Medicine, Ohio State University.
THE new antibiotic Chloromycetin (Chloram-
phenicol) is derived from Streptomyces
venezuelae, a fungus recently identified in
the laboratory of Dr. Paul Burkholder, who
demonstrated its antibacterial effect. Since its
discovery, Chloromycetin has been synthesized
in crystalline form by Ehrlich1 and his associates.
It is neutral in reaction and very stable, rela-
tively resistant to heat and unaffected by wide
variations in pH. Chloromycetin is unique
among antibiotics in that it contains both nitrogen
and nonionic chlorine. Serum levels that are ob-
tained following oral administration compare fa-
vorably with those obtained by parenteral injec-
tion, indicating that the drug is well absorbed
from the gastrointestinal tract. It is rapidly ex-
creted or inactivated by the body. Serious toxic
manifestations following oral administration have
not been reported.
Chloromycetin has a wide range of useful-
ness. It has been shown to be effective in the
treatment of Rickettsial infections, such as
Rocky Mountain spotted fever, epidemic and
endemic typhus, and scrub typhus. Gram-nega-
tive bacillary infections, such as brucellosis,
tularemia, and those due to the Salmonella
group also respond well to Chloromycetin. In
addition, preliminary reports indicate that it may
prove to be of value in the treatment of the
psittacosis-lymphopathia venereum group and
primary atypical pneumonia. Woodward, et al.,2
reported in 1948 the first clinical trial of this
new antibiotic in the treatment of 10 patients
with typhoid fever on the Malayan peninsula
where the disease is endemic. Their results in-
dicate that Chloromycetin favorably influences
the course of the disease with rapid deferves-
Submitted February 13, 1950.
cence, relief of subjective complaints and eradi-
cation of Salmonella typhosa from blood, feces
and urine. Those treated on the ninth day of
disease had normal temperatures within 3.5 days,
whereas untreated control patients had an aver-
age of 26 days of fever after the corresponding
day of illness. This report was of momentous
importance to the medical profession which in
1948 had nothing more specific to offer the
patient with typhoid fever than it had in 1900.
The purpose of this communication is to re-
773
port further experiences and results in the treat-
ment of typhoid fever with Chloromycetin.
TYPHOID— A RURAL DISEASE
The twelve patients included in this study
represent sporadic cases of typhoid fever ad-
mitted to the Contagious Disease Service of Uni-
versity and Children's Hospitals, Columbus, Ohio,
since February 1, 1949. These patients came
principally from farms and small rural com-
munities in Central Ohio, within a radius of
fifty miles of .Columbus. Of this group six
were children and six were adults. The chil-
dren ranged from twenty-two months of age to
thirteen years, and the adults varied from
twenty-three to forty-two years. Seven of the
patients were females and five were males. In
nine patients the source of infection was traced
to contaminated well water; in one patient, a
nurse, the disease was contracted while caring
for a patient who subsequently was shown to
have typhoid fever; and in two patients, the
source of infection could not be determined
definitely.
The total duration of illness before admission
to the hospital varied from two to twenty-one
days with an average of 12.2 days. The average
duration of illness before the institution of
Chloromycetin therapy was 14.3 days. Thus,
in the usual case, the diagnosis of typhoid fever
was established and the treatment was begun
within an average of 2.1 days after admission.
In this series, the diagnosis of typhoid fever
was established in every case by the isolation of
Salmonella typhosa from the blood, feces or
both. Eleven of the twelve patients had blood
cultures showing Salmonella typhosa, four of
whom also showed the presence of typhoid organ-
isms in their stools. In one patient, the causative
organisms were found only in the feces. Typhoid
O agglutinins were present in significant titer
(1:80 or more) in all of the adult cases. The
agglutination titers in children tended to be lower
and to develop more slowly than in adults.
Typhoid 0 agglutinin titers taken on admission
in the children ranged from a low of 1:10 to a
high of 1:128. It is probable that higher titers
would have been found if serial determinations
had been made.
As soon as the diagnosis was established,
a large initial dose of Chloromycetin (50 mil-
ligrams per kilogram of body weight) was given
orally in all cases. This relatively large dose
was given at one time in children, whereas in
adults one-third of the dose was given at hourly
intervals until the entire amount had been ad-
ministered. As a rule, the children received
proportionately a larger maintenance dose than
did the adults. Following the first dose, the chil-
dren received 0.25 gram every four hours for a
period of eight to ten days, irrespective of size,
age or clinical response. The adults, on the
other hand, received 0.25 gram every two hours
until the temperature returned to normal, after
which time the same amount was given every
four hours for a minimum of five days. In
children the average dose of Chloromycetin
was 80.8 milligrams per kilogram per day, while
that of the adults averaged 40.5 milligrams per
kilogram per day. The antibiotic was administered
for an average of 9.50 days, ranging from a min-
imum of seven days in one patient to a maximum
of twelve in two other patients. Even in the chil-
dren who received relatively large amounts, no
untoward reactions to the Chloromycetin were
observed.
CLINICAL RESPONSE IS RAPID
In every patient the results of Chloromycetin
therapy were very gratifying. The body temper-
ature returned to normal within an average of
3.16 days after the beginning of treatment. Of
the 12 patients in this group, eight had normal
temperatures within seventy-two hours or less
after the institution of treatment, and of these
eight, five had no fever within forty-eight hours.
One patient, an adult, continued to have fever
for six days after treatment was started, the
longest in this series. The response in children
was definitely more rapid than in adults. All
of the children had normal temperatures in
forty-eight hours or less except two, and both
of these were afebrile in less than seventy-two
hours. The average febrile days in children after
treatment was started was 2.3 in contrast to four
in the adults. Serial stool cultures were made
in four of the five patients showing Salmonella
typhosa in the feces. Stool cultures were re-
ported as negative in an average of 4.25 days,
the range being from two to nine days.
One patient expired suddenly on the fourth
hospital day. This young woman had been
given Chloromycetin for two days prior to
admission, and this therapy was continued in the
hospital. On the second hospital day (the fourth
day of Chloromycetin therapy) her temper-
ature had returned to normal, and she was greatly
improved. After two days of normal temper-
atures and continued improvement, she expired
suddenly. Complete necropsy, performed five
hours after death, showed evidence of healing
typhoid fever, but no cause for her death could
be demonstrated.
RELAPSES MAY OCCUR
Two of the Chloromycetin treated patients
suffered relapses 16 and 34 days after discharge
from the hospital. During their initial hospital-
ization both had a prompt clinical improvement
with eradication of the typhoid organisms from
the stools in two and six days after therapy
was begun. In the relapse, the clinical response
to the second course of Chloromycetin was
relatively prompt, both having normal temper-
atures in less than four days. However, a con-
774
The Ohio State Medical Journal
siderably longer period of time elapsed, sixteen
and twelve days respectively, before the typhoid
organisms could be eradicated from the stools.
For contrast, results of the previous twelve
consecutive, untreated patients with typhoid fever
admitted to University and Children’s Hospitals
are presented. This control group was com-
parable in age and sex distribution to the group
receiving Chloromycetin. After the fourteenth
day of illness (the same day that Chloromycetin
was started in the treated group), the control
patients had a febrile course in the hospital
that ranged from a minimum of six days to a
maximum of twenty-two with an average of
13.5 days. This is in distinct contrast to the
treated patients in whom the average febrile
days were 3.16, less than one-fourth that of the
control group. Eleven of the 12 control patients
had stool cultures taken on admission that
showed the presence of Salmonella typhosa.
After the fourteenth day of illness, 21.6 days
on an average were required to obtain cultures
free of the typhoid organisms, more than five
times as long as in the treated patients (4.25).
There were two relapses in both the control
and treated groups. The recurrent febrile period
in the controls was fifteen and sixteen days, while
in the treated patients fever was present in each
for less than four days after a second course
of Chloromycetin was administered.
The following case histories have been selected
to illustrate: (1) The average response to Chlor-
omycetin treatment of typhoid fever; (2) fail-
ure of aureomycin therapy; and (3) the results
obtained in the treatment of relapses.
CASE REPORTS
Case 1. J. L., a 42-year-old white housewife,
was admitted to University Hospital, August 22,
1949. She had been in good health until five
days before admission when she was suddenly
seized by severe sharp pains in the lower ab-
domen that radiated to the back. There were no
attendant gastrointestinal symptoms at that time.
The pains were partially relieved by lying down,
and were present intermittently until admission.
Two days before admission she began to have
shaking chills, and her temperature rose to
103°F. At the same time she became nauseated
and vomited a dark brown material on several
occasions, following which she was unable to
retain any food or fluids. There was no diarrhea
or other change in the feces. Because of the
persistent pain and tenderness over the lower
abdomen, she was admitted to the surgical
service. Examination revealed a well-developed,
well-nourished woman complaining of pains in
the abdomen. Except for evidence of dehydra-
tion, significant physical findings were confined
to the abdomen where diffuse tenderness and
moderate spasm were noted over the lower por-
tion. The edge of the liver was palpated about
eight centimeters below the right costal margin.
No masses or other solid organs could be felt.
Rose spots were not present.
Blood cultures drawn on the first and third
hospital days showed the presence of Salmonella
typhosa after ninety-six hours incubation. On
the third hospital day, the typhoid 0 aggultina-
tion was positive in a dilution of 1:80 and H
was negative. During the period of observa-
tion, the patient’s complaints persisted and her
general condition remained unchanged. Her
course was characterized by high spiking fever
occurring in afternoon and evening, at which
time she became stuporous and disoriented. On
the fifth day the patient was transferred to the
Contagious Disease service. Chloromycetin
therapy was started immediately with an initial
dose of 3.0 grams, (approximately 50 milligrams
per kilogram of body weight) and maintained
at 0.25 gram every two hours. In less than
seventy-two hours her body temperature had
6 Chloromycetin (grams /doy)
4-
3-
2-
I -
0J
J. L. age 42, wh ? (weight 155 1b.)
Figure 1. Hospital course in Case 1. The prompt clini-
cal improvement of this patient resulting from Chloromy-
cetin (Chloramphenicol) therapy is representative of the
average responses of all patients in this series.
returned to normal and she had almost complete
relief of her subjective complaints. Then, she
was given Chloromycetin 0.25 gram every four
hours for six days. Although she had several
stool cultures that showed Salmonella typhosa
while under treatment, she was discharged on
the sixteenth hospital day after three consecu-
tive stool and urine cultures failed to show the
presence of typhoid organisms.
Comments: Because this patient’s complaints
were referrable to the abdomen, she was admitted
to the surgical service. The relatively sudden
onset of severe abdominal pain ushering in typhoid
fever is unusual. However the possibility of ty-
phoid fever was considered by the attending sur-
geon, and blood and stool cultures and typhoid ag-
glutination tests were made. The diagnosis was
definitely established on the fifth hospital day by
means of the blood culture, and Chloromycetin
was then started. The institution of therapy was
followed by prompt defervescence and relief of
subjective complaints. Her course is representa-
tive of the average clinical response of all patients
in this series who received Chloromycetin treat-
ment, except for the delay in the eradication of the
Salmonella typhosa from the stools.
* * *
Case 2. V. B., a six-year-old white girl, was
admitted to Children’s Hospital on February 24,
1949. She had been well until eight days before
for August, 1950
775
admission at which time she became unusually
tired and complained of generalized aching. She
ate poorly, and her mother noticed that her
skin felt hot. On the second day of her illness
she developed a hacking, non-productive cough.
At this time her temperature was recorded at
103 °F., and sulfonamide therapy was instituted
by the family physician. She had frequent
chills, and her fever continued between 103°
and 105°F. On the third day of her illness she
began to vomit, and on the fifth day she passed
several loose green stools. Because of her failure
to improve at home, she was admitted to Chil-
dren’s Hospital for diagnosis and treatment.
Examination revealed a poorly developed, poorly
nourished, dehydrated child who appeared
acutely ill. The temperature was 103.2° F.,
pulse 132 and respirations 40. Pertinent phy-
sical findings were limited to the chest and ab-
domen. Percussion of the chest revealed dullness
over the right lower lobe posteriorly. Fine
crackling rales were scattered diffusely through-
out both lung fields anteriorly and posteriorly,
most prominent in the right lower lobe. The
abdomen was distended and tympanitic without
tenderness or rigidity. The spleen and liver
were not palpably enlarged.
Blood and stool cultures taken at the time of
admission showed the presence of Salmonella
typhosa. A diagnosis of typhoid fever was
made on this basis. Since Chloromycetin was
not available for general use at the time, this
patient was treated with aureomycin. Begin-
ning on her third hospital day, she was given
0.25 gram of aureomycin orally four times a
day for a period of eight days. Her temperature
remained spiking in character, and blood cultures
showed the continued presence of Salmonella
typhosa on two occasions. Then, the dose of
aureomycin was increased to 0.50 gram four times
a day and continued for a period of nine days.
Although this was more than twice the usual
recommended dosage of aureomycin, there was no
change in her clinical course. Also it is of interest
to note that there were no signs of toxicity. On
the twenty-fifth hospital day she became afebrile
for the first time and was discharged five days
later.
V B. oge 6, wh. 2 (weigh! 30 lb.)
Figure 2. Hospital course and pertinent data in Case 2.
This child received intensive treatment with aureomycin
without any demonstrable alteration in the course of the
disease. In contrast, very rapid improvement followed the
Chloromycetin (Chloramphenicol) treatment of the relapse.
For the ensuing four weeks she remained well.
One week prior to her second admission she
began to eat poorly, became listless and had
frequent shaking chills. Her temperature varied
from 100° to 103°F. Two days before her second
hospitalization she began to have three to four
loose stools per day. A diagnosis of recurrent
typhoid fever was made, and she was re-
admitted on May 3, 1949, for treatment.
On admission her temperature was 104° F.
Examination again revealed pulmonary changes
compatible with a bronchopneumonia. The liver
was palpated three centimeters below the right
costal margin. There were no other abnormal
findings. The blood culture taken at the time of
admission showed the presence of Salmonella
typhosa after forty-eight hours’ incubation.
Then, she was given an initial dose of 0.75
gram of Chloromycetin. Subsequently, she was
given a maintenance dose of 0.25 gram every
four hours for eight days. There was rapid
subjective improvement and her temperature
returned to normal in forty-eight hours, remain-
ing normal during the remainder of her hospital
stay.
Comments: Although this child received mas-
sive doses of aureomycin, it apparently did not
exert any beneficial influence upon the course
of her disease, since her fever continued until
the twenty-fifth hospital day. In very distinct
contrast was the course of the relapse when
treated with Chloromycetin. She had rapid
subjective improvement, her fever was gone in
less than two days, and Salmonella typhosa
were promptly eradicated from the body. In
passing, it is of interest to note that such a large
dose of aureomycin as 2 grams per day did not
result in any toxic manifestations in a child
weighing only thirty pounds.
H*
Case 3. P. H., a 33-year-old white male la-
borer, was admitted to University Hospital on
August 10, 1949. He had been well until eleven
days before admission when he noticed gradual
development of headache, malaise and easy fati-
gability. Six days before admission he began
to have chills, associated with increasing fever.
He had anorexia but no nausea or vomiting. Mild
diarrhea began five days before admission with
four or five loose stools per day. The stools
were not bloody or tarry. The water supply
at his home was from a shallow untested well.
Examination revealed a well-developed, fairly
well-nourished white male. The skin and oral
mucosa showed evidence of dehydration, and the
odor to his breath was fetid. The abdomen was
essentially normal except for mild diffuse tender-
ness on palpation. A few rose spots were scat-
tered over the abdomen and lower back. No
other abnormal findings were noted.
Repeated blood and urine cultures were
negative for Salmonella typhosa. Stool culture
taken on admission was negative, but a stool
specimen taken on the third hospital day showed
the presence of Salmonella typhosa after forty-
eight hours’ incubation. He was then given 3.0
grams of Chloromycetin (approximately 50
milligrams per kilogram of body weight) as an
initial dose and then maintained at 0.25 gram
every two hours. His temperature returned to
normal in seventy-two hours with complete relief
of subjective complaints except for weakness.
Thereafter he was given 0.25 gm. of Chloromycetin
every four hours for the remaining five days
in the hospital. After three consecutive daily
stool and urine cultures failed to show the
presence of Salmonella typhosa he was discharged
from the hospital.
The patient returned to his home, and after
two weeks of rest, he resumed his usual occupa-
tion which he was able to perform without undue
fatigue. On September 24, 1949, he began to
77 6
The Ohio State Medical Journal
notice increasing fever, especially in the evening,
associated with malaise, generalized aching and
a few loose stools. His illness became steadily
more incapacitating and diarrhea increased to
six to nine watery stools per day. Although
anorexia was marked, he was able to take large
amounts of fluid each day. About two days be-
fore admission he developed a productive cough.
He was readmitted on October 7, 1949, thirty-
four days after his release from the hospital.
Examination on admission revealed a well-
developed, underweight white male who appeared
acutely ill. His face and neck were quite
flushed, and rose spots were unusually numerous
34 toy Jnt*rvol
Chloromytotln (groms/toy) / Chloromyc«»ln (grami/doy)
PH. oge 33 wh. (f (weight 145 k>.)
Figure 3. Hospital course in Case 3. During the patient’s
first hospitalization for typhoid fever he had a prompt
clinical recovery attributable to his Chloromycetin (Chloram-
phenicol) treatment. It is of interest to note that in his
relapse his response was amost as rapid although a con-
siderably longer period of time was required for the eradi-
cation of the Salmonella typhosa from the stools.
over the chest, abdomen and back. The pulse
showed a relative bradycardia (92 per minute
when his temperature was 104.5°F.), and it was
dicrotic. The liver was palpated four centimeters
below the right costal margin, and the tip of the
spleen was palpable. No other abnormal find-
ings were noted.
Blood and stool cultures taken on admission
showed the presence of Salmonella typhosa. Im-
mediately upon readmission to the hospital, he
was given 3 grams of Chloromycetin and then
0.25 gram every two hours. His temperature
fell from 104.5°F to normal within ninety-six
hours, accompanied by complete relief from all
subjective complaints. Although his clinical
response to Chloromycetin was almost as
prompt as it was during the first time, he
continued to have stool cultures which contained
Salmonella typhosa intermittently for twelve
days.
Comment: This patient was only moderately
ill with typhoid fever on his first admission.
Chloromycetin therapy resulted in rapid im-
provement and elimination of Salmonella typhosa
from the stools. However, the relapse would in-
dicate that in spite of eight days of Chlor-
omycetin therapy in this patient it was not ade-
quate to completely eradicate Salmonella typhosa
from his body. On readmission he was much
more acutely ill than during the first hospital
stay. His clinical response to Chloromycetin
was almost as rapid as during his first course
of treatment. However, it will be noted that a
considerably longer period of treatment with
relatively larger doses was required to eliminate
the causative organisms from the stools during
the relapse.
DISCUSSION
It appears from the data presented that Chlor-
omycetin (Chloramphenicol) is quite effective
in the treatment of typhoid fever. The patients
so treated experienced rapid subjective improve-
ment as well as a prompt defervescence. The
average number of days of fever in this group
was 3.16. In the few whose temperatures re-
mained elevated for more than three days, a
definitive subjective improvement was noted by
the end of forty-eight hours and before the
fever showed evidence of subsiding. In addition
to the prompt relief of symptoms and the defer-
vescence, the Salmonella typhosa were much more
rapidly eradicated from the blood and/or the
stools than in the untreated, and the period of
hospitalization was considerably shortened.
The data of this series confirm the favorable
results first reported by Woodward, et al.,2
in the treatment of typhoid fever with Chlor-
omycetin. Essentially similar results from a
series of twenty-one patients were published
later by Woodward.3 Recently, Collins and Fin-
land4 reported on the Chloromycetin treat-
ment of four patients with typhoid fever. Their
results were not as impressive as those of
previous reports, either as to clinical improve-
ment or to the eradication of Salmonella typhosa
from the blood or stools. In their experience
the difference between the effects of Chlor-
omycetin and aureomycin is not as striking as
others have reported. However, for the patients
herein reported the subjective improvement and
prompt defervescence was dramatic. The con-
version of positive cultures to negative was
usually prompt. Certainly the results were in
very distinct contrast to the prior series of pa-
tients who did not have the benefit of Chlor-
omycetin treatment.
Woodward2, 3 reports that certain serious com-
plications, viz., hemorrhage and intestinal per-
foration, may occur during or after treatment
although possibly in decreased incidence. Hemor-
rhage or perforation did not occur in our series
and no other complications were present. How-
ever, one death occurred which could not be
ascribed to either the typhoid fever or the
Chloromycetin.
Early data pertaining to the use of Chloromy-
cetin have been characterized by the absence of
toxic reactions. Woodward3 states that “signifi-
cant toxic effects have not been observed.”
However, Collins and Finland4 report one pa-
tient with vertigo, heartburn, sour taste and
anorexia and another with nausea, vomiting,
glossitis and cheilitis that might be attributed,
in part, to this antibiotic. However, the evalua-
tion of anorexia, nausea, vomiting, or diarrhea
as a toxic manifestation due to Chloromycetin
is particularly difficult in this instance because
they are frequent occurrences in the course of
typhoid fever. In the present series there were
no apparent untoward effects resulting from the
use of this antibiotic.
Aureomycin, in the treatment of typhoid fever,
for August, 1950
777
has produced only equivocal results.5 In the one
patient in this series who was treated with
aureomycin, there was no demonstrable altera-
tion from the usual course of untreated typhoid
fever. However, when the relapse occurred, there
was very prompt clinical improvement and defer-
vescence as the result of Chloromycetin ther-
apy. These results are in agreement with those
of Woodward3 who in comparing aureomycin
and Chloromycetin concludes that the latter is
definitely the drug of choice in the treatment of
typhoid fever.
Published data indicate that, while the clinical
response of typhoid fever to Chloromycetin is
striking, Salmonella typhosa may persist in the
body in some instances. Thus, relapses may
occur in spite of apparently adequate treatment.
In this series there were two patients who,
following eight and ten days of Chloromycetin
therapy, had bacteriologically confirmed relapses.
Although both responded promptly to a second
course of Chloromycetin, Salmonella typhosa
persisted in the stools for a much longer period
than during the initial hospitalization even though
the antibiotic was administered for a longer time.
According to Smadel, Woodward, and Bailey6
there is a definite relationship between the dura-
tion of therapy and the incidence of relapses.
To avoid possible relapses, they believe that all
patients should be treated for a minimum of
nine days, but that little is to be gained in
continuing therapy beyond fourteen days. It
would appear that considerable further study and
experience will be necessary to determine the
optimum dosage for Chloromycetin in the treat-
ment of typhoid fever.
CONCLUSION
1. Chloromycetin appears to be effective in
the treatment of typhoid fever, affecting relatively
prompt defervescence and relief of subjective
complaints. In some patients there is a lag
between the clinical improvement and the eradica-
tion of Salmonella typhosa from the body.
2. Even with apparently adequate Chlor-
omycetin therapy, relapse may occur. In the
present series two patients had relapses, both
of whom had prompt clinical response to a second
course.
3. In relapse treated by Chloromycetin a
longer period was required for the eradication of
Salmonella typhosa from the stools than during
the initial attack.
4. None of the patients showed any evidence
of toxic reaction to Chloromycetin.
5. In the one patient treated with aureomycin
there was no demonstrable influence upon the
course of the disease.
BIBLIOGRAPHY
1. Ehrlich, J., Bartz, Q. R., Smith, R. M., Joslyn, D. A.,
and Burkholder, P. R. ; Chloromycetin, A New Antibiotic
from a Soil Actinomycete. Science, 106, 417, Oct. 31. 1947.
2. Woodward, T. E., Smadel, J. E., Ley, Jr., H. L.,
778
Green, R., and Mankikar, D. S. : Preliminary Report on
the Beneficial Effect of Chloromycetin in the Treatment
of Typhoid Fever. Ann. Int. Med., 29, 131, July, 1948.
3. Woodward, T. E. : Chloromycetin and Aureomycin :
Therapeutic Results. Ann. Int. Med., 31, 53, July, 1949.
4. Collins, H. S., and Finland, M. : Treatment of Typhoid
Fever with Chloromycetin, New Eng. Jour. Med., 241, 556,
Oct. 13, 1949.
5. Finland, M., Collins, H. S., and Paine, T. F. : Aure-
omycin— A New Antibiotic. J. A. M. A., 138, 946, Nov. 27,
1948.
6. Smadel, J. E., Woodward, T. E., and Bailey, C. A.:
Relation of Relapses in Typhoid Fever to Duration of
Chloramphenicol Therapy. J.A. M. A., 141, 129, Sept. 10,
1949.
KEEPING UP WITH MEDICINE
• In the study of human beings and their re-
actions, one must always consider the whole
individual personality. The good physician has
always found it necessary to concern himself
not only with the disease pattern of his patient
but also with the personality of the patient
himself.
-Jfi *
• The age-old theory that women are less crimi-
nal than men has been shattered. Her trans-
gressions are masked while showing a predi-
lection for and an adeptness at deceit.
* * Si
• In many places throughout history cross-eye
was associated with “the evil” and black magic
and its victims were often blamed for out-
breaks of pestilence, famine, fits among chil-
dren, miscarriages, sickness of domestic animals,
and other afflictions.
* S|C &
• It is suggested that one full year of sterility
after contraconception practices have been dis-
continued should be a matter of concern for the
family physician since recent surveys show
90 per cent of planned pregnancies occurred
within that time.
* * *
• Studies of the cervical mucus is proving to
be helpful in investigating sterility, fertility,
and other aspects of the reproduction process.
* * *
• The ever-increasing mechanization of our
common tasks and the ease of transportation
have lessened the ordinary physical activity to
the point that the natural demands of the hu-
man body for sternous movements are not being
met in the majority of our people.
* * *
• The preserving action of common salt on
meat seems to depend upon five factors viz: de-
hydration, the direct effect of the chloride ion,
removal of oxygen from the medium, sensitiza-
tion of micro-organisms to carbon-dioxide and
the interefence with the rapid action of
proteolytic enzymes.
4= * *
• Cardiovascular diseases accounted for
44 per cent of all deaths in the United States
in 1948. If you are past 65 the chances are
55 out of 100 they will get you. — J. F.
The Ohio State Medical four fiat
The Management of Acute Cholecystitis
CHARLES E. HOLZER, Jr., M. D.
The Author
• Dr. Holzer, Gallipolis, Ohio, is a grad-
uate of Cornell University Medical College,
New York, 1941; diplomate, American Board
of Surgery; fellow, American College of
Surgeons; chief of staff, Holzer Hospital,
Gallipolis, Ohio.
THE policy of early operation in acute
cholecystitis, though it has been in the
recent past the subject of much controversy,
has now been fairly generally adopted, at least
in principle if not in practice. There is very
little argument concerning the advisability of
removing or draining the acutely obstructed
gallbladder as soon as possible after the onset
of the attack. A review of the literature shows
that in the past tw'o decades the debate over the
management of acute cholecystitis went through
much the same stages as the earlier discussions
concerning the management of acute appendicitis.
Around the year 1900 there were surgeons who
advocated appendectomy early in the disease, and
those who preferred to delay the operation until
drainage became necessary or until the attack
had subsided and appendectomy could be done as
an elective procedure.
ONLY ACCEPTED TREATMENT
Now of course the only accepted treatment
of acute appendicitis is appendectomy as early
in the course of the disease as possible, usually
as soon as the diagnosis is made or even
suspected. The same principle with minor varia-
tions can and should be applied to the manage-
ment of acute cholecystitis. Much of the con-
troversy over the subject was caused by con-
fusion over the definition of “early operation,”
some writers using the term to mean “operation
soon after admission to the hospital” and others
meaning “operation early in the course of the
attack.” It is of historical interest to note that
Finney, Heuer, Judd, Eliason, and Zinninger
were among those strongly advocating early
surgical management, the opposing viewpoint
being taken by Behrend, Deaver, E. A. Graham,
Lewis, and Lahey.
While very few surgeons w'ould now follow'
any other course than early surgical interfer-
ence in acute cholecystitis, there still exists the
concept that “the acute gallbladder attack” is
a condition which can be managed at home, and
that the patient need be sent to the hospital
only if the signs and symptoms do not subside
in a few days. This has resulted from the previ-
ous controversies on the subject, and it is only
i>y constant repetition of the doctrine that acute
cholecystitis is a surgical emergency, every bit
as urgent as acute appendicitis, that the mortality
and morbidity of acute cholecystitis can be di-
minished.
SURGICAL EMERGENCY
The purpose of this paper is to re-emphasize
this teaching, to review' the factors that in-
Presented before the Athens County Medical Society on
September 13, 1949.
fluence the mortality and morbidity resulting
from acute cholecystitis, to analyze our experi-
ence with the condition, and to try to illustrate
conclusively the validity of the above stated
principle.
Acute cholecystitis is almost always secondary
to cholelithiasis. The incidence of acute cholecy-
stitis in patients with gallstones, though no ac-
curate determination can be made is estimated
to be rather high. Heuer has put this probable
figure as high as 20 per cent. If this is true,
it is a strong argument for the removal of any
gallbladder containing stones, particularly in a
younger person who would thereby be saved the
one to five chance of developing acute cholecys-
titis. Since in experienced hands cholecystectomy
in the absence of complications such as acute
cholecystitis, common duct stone, or pancreatitis,
carries a mortality of less than one per cent, there
is no excuse for a physician’s allowing a person
to retain such dangerous possessions as gallstones
year after year, especially if that patient is hav-
ing any related symptoms. When one adds to
the hazard of acute cholecystitis the chance of de-
velopment of cancer of the gallbladder, common
duct stone, or acute pancreatitis, all of which are
directly related to gallstone disease, there is no
question as to the justification of the above con-
demnation. Every physician knows of patients
who have had gallstones for many years without
any symptoms or complications, yet it would seem
far better to remove a number of gallbladders
needlessly than to chance the death of any of
these patients from a complication of cholelithi-
asis provided the gallbladder can be removed
safely in that particular patient.
Acute cholecystitis is primarily an obstructive
phenomenon. The usual chain of events is first
the impaction of a stone in the ampulla or cystic
duct producing a complete obstruction to the
outflow of bile. Edema and distention of the
gallbladder follow. The blood supply is impaired
or occluded by pressure of the distended and
edematous tissues. This is the typical picture
in the first forty-eight hours. Subsequently
the course may vary. The stone may become dis-
for August, 1950
779
lodged allowing the gallbladder to empty, in
which event there will be residual fibrosis, and
after repeated such attacks a small, fibrotic
viscus will result. If the obstruction persists
complete occlusion of the arterial blood supply
may supervene resulting in gangrene and per-
foration, in which case either bile peritonitis or
a pericholecystic abscess will ensue, depending
upon the rapidity of the changes and the ability
of the omentum to wall off the gallbladder.
Bacterial invasion of the obstructed gallbladder
may occur, resulting either in suppurative
cholecystitis or in empyema of the gallbladder.
Sometimes the inflammation may subside in spite
of persistent obstruction of the cystic duct pro-
ducing a so-called hydrops of the gallbladder.
In all of the 50 operated cases in our series
obstruction of the gallbladder existed. Twelve
cases showed patchy or extensive gangrene, four
had pericholecystic abscesses, two had free per-
forations with bile peritonitis, one had empyema,
and one had hydrops of the gallbladder.
FAMILIAR SYMPTOMS AND SIGNS
The symptoms and signs of acute cholecystitis
are of course familiar. The attack usually begins
with severe colicky pain in the right upper
quadrant or epigastrium radiating around the
right costal margin to the tip of the right scapula.
Vomiting is a frequent occurrence and the
pain is often relieved afterward. A persistent
ache and tenderness in the right upper quadrant
follow. Fever and sometimes a chill may occur.
The leukocyte count is elevated to a variable
degree depending on the extent of infection and
necrosis. Physical examination reveals tender-
ness in the right upper quadrant associated with
muscular rigidity. A tender mass is usually
felt. A sign valuable in differentiating the
acutely inflamed gallbladder from other path-
ological conditions in the right upper quadrant is
the severe exacerbation of pain on deep inspira-
tion while the examiner presses the abdominal
wall inward against the gallbladder. The pain
results from irritation of peritoneal nerve end-
ings as the fundus of the gallbladder descends
against the adjacent parietal peritoneum. This
sign is absent in acute pancreatitis, acute passive
congestion of the liver, ruptured peptic ulcer and
other conditions which might be confused with
acute cholecystitis. A mass can usually be felt
if the examiner is able to overcome the muscle
spasm by using a patient, gentle touch. Pal-
pation is aided by the left hand pushing forward
from behind in the right flank. Masses were
described in 40 of our 58 cases. The mass is
formed by the dome of the distended gallbladder
usually surrounded by edematous omentum.
In this clinic once the diagnosis of acute chole-
cystitis has been made it is the policy to operate
as soon as it is feasible, the general condition of
the patient, the duration of the disease, and the
presence of complications of gallstone disease all
being taken into consideration. Considerable time
may elapse between admission to the hospital and
the operation, but in only exceptional instances is
a conservative regime deliberately adopted. A
careful clinical and laboratory study is made not
only to confirm the diagnosis and to detect com-
plications such as pancreatitis, or cholesdocho-
lithiasis, but also to evaluate the fitness of the pa-
tient for immediate or subsequent operation and
to determine the conditions which must be cor-
rected before operation can be safely attempted.
PREPARATION FOR SURGERY
As soon as the situation can properly be
evaluated such measures as are indicated are
taken to prepare the patient for operation. Fluid
balance is restored, gastric suction may be in-
stituted to relieve vomiting and abdominal dis-
tention, an enema may be given, antibiotic ther-
apy with penicillin may be begun if the indica-
tions are that infection is present, diabetes is
treated, cardiac failure is remedied and the pa-
tient is kept as comfortable as possible prefer-
ably with demerol, as this drug has been shown
to have a spasmolytic effect on smooth muscle
as well as its analgesic action.
The decision as to when to operate then must
be made. There is always sufficient time for a
careful initial evaluation of the patient and
this evaluation should never be by-passed be-
cause of an urgency to bring a patient to opera-
tion early. If the attack is of a few hours dura-
tion and the patient’s condition is good the opera-
tion should be carried out immediately. Cholecys-
tectomy can usually be done safely. If the
disease is of longer duration it is ordinarily
necessary to take a longer time in the prepara-
tion of the patient. Occasionally one is forced
into operating on a patient before preparation
is deemed complete. The temperature, pulse,
leukocyte count, and the status of the abdominal
findings are of some importance in determining
whether or not it is safe to procrastinate fur-
ther. Rapid enlargement of the mass accom-
panied by an increase in the fever and the
leukocyte count urge immediate surgical inter-
vention. It must be kept in mind constantly
however that the vital signs are notoriously un-
reliable in indicating the true state of affairs
with the acutely obstructed gallbladder. The
surgeon must be on his guard against being lulled
into a false sense of security by a subsiding
temperature and leukocyte count and a general
improvement in the condition of the patient. The
operation should be done at the earliest auspicious
moment. Thirty-three of the 50 patients herein
discussed were operated on within 48 hours of
their admission to the hospital. Since one-half
of the cases were admitted to the hospital
within 48 hours of the onset of their attack
780
The Ohio State Medical Journal
it is clear that the policy of early operation was
carried out with consistency.
CHOICE OF OPERATION
The choice of operation is a matter of great
importance. Cholecystectomy is the procedure
of choice and should be carried out if possible
without increasing too greatly the risk to the
patient. There are certain instances in which
cholecystostomy is indicated not only as a
“second best” procedure after cholecystectomy
has been attempted and found hazardous, but
as the procedure of choice. The use of cholecys-
tostomy varies a great deal in the reported
series of cases. Marshall1 in the Lahey Clinic
reports 74 cases of acute cholecystitis in only
one of which was cholecystostomy carried out,
the remaining patients having cholecystectomies.
Glenn2 reports an incidence of 12.6 per cent
cholecystostomies in 527 patients operated on
for acute cholecystitis at the New York Hospital.
Eliason3 in 135 cases reported 68 per cent who
had cholecystostomies. In our own series 30
patients had cholecystectomy and 20 had cholecys-
tostomy, an incidence of 40 per cent for cholecys-
tostomy. A comparison of the incidence of
cholecystostomy means very little in determining
the operation to be . used in acute cholecystitis.
Certainly the cases must vary considerably in
the series reported, depending on the economic
status of patients treated, the location of the
clinic, and the' type of hospital. In our series
cholecystostomy was done 20 times. Only two
of these patients were under 50 and ten were
over 70. Only seven of them were seen in less
than 48 hours after the onset of the attack.
Four patients had pericholecystic abscesses,
one had acute pancreatitis and cholangitis, one
had severe diabetes, and four had serious cardiac
disorders. Our indications for cholecystostomy
are clearly expressed in these statistics. Rarely
should cholecystectomy be attempted in a pa-
tient over 70 years of age. Cholecystostomy
serves exactly the same purpose with regard
to the immediate danger of the disease, carries
a much lower risk, and if performed properly,
produces as good postoperative results in the
immediate future.
The follow-up results in all of our patients
with cholecystostomy have been quite satisfac-
tory. In almost all patients over 70 in our
practice cholecystostomy is elected and carried
out as a planned procedure under local anes-
thesia through a short subcostal incision. Care
is taken to see that all stones are removed.
The mucosa is curetted thoroughly and the gall-
bladder is irrigated to remove all stones and
debris. A large rubber tube is sewn into the
fundus and several Penrose drains are distributed
around the gallbladder. Bile drainage usually
continues for 10 days to two weeks in gradually
diminishing amounts. The tube can be removed
in 10 to 14 days. Following this the biliary
fistula closes in a few weeks. We have found
the results of cholecystostomy to be quite satis-
factory and do not hesitate to employ it at any
time to avoid undue risk to the life and welfare
of the patient. The surgeon should not hesitate
to change his mode of attack to cholecystostomy
either when he encounters a pericholecystic abs-
cess, acute pancreatitis, or too much edema
and inflammation about the hepatic porta to
make cholecystectomy safe, or in the event of
some sudden change for the worse in the pa-
tient’s condition.
Choledochostomy should be avoided if at all-
possible in acute cholecystitis. The edema and
inflammation of the peritoneum and areolar tissue
around the common duct make exposure and
visualization of all the structures difficult and
often impossible. Many times it is preferable
even if common duct obstruction is present to
perform a cholecystostomy and plan to explore
the duct later and remove the gallbladder.
TECHNIQUE
Little need be said about the technique of
operation for acute cholecystitis. If cholecystec-
tomy is done the greatest care must be taken
to control bleeding from the gallbladder fossa.
The cystic duct and artery should be visualized,
isolated, and individually ligated. The common
duct should be identified before any structure
is clamped, ligated or divided or if because of
edema and inflammation the structures cannot
be identified the gallbladder should be removed
from the fundus downward until the cystic duct
can be isolated. The danger of operative injury
to the common duct is especially great in these
cases. It is our practice to drain all cases.
Twm to four Penrose drains are placed down to
Morrison’s pouch and brought out through a
stab wound separate from the working incision.
Although an occasional case can be closed safely
without drainage we are frank to admit that
we do not feel capable of selecting these cases.
One is often surprised at the amount of drain-
age of bile and serosanguineous fluid following
an apparently perfect operation in a seemingly
dry field. A second argument for routine drain-
age is that occasionally the ligature on the
cystic duct may slip or cut through allowing a
free flow of bile from the duct. If drainage
has been provided this complication is of little or
no consequence, but if the abdomen has been
closed without drainage, a fatality may very
well result. Drainage of the pouch of Morrison
results in little or no increase in morbidity or
discomfort and may be life-saving in certain
circumstances, as has been pointed out. The
drains should if possible never be brought out
through the working incision but through a
separate stab wound. This procedure avoids
contamination of the larger incision, it places
for August, 1950
781
the drainage area at a distance in case the wound
has to be re-entered for some reason, and in
the event that a biliary, duodenal or pancreatic
fistula should develop, the working incision will
not be exposed to digestive enzymes causing dis-
ruption of the entire wound.
ANESTHESIA PREFERENCES
The anesthetic used depends on the condition
of the patient, the agents available, and the
skill of the the anesthetist. If cholecystostomy
is to be done as the procedure of choice, local
infiltration and regional block of the abdominal
wall with procaine affords adequate anesthesia
and relaxation with practically no risk. For
cholecystectomy may be used either spinal anes-
thesia with procaine or pontocaine, or endotra-
cheal inhalation anesthesia using cyclopropane,
ether, or a combination of gases supplemented
with curare if necessary for relaxation. The
trend in our clinic has been towards endotracheal
inhalation anesthesia for upper abdominal surgery
whereas formerly spinal anesthesia was pre-
ferred. The development of better techniques
and more skill in handling endotracheal anes-
thesia accounts for this trend.
It is difficult to avoid some discomfort to the
patient when operating in the upper abdomen un-
der spinal anesthesia because of the necessity of
placing traction on the costal margins, the dia-
phragms and occasionally on the esophagus. This
disadvantage can be overcome by using small
doses of sodium pentothal. However in the hands
of a skilled anesthetist endotracheal inhalation
anesthesia has most of the advantages and
none of the disadvantages of spinal anesthesia
and is our choice in these cases.
POSTOPERATIVE CARE
The postoperative care after cholecystectomy
or cholecystostomy for acute cholecystitis fol-
lows in general that for other intra-abdominal
operations. Fluid balance is maintained by the
parenteral route until oral feedings can be re-
sumed. Vomiting and distention are managed
by means of gastric suction. Antibiotic therapy
with penicillin and occasionally streptomycin is
used when indicated by evidence of extensive
infection or perforation. Early postoperative
ambulation is instituted with all patients who
can tolerate it. The drains are removed in stages
starting on the fourth or fifth day after the
operation. The patients remain in the hospital
from 10 to 15 days in the uncomplicated cases.
CASE RECORDS STUDIED
Fifty-eight case records covering a period of
three years were studied in connection with this
report. Several other cases were excluded be-
cause the findings were not clear-cut enough to
place them in the category of acute obstructive
cholecystitis. Fifty patients were operated
with a total of three deaths. One of those pa-
tients was moribund on admission with a per-
forated gallbladder and generalized peritonitis,
cholecystostomy being done as a last desperate
measure. The second patient died suddenly at
home on the thirtieth postoperative day pre-
sumably from a pulmonary embolus. The third
death was in a 58-year-old woman who died of
coronary artery occlusion and myocardial in-
farction on the ninth day after operation. A
cholecystectomy had been done despite a past
history of angina pectoris and hypertension.
The electrocardiogram was normal. The advis-
ability of performing cholecystectomy instead of
cholecystostomy was discussed before operation
and it was the opinion of the medical consultant
that the cardiac damage did not make her an
unreasonably bad risk for cholecystectomy. In
retrospect it would seem that cholecystostomy
should have been elected and might perhaps have
been survived by the patient.
The operative mortality in this series of cases
was therefore six per cent, which compares favor-
ably with most other published statistics. We
consider the results a favorable argument for
the plan of management stated above when one
considers that twelve of the patients operated
or 24 per cent, were 70 years of age or over
and that 50 per cent were not seen within 48
hours of the onset of the attack. There were
no complications such as wound disruption,
fistula formation, or infection in the wounds
closed without drainage. Other complications
were atelectasis — 3 cases, pulmonary infarction
— 1 case, phlebothrombosis — 2 cases, coronary
occlusion — 1 case, acute pancreatitis — 1 case.
It is of interest to consider the eight cases
in which a diagnosis of acute cholecystitis was
made but in which for some reason operation
was not carried out. Three of these patients
were aged and had severe heart disease. A
plan of watchful waiting resulted in subsidence
of the signs and symptoms in less than 24 hours
allowing the operation to be postponed until
such time as it might become mandatory. Had
the signs and symptoms of acute cholecystitis
persisted, these patients would have had cholecy-
stostomy despite the risk. Three patients refused
operation largely because their pain had begun
to subside. They recovered from the acute
attack. One 38-year-old woman was treated con-
servatively because her acute attack started
one day after a hysterectomy. She was treated
expectantly and her symptoms abated. The last
patient was a 48-year-old woman who was in a
critical condition with jaundice, fever, and vomit-
ing of several weeks’ duration. While being pre-
pared for common duct exploration she developed
generalized peritonitis with shock and died in
48 hours. Autopsy revealed a perforated gall-
bladder with bile peritonitis, and a large stone
completely obstructing the common duct. The
fact that in seven patients the pathological proc-
782
The Ohio State Medical Journal
ess apparently subsided without operation might
seem to constitute an argument for the conserva-
tive management of acute cholecystitis. How-
ever, as it has been pointed out previously one
is unable to predict in which cases this will
occur. The surgeon is not justified in waiting
for such an occurrence with the idea that opera-
tion may be done at any time, because the
technical difficulties and risk to the patient’s
life are greatly increased w'hen operation is
delayed.
SUMMARY
The pathogenesis, clinical diagnosis, and man-
agement of acute obstructive cholecystitis have
been discussed and a plan of management has
been presented.
The result of the management according to
this plan of 58 patients with acute cholecystitis
is reported.
CONCLUSION
1. Acute cholecystitis is primarily an obstruc-
tive phenomenon usually of a progressive nature.
2. Conservative management of acute cholecys-
titis is hazardous, especially because of the
unreliability of the clinical signs and symptoms
as indicators of the course of the pathological
processes involved.
3. Cholecystectomy within the first 72 hours
of the onset of the disease is the treatment of
choice.
4. When cholecystectomy is not feasible be-
cause of the poor condition of the patient or be-
cause of technical difficulties cholecystostomy
produces good immediate results.
BIBLIOGRAPHY
1. Marshall, S. F., Phillips, E. S. : The Acute Gallbladder.
S. Clin. North America, 633-639, June, 1948.
2. Glenn, F. : The Surgical Treatment of Acute Cholecys-
titis. S. G. and O., 83 :50-54, 1946.
3. Eliason, E. L., Stevens, L. W. : Acute Cholecystitis.
S. G. and O., 78:98-103, 1944.
Foreign Body of the Rectum and Colon
The motives from which foreign bodies are
introduced into the rectum and colon fall into
four groups: criminal assault, evil pranks, ac-
cidental impalement, and sexual perversion.
The objects found in the rectum and colon
due to criminal assault and evil pranks are
chiefly: olive bottles, whiskey glasses, electric
light bulbs, vaseline bottles, various sorts of
sticks and etc.1, 2> 3- 1
Accidental impalement occurs chiefly in rural
districts and the foreign bodies are usually the
handles of a hoe, rake, or pitchfork.
Sexual perversion is another form of introduc-
ing objects into the rectum and colon. A con-
stant use of this procedure may result in injury
to the perianal tissue, rectum, or perforation of
Submitted January 25, 1950.
the rectosigmoid. The seriousness, of course,
depends upon the size, shape, and sharpness of
the object plus the direction and force used in
driving the foreign body into the anus and rectal
canal. The removal of such foreign bodies de-
pends upon their size and shape, and the ability
to get access to the foreign body. Large bodies
in the colon usually require a laparotomy.
The case I wish to present is unusual because
of the size and shape of the object. It con-
sisted of a vaginal douche tip measuring 5%
inches in length attached to a heavy rubber
insulated electrical wire, 14 gauge, measuring
17 inches in length. The douche tip was bent
upon the wire. The over-all length is 22^
inches.
REPORT OF CASE 7432 E
A young, well-nourished, white male, age 25,
was first seen in the emergency room at St.
Thomas Hospital, Akron, Ohio, with a com-
plaint that he introduced an electrical wire into
his rectum two days ago and was unable to
remove it. No other history was obtainable as
the patient refused to comment on the size,
shape and length of the wire and motive of
insertion. The patient was quite comfortable
except that he could not sit down because of
the wire protruding from the anus about one
inch. Slight traction was applied to the wire
and the patient complained of abdominal dis-
comfort. Digital examination revealed only
a long wire extending as high as the finger
could reach.
The patient was then taken to surgery and under
spinal anesthesia, a sigmoidoscope was passed
with the wire through the scope in an attempt
to find the proixmal end of the wire and dis-
lodge the end. This was unsuccessful because
the wire extended beyond the length of the
sigmoidoscope. The patient was then prepared
for a laparotomy and through a left rectus
incision the abdomen was opened and explored.
No perforations were found in the rectum,
sigmoid, or colon. The foreign body was easily
palpated in the mid-descending colon. The
descending colon was opened just superior to the
foreign body, cutting through the tinea for
about three inches. The curved part of the
object was removed through this opening.
The colon was closed with interrupted Lam-
bert sutures of black silk and reinforced with in-
terrupted black silk sutures. A piece of
omentum was then sutured over this incision.
The abdomen was closed in layers with no drain-
age. The patient received streptomycin and
penicillin postoperatively. Convalescence was
uneventful and he left the hospital on the eighth
postoperative day. A history was later obtained
revealing that the patient had been following
such practices for the past year, deriving a sat-
isfaction of his sexual demands.
BIBLIOGRAPHY
1. Dugeon, H. R. : Foreign Body in Colon. Ann. Surg.,
1946, 124:604-605, Sept.
2. Macht, S. H. : Foreign Bodies in Rectum. Radiology,
1944, 42:500-501, May.
3. Alby, R. C. : Unusual Foreign Body in Rectum.
Kentucky M. J., 35:67, Feb., 1937.
4. Gillepsie, W. F. : Vaseline Bottle in the Rectum.
Canad. M. A. J., 31 :302, Sept., 1934.
— Leo J. Szary, M. D., Akron, Ohio.
for August, 1950
783
Innocuity of Protracted Oral Administration of Special
Fermentation Concentrates of B 12 as Demonstrated
In a Patient With Acute Leukemia
ROBERT D. BARNARD, M. D., and HARRY L. FOX, M. D.
The Authors
• Dr. Barnard, Brooklyn, N. Y., is a grad-
uate of Chicago Medical School, 1934; diplo-
mate of the American Board of Pathology;
and visiting hematologist, Terrace Heights Hos-
pital, Queens, N. Y.
• Dr. Fox, Queens, N. Y., is a graduate of
the New York Medical College, 1936; and visit-
ing physician, Terrace Heights Hospital,
Queens.
EXTENSIVE pharmacologic and toxicologic
studies on B12 administration to human
beings have not as yet appeared in the liter-
ature though the innocuity of the material would
seem to be established, for the usual doses,
by the presence of Bl2 in liver extracts and
in animal proteins generally. The cobalt con-
tent of Bi2 is so small (4 per cent) that one
would hardly anticipate any of the pharma-
codynamic effects of that element though Bar-
nard and Weitzner did observe skin flushing,
diuresis1 and muscle cramps after more than
the usual dose.
It has not been determined whether these
effects were due to impurities in their prepara-
tion. So far, the only untoward effect of rel-
atively massive doses of oral Bi2 that has been
observed in 200 patients receiving this material
is an occasional acneform eruption which four
patients considered to be casually connected with
the medication. A heightened skin color or
flush has also frequently appeared in patients
receiving oral grades of BX2 but this can hardly
be classified as an untoward effect. In the
vast majority of instances, administration of
a fermentation product containing 6 micro-
grams/gram, in doses of forty grams per day,
continuously for several weeks has been with-
out incident. The majority of patients to whom
this material was fed, were not seriously ill.
It was conceivable that a noxious agent would
be borne with impunity by an individual in good
health but that invidious qualities would be
brought out on administration to a person in
poor health. Thus, the senior author has seen
blast crises produced by small doses of inorganic
cobalt in acute leukemic patients.2 The present
report deals with an acute leukemic patient who
has received a total of 30 milligrams of B12 over
the past three months. It is presented only
from the viewpoint of the apparent innocuity of
the material whqn administered by mouth,
though the case will be discussed also on the
basis of interesting features of acute leukemia
which it reflects.
CASE REPORT
W. L., a 64-year-old bakery worker developed
what was thought to be an atypical or viral
Submitted April 26, 1950.
pneumonia early in December, 1949. He failed
to respond to antibiotic therapy and fever and
prostration failing to abate, a blood count was
procured. This revealed a marked macrocytic
anemia and normoblastosis along with a total
leucocyte count of 1,800 of which 33 per cent
were reported to be granulocytes and 22 per cent
as unidentified cells. He was seen by the writers
on December 14 when a sternal marrow aspir-
ation was performed and revealed that 67 per
cent of all nucleated forms were of the blast
type. The spleen was palpable with its inferior
border about midway between the costal margin
and the umbilicus. He was hospitalized on
December 16 because of progressive prostration,
fever and pallor. On the basis of the marrow
findings, the peripheral blood granulocyte hiatus,
a strongly positive plasma polyphenol reaction
and the moderate splenomegaly, a diagnosis of
acute estrapenic leukoblastosis (acute leukemia)
was made without qualification as to type. He
was given 500 cc. of whole blood intravenously
and 30 grams of reconstituted pooled irradiated
(ultra-violet) human plasma fraction “44-66”
subcutaneously* following which, myelocytes ap-
peared in the peripheral smear and permitted
the designation of the leucoblastosis as myeloid
in type. The patient left the hospital on De-
cember 18, not sensibly benefitted by the in-
fusions and a rapid dissolution was anticipated.
On the day of discharge, he was started on a
* This fraction is prepared by precipitating all protein
which is insoluble at 66 per cent ammonium sulfate satura-
tion, after the gamma globulin has been removed by 44
per cent ammonium sulfate saturation ; hence the designa-
tion as “44-66.” The fraction recovered between these
ammonium sulfate saturation percentages contains the
plasma cholinesterase, a fraction which inhibits glyco-
protein pseudoagglutination and also, apparently, the
“myeloblast maturation” factor of Schwind.3 We are in-
debted to Drs. Robert Pennell and Peter Masucci of the
Medical Research Division, Sharp and Dohme, for this
fraction. We have used it in other cases of acute leukemia
to attempt to augment the diminished blood cholinesterase
which we believe to be responsible for some of the morbid
manifestations of acute leukemia.
784
The Ohio State Medical Journal
dietary supplement of 20 grams of crude linseed
oil emulsified in milk with Tween 80 and 10 grams
of crude fermentation concentrates’! four times
daily.
The patient’s dissolution was not as rapid as
was anticipated, somewhat to the embarrassment
of the attending physicians who had summoned
the children from a considerable distance. Over
the next two weeks the patient’s appetite re-
turned and became voracious, the temperature
underwent a lytic decline, the drenching sweats
and pallor abated gradually and at the end of
a month after discharge from the hospital, all
symptoms except a persistent, but smaller
spleen, had disappeared. The clinical change
was concomitant with an improving hematologic
status which is recorded throughout the course
in Figure I. Initially, there was gradual fall
in the elevated sedimentation rate and (not re-
corded) a lowering of the plasma polyphenol
content. Except for a moderate anemia, this
hematologic normalization was most apparent at
the end of the second month of the treatment
period. A definite hematologic relapse is in-
dicated by the graph at the beginning of the
third month though the patient’s physical condi-
tion remained superb; he walked two miles twice
a day and it was only for forensic reasons that
we refused permission for him to return to
work. However, he had gained 32 pounds since
the onset of his illness. Careful evaluation failed
t This product and related materials were generously
supplied by Charles Pfizer and Company, Brooklyn, N. Y.
to show this to be due either to edema or
tumor; the spleen, in fact, was still shrinking.
The weight gain was apparently flesh and so
the linseed oil-Tween 80 emulsion ( representing
almost one thousand calories per day) was dis-
continued and the special fermentation concen-
trate changed to one that contained 8 micro-
grams/gram so that the daily dose was 320
micrograms of B12. At the present time there
is essential normality both of the clinical and
hematologic aspects of the case.
DISCUSSION
The potential remissibility of acute leukemia
has been a previous theme4 and the concept of
the nature of acute leukemia as a decompensatory
atopic-exudativte reaction, mandating such a
potentiality for remission, has been repeatedly
elaborated.5 From that standpoint, we see
nothing remarkable about the course of this
patient’s illness nor do we attribute to the
high dosage of Bi2 other than a supportive role,
if anything, in the evolution of this particular
case. If it is to be discussed as one of acute
leukemia showing more than a single (hemato-
logic) remission, then it should be remarked that
we are in possession of a case history which
exhibited one more remission than did the
present case; a total of three distinct simultan-
FIGURE I
A B C D E
I | : v/ \/
INTENSITY FEVER. PROSTRATION 8 I
NIGHT SWEATS |
I SEDIMENTATION RATE IN MM. * 10
At A the blood-plasma concentrate transfusion was administered. During the period B the diet was supplemented
by 80 grams of linseed oil with Tween 80 and 40 grams of concentrate from an antibiotic producing streptomyces
strain, daily. ..The concentrate was known to contain 6 mi programs of B12 activity and 225 units of antibiotic (as strep-
tomycin activity) per gram during the early portion of the B interval; during the latter portion .while the Bu> unitage
remained constant, there is no assay of antibiotic potency which may not have been present. There was hematologic,
though no clinical deterioration during this latter portion of the B period. During the C period, a concentrate contain-
ing 8 micrograms of B12 and 300 units of antibiotic per gram was administered daily in 40 gram dosage. At D this
was replaced by a concentrate from a streptomyces strain which was an antibiotic non-producer, in doses corresponding
to 550 micrograms of B12 daily. D was terminated at the end of ten days because of indications of clinical, though
none of hematologic deterioration. During E, which is still extant, 10 grams of the same material used during in-
terval C, along with 750 milligrams of terramycin (from streptomyces rimosus) is given daily. During this last period
there has been rapid regression of residual splenomegaly and the condition is evidently normal. There are two bowel
movements a day which show a gram positive bacillary character. Normoblasts, always present previously, have not
been seen since the 50th day of illness, even during the blast crisis of 60-80th day. The latter point stresses the lack
of corcordance throughout between clinical and peripheral hematologic findings.
for August, 1950
785
eous hematologic and clinical remissions and
relapses. From this standpoint, as well as sev-
eral others, we regard the present situation in
the treatment of acute leukemia to be exactly
comparable to that existing for Addisonian
anemia just prior to the announcement of liver
therapy by Minot and Murphy6 but consequent
to the excellent studies of Mosenthal7 and of
Gibson and Howard8 who used their own ideas of
supportive regimes.
On the basis of our concept of the nature
of the acute leukoblastotic process, whereby
the blast is regarded as a result, rather than
as a cause of the disease, we eschew all forms
of myelosuppressive therapy and though our
experience has been as universally bad as that
of any other observer, our durations appear to
be over twice as long and we are more optimistic
than ever that the disease will soon be numbered
among those conquered. We cannot regard the
admittedly unusual (for an elderly person)
course of the disease as being anything but
coincidental to the Bi2 administration at this
time because the preparation fed to the patient
has a variety of factors known to be distin-
guishable from B12. But that the increasingly ap-
parent tonic and supportive properties of fac-
tors associated with Bi2 may play an important
role in the ultimate management of the malig-
nant leukoblastoses, is freely admitted.
SUMMARY
A patient with acute leukemia exhibited a
sustained clinical remission while receiving a
daily dietary supplement containing from 240
to 320 micrograms of Bi;. The remission may
have been purely coincidental but the results
imply the complete innocuity of massive oral
doses of B12.
Addendum: July 1, 1950. The patient, taking
100 mgms. of terramycin daily is entering the
eighth month of remission. The coliform sup-
pressing antibiotic present in the fermentation
concentrate was presumably responsible for the
initial result because the senior author has now
recorded 18 remissions in 29 acute leukemic
patients given materials from antibiotic-
producing streptomyces species.
BIBLIOGRAPHY
1. Barnard, R. D., and Weitzner, H. A. : Bi» Diuresis.
Lancet 2, 717-718, Oct. 19, 1949.
2. Barnard, R. D. : Unpublished Observations.
3. Schwind, J. L. : Partial Maturation of Leukemic
Myeloblasts Following Fresh Plasma Transfusion. Am. J.
Med. Sciences, 218, 170-175, Feb., 1947.
4. Barnard, R. D. : Cholinesterase in Plasma (Corr.).
Modern Medicine 15, 12-14, May, 1947.
5. Barnard, R. D. : The Natui'e of Acute Leukemia and
the Interrelationship of the Malignant Dyscrasias. N. Y.
State J. Med., 47, 2703-2709, Dec. 15, 1947.
6. Minot, G. R., and Murphy, W. R. : Treatment of
Pernicious Anemia by Special Diet. J. A. M. A., 87, 470-
476, Aug. 14, 1926.
7. Mosenthal, H. O. : Blood in Pernicious Anemia. Bull.
Johns Hospkins Hosp., 29:129-137, June, 1918.
8. Gibson, R. B., and Howard, C. P. : Metabolic Studies
in Pernicious Anemia. Arch. Int. Med., 32, 1-16, July, 1923.
The Story Behind the Word
Some Interesting Origins of Medical Terms
Platinum — Platinum ore was discovered in
Peru, South America in the middle of the
Eighteenth Century by the Spaniards. They
named it platina which is the diminutive of plata,
the Spanish word for silver, because of its re-
semblance in color and appearance to that sub-
stance.
Radium — Professor and Madame Curie, the
discoverers of this element, named it radium be-
cause of its intense radio-active powers.
Condom — The facts concerning the origin of
this device are shrouded in obscurity. Turner
in 1717 attributed its invention to a Dr. Conton,
an Englishman who made a protective sheath
from the sheep’s cecum for covering the penis.
Others ascribe the invention to a Frenchman,
Monseiur de Condom. Still other authorities
question the existence of either a Dr. Conton
or a Monsieur de Condom and think that the
name is derived from the Latin “condere” or
“condus” meaning to hide or to protect.
Cough — An imitative word which is supposedly
a description or imitation of the sound produced.
Lumbago — A hybrid term of both Latin and
Greek origin. It comes from the Latin word
“lumbus,” the loin or haunch, with the “ago”
portion of the word coming from a corruption
of the Greek term “algos” or pain.
Pylorus — Gabriele Zerbi in 1502 described the
muscles of the stomach and introduced the term
pilorium, which was later purified by Vesalius to
pylorus. This term was given to the lower
orifice of the stomach because of its function.
It is derived from the Greek word “pulore” mean-
ing a janitor or gatekeeper and in turn comes
from the Greek word “pule” or gate.
Corn — This common and troublesome condi-
tion of the skin of the toe or foot is so-called
because it is a horny induration or excrescence.
It is derived from the Latin word “cornu” or
horn.
Chancre — This word is known to have been
in existence since the beginning of the Fifteenth
Century and is assumed to be a diminutive of the
word “caries” which had long been applied to
destructive genital lesions. The Latin word
“caries” literally means decay or rottenness.
Other authorities state that the term chancre
is derived from the Latin “cancrum” meaning
a cancer.
Sycosis — The name for this skin disease is said
to have first been used by Heraclides in 75 B. C.
The term sycosis is derived from the Greek word
“sukon” a fig. Celsus in his De Medicina about
30 A. D. states: “There is also an ulceration
called sycosis by the Greeks from its resemblance
to a fig.”
— Harry Wain, M. D., Mansfield, Ohio.
786
The Ohio State Aledical Journal
Chorionepithelioma of the Fallopian Tube:
Report of a Case with Autopsy
OTIS G. AUSTIN, M. D.
The Author
• Dr. Austin, Medina, Ohio, is a graduate
of Vanderbilt University School of Medicine,
1943; on staff, Medina Community Hospital,
and courtesy staff, obstetrics-gynecology, St.
Thomas Hospital, Akron; at time of paper was
resident, obstetrics-gynecology, Mercy Hospital,
Canton.
THE most recent case of chorionepithelioma
of the Fallopian tube to be found in the
literature was reported by Smith and
Werthesen in 1941. 1 Marchand described the
condition first in 1895. 2 Because of the rarity
of this disease, the following case is reported.
REPORT OF CASE
Mrs. M. S. No. C-1967. This 32-year-old white
woman, a patient of Dr. E. T. McCune of Seb-
ring, Ohio, had four pregnancies prior to the
present illness. Three pregnancies terminated in
spontaneous abortion at six to twelve weeks be-
fore a normal child was born three years prior
to admission. Her general health had been ex-
cellent. The menstrual history prior to the
present illness was not remarkable. There were
no previous operations.
The last normal menstrual period began
November 1, 1947. On December 13, 1947, a
laparotomy was performed by Dr. J. R. Caldwell
at Alliance City Hospital, Alliance, Ohio, for a
ruptured tubal pregnancy. The left tube was
removed uneventfully. However, the pathologist,
Dr. A. P. Falkenstein, noted unusual activity
of trophoblastic cells and warned the surgeon
that there was a possibility of malignant change.
A Friedman test done January 10, 1948, was
negative. On February 19 the patient was seen
again, this time complaining of weight loss and
nervousness. Examination was not contributory
and the Friedman test was again negative. There
was uterine bleeding for several days beginning
the first week in January and again early in
February.
On March 9, 1948, three months after sal-
pingectomy, the patient complained of increas-
ingly severe fatigue, nervousness, weakness and
lower abdominal discomfort. A pelvic tumor was
now noted on the left, separate from the uterus
which was thought to be slightly enlarged. There
was a small, flat, brownish area about 3 mm. in
diameter on the posterior cervical lip at 7 o’clock.
It bled easily. No abnormal cells were found
in smears from the cervix and vagina. A Fried-
man test was strongly positive. X-ray examina-
tion of the chest revealed an opaque area 2 cm.
in diameter in the right lower lobe. Laboratory
studies of blood and urine were normal.
A diagnosis of chorionepithelioma was made,
and on March 22, 1948, the abdomen was re-
explored, A vascular and friable inoperable
pelvic tumor was found to fill most of the left
side of the pelvis extending nearly to the
umbilicus. Hemostatic gel was placed over the
surface of the tumor mass after the bleeding was
controlled as well as possible and the abdomen
was closed with drainage. The patient received
2500 cc. of whole blood within the next five
days, plus antibiotics, parenteral fluids and
Wangensteen drainage. On the third postopera-
tive day the patient was moved to Mercy Hos-
pital, Canton, Ohio. Teropterin® (sodium
Submitted November 9, 1949.
pteroyltriglutomate*) was given in doses of 10
mgm. daily intramuscularly for a week, then
twice daily. The appetite improved and the
patient felt better.
Deep X-ray therapy to both the chest and the
abdomen was instituted. A total of 750 roentgen
units was given to each of the four quadrants of
the abdomen and to each side of the chest. X-ray
therapy was not completed.
At two or three-day intervals she received six
separate transfusions of 250-300 cc. whole blood.
Donors were women one to four days post-
partum. These transfusions were given in an
effort to supply a “restraining factor” to the
trophoblastic cells and to halt their invasive
activity. Following each of the last three
transfusions there was a mild chill followed
by temperature rise to 102° - 104° F., so this ap-
proach was temporarily abandoned. The abdomi-
nal wound healed well.
On the seventeenth postoperative day there
was a small amount of bloody sputum and pain
in both sides of the chest anteriorly. Two days
later there was evidence of massive internal
hemorrhage with dyspnea, cyanosis, rapid, low
volume thready pulse and nearly unobtainable
blood pressure. Red blood count and hemo-
globin dropped from normal to 1,700,000 and
33 per cent (5 Gms.), respectively. Administra-
tion of oxygen and supportive therapy revived
the patient to a great extent but were necessary
continuously thereafter. Moderate vaginal bleed-
ing began on April 16, the twenty-fifth post-
operative day. The patient expired April 19,
1948, twenty-eight days after the exploratory
operation and four months after the original
operation for tubal pregnancy.
AUTOPSY PROTOCOL
The body was that of a markedly emaciated,
young white woman.
Abdomen: The abdomen was not distended.
The peritoneal cavity contained about one liter
of clotted and fluid blood. A mass filled the
left side of the pelvis extending to 2 cm. below
the umbilicus. It measured 10 x 8 x 10 cms.,
was spongy, red and necrotic and was adherent
to the left cornu of the uterus. The sigmoid was
* Lederle product which has been used experimentally
to inhibit sarcomatous growth, and has not, to our
knowledge, been used previously in treatment of this
type of growth.
for August, 1950
787
attached to the upper aspect of the mass over
a distance of 20 cms.
Left tube and ovary, not visible. Right tube,
normal in size. The ovary was polycystic, lobu-
lated and measured 5x4x3 cms. Thick- walled
cysts contained heavy dark semisolid material.
No vaginal lesions.
The uterus approximately normal size, meas-
ured 4 cm. between the cornua, 8.5 cm. from
fundus to cervix; 3 cm. thick at corpus. Uterus
with attached adnexa and tumor mass weighed
550 gms. A small flat brownish area, 3 cm. in
diameter, was seen at 7 o’clock on the posterior
cervical lip. Endometrium was thin and pale, with
no evidence of hemorrhage.
The liver was large and pale, weighed 2400
gms. and contained multiple lesions, from 2 to 6
cm. in diameter, which were circular, soft, red
and necrotic. Cut surface showed numerous simi-
lar lesions throughout the liver tissue.
Nodes: Many small, firm lymph nodes were
found in the mesentery and retroperitoneal area.
Thorax: In the right pleural cavity there was
about 2 oz. of free blood. In the upper portion
of the right lower lobe, and in the left upper
lobe there were soft, rounded, fairly well de-
marcated masses, 2 to 4 cm. in diameter. Cut
surfaces were hemorrhagic and necrotic.
Figure I. Photomicrograph shows the uterine tube with
invasion of the wall by both the syncytial and the
Langhans elements.
Microscopic: Sections taken through the ad-
nexal mass presented necrotic material with
blood clots and vascular connective tissue
containing considerable pigment. The right
ovarian cyst contained blood. The cyst lining
was made up of several layers of luteinized
cells. Multiple sections through the cervix did
not reveal tumor cells. The hepatic and pulmon-
ary lesions contained blood and a great number
of Langhans’ or cytotrophoblastic cells. Also
there were masses of cells having the char-
acteristics of syncytium or plasmoditrophoblast.
No villi were seen. Chorionic cells were present
in the large pulmonary vessels.
DISCUSSION
Williams in 19383 reviewed the literature and
reported a case in which a chorionepithelioma
arose from a tubal pregnancy. He classified ex-
trauterine chorionepithelioma according to ori-
gin, as follows:
1. Those in which the tumor follows
ectopic pregnancy. This is apparently the
most common type.
2. Those which follow intrauterine preg-
nancy, villi being transported during or sub-
sequent to the pregnancy to the tube or broad
ligament and without initial malignant lesion
in the uterus.
3. Those which are purely metastatic from
a primary growth in the uterus to extra-
genital locations.
4. Those which arise from chorionic cells
in a teratoma, more common in the ovary.
A chorionic tumor of ectopic origin may be
mistaken during operation for ruptured ectopic
pregnancy and the true nature of condition re-
main unsuspected until metastases appear or
autopsy is performed. Repeated hormonologic
tests should be used in all suspected cases to
follow the development of this condition.
Statistics pertaining to incidence and cures
of chorionepithelioma must be accepted with
reservation because of the unusual difficulties
encountered in diagnosis. Chorionic cells are
innately invasive, may enter blood vessels and
lodge in lungs or other viscera even in uneventful
pregnancies. The nature of the stimulus which
initiates the malignant change is completely
unknown. Likewise, there is no known cause
for the dissolution of these wandering cells
during the normal puerperium.
In cases of chorionepithelioma of extrauterine
origin which were reviewed, the mortality rate
was 93 per cent. Fatal cases usually proceeded
rapidly to their termination. Williams’ pa-
tient lived 22 months and Smith and Werthesen’s
patient lived nine months after the diagnosis was
established. Our patient died four months fol-
lowing the operation for ectopic pregnancy.
Treatment of the disease should consist of
radical surgery and supportive measures using
blood transfusion liberally. Irradiation should
be tried when feasible.
SUMMARY
A patient with chorionepithelioma of the
Fallopian tube arising in a tubal pregnancy
is reported. This is the forty-fourth case to
be reported in the literature.
The difficulties of diagnosis are discussed. In
this patient tests for gonadotropic hormone
were not positive until anatomical evidences of
recurrence were present.
Unusual details of treatment involved trans-
fusions of whole blood from post-partum women
donors and Teropterin,® terminally, which seemed
to contribute to the patient’s sense of well-being
until her death.
BIBLIOGRAPHY
1. Smith, J. T., and Werthesen, N. T. : Chorionepithelioma
Associated with Tubal Pregnancy and Pulmonary Metastases.
Am. J. Obst. & Gynec., Vol. 41 :153, Jan., 1941.
2. Marchand, F., Monatschr, F. Geburts. u. Gynak : 1 :419,
1895.
3. Williams, T. J. : Chorionepithelioma of the Fallopian
Tube. Am. J. Obst. & Gynec. Vol. 35 :868, May, 1938.
788
The Ohio State Medical Journal
Intra- Abdominal Hemorrhage During Pregnancy from
the Spontaneous Rupture of a Uterine Vein
FRANKLIN C. HUGENBERGER, M. D., JAMES M. McCORD, M. D., and
CHARLES H. HENDRICKS, M. D.
The Authors
• Dr. Hugenberger, Columbus, Ohio, is a
graduate of Harvard Medical School, 1930;
diplomate, American Board of Obstetrics and
Gynecology; chairman, obstetric staff, Grant
Hospital; on staff, University, St. Ann’s Mt.
Carmel and St. Francis Hospitals.
• Dr. McCord, Columbus, Ohio, is a grad-
uate of University of Michigan Medical School,
1942; chief resident and instructor in obstetrics
and gynecology. University Hospital.
• Dr. Hendricks, Columbus, Ohio, is a grad-
uate of University of Michigan Medical School,
1943 ; instructor in obstetrics and gynecology,
University Hospital.
RUPTURE of uterine veins constitutes one
of the rare but dramatic complications
^associated with pregnancy. Harding and
Concannon,1 in 1943, found twelve cases in the
literature and added one of their own. Lee2
added another case in 1947. A survey of the
literature since that time reveals no further
cases and with the patient here reported the
total stands at fifteen.
CASE REPORT
Mrs. D. R., a 34-year-old housewife, was
brought to the Ohio State University Hospital
on the evening of August 28, 1948, complaining
of severe lower abdominal pain. She was para 0,
gravida 4, having had three previous instrumen-
tal abortions. She was due to deliver on Octo-
ber 17 and was therefore slightly over seven
months pregnant. There was a vague history
of albuminuria in 1933, but otherwise the sys-
temic review was negative.
The present pregnancy had progressed nor-
mally until the afternoon of admittance when
the patient, wdiile sitting quietly sewing, sud-
denly experienced severe low midline abdominal
pain of such intensity that she was unable to
walk. Two hours later the pain spread to the
right upper quadrant of the abdomen and then
into the epigastrium. She was taken to the
hospital five hours later.
Examination revealed a well-developed, mod-
erately obese white female who was acutely ill
and in severe pain. The pain was such that she
could move in bed only with great difficulty, and
jarring the bed caused increased pain. There
was, however, no shoulder pain. The blood pres-
sure was 132/90, pulse 76, temperature 99.2 F.
The fundus rose in the abdomen slightly higher
than would be expected of a seven months’ preg-
nancy and was markedly deviated to the right.
There was generalized abdominal tenderness
and voluntary spasm but no true rigidity. The
fetal heart sounds were located in the left
lower quadrant of the abdomen and were regular
and of good quality. Sterile vaginal examina-
tion showed no bleeding. The cervix admitted
one finger; the membranes were intact. There
was mild pitting edema of the feet and ankles.
Laboratory examinations showed a red blood
cell count of 4.55 M., and a white blood cell
count of 28,950. A catheterized urine showed a
trace of albumen, and the sediment was loaded
with white blood cells. A flat plate of the ab-
domen showed a fetus in cephalic presentation,
markedly deviated to the right. No other
unusual findings were noticed.
Because of the presence of the numerous white
blood cells in the urine the patient was examined
in the Urology Department where a cystitis and
Submitted December 15, 1949.
a mild right hydronephrosis were noted, but
these findings were not believed to be the major
source of the patient’s difficulty. About six
hours after the first blood level, a second blood
level was done. On this occasion the red blood
cell level was 2.5 m. Her general condition
had remained unchanged, and she had received
three liters of 5 per cent glucose intravenously.
The fetal heart was also unchanged.
The patient was taken to surgery with a pre-
operative diagnosis of hemorrhage into the peri-
toneal cavity of unknown origin. Rupture of the
uterus and premature separation of a normally
implanted placenta were considered. The possi-
bility of ruptured uterine vein was mentioned,
but not given serious consideration because of
the extreme rarity of the condition. The possi-
bility of pregnancy in the right horn of a
bicornuate uterus was mentioned because of the
position of the fetus in the right side of the
abdomen. Under spinal anesthesia a low mid-
line incision was made into the abdomen. Free
blood amounting to approximately 1000 cc. was
found in the abdomen but the source could not
immediately be ascertained. A Caesarean sec-
tion was deemed advisable and a live baby was
extracted from the uterus through a trans-
verse incision into the lower uterine segment.
The placenta was extracted and the contracted
uterus then examined. The anterior surface of
the fundus was covered with blood clot and
when this was removed blood was found to be
flowing from a ruptured vein on the anterior
surface of the uterus to the right of the midline.
This was directly over the placental site. The
bleeding was controlled with several catgut
sutures. However, on reexamining this area it
was seen that oozing had reappeared and it was
for August, 1950
789
necessary to take several more catgut sutures
in this area for hemostasis. It was found then
that the pregnancy had occurred in the right
horn of a bicornuate uterus. One thousand cc.
of blood were given during the operation. The
mother made an uneventful recovery. The
infant, which weighed 3 lbs., 10 oz., at birth,
was doing well one month later.
DISCUSSION
In seven of the fifteen reported cases the
diagnosis was made at autopsy. Of the remain-
ing eight cases one is reported above in detail;
a brief survey of the other seven follows.
In 1928, J. K. Miller3 performed a classical
Caesarean section on a woman 31 weeks preg-
nant who had abdominal pain. The preoperative
diagnosis was concealed accidental hemorrhage.
He found 600 to 900 cc. of free blood in the
peritoneal cavity but was not able to identify
the source of bleeding until the uterine incision
was closed. It was then seen that the bleed-
ing was coming from a ruptured uterine vein
and was controlled with a single catgut suture.
The baby died a few hours after birth; the
mother made an uneventful recovery.
In 1929, Modiano4 operated a patient at IV2
months gestation with a preoperative diagnosis
of ruptured uterus or peritonitis secondary to
appendicitis. The abdomen was filled with blood
and the source was recognized as a vein situated
on the anterior surface of the uterus. Because
of the possibility that another vein might rup-
ture if the pregnancy continued, a Caesarean
section was done. The infant died on the fourth
day, the mother made an uneventful recovery.
In 1931, M. C. Falk5 operated on a woman
26 weeks pregnant with a preoperative diag-
nosis of intra-abdominal hemorrhage, etiology
unknown. A large amount of blood was found
in the abdominal cavity. An area was found on
the posterior surface of the uterus which bled
when the surrounding blood clots were removed.
A supra-vaginal hysterectomy was done. The
specimen was examined and a six months fetus
removed which died almost instantly. The
bleeding area was shown to be a thin-walled
vein. The mother made a good recovery.
In 1936, Neuman6 did a Caesarean section on
a woman at term but not in labor who had
developed signs of intra-abdominal hemorrhage.
A live child was delivered, but because the rup-
tured uterine vein was below the level of the
internal os bleeding could not be controlled and
it was necessary to do a supra-vaginal hysterec-
tomy.
In 1939, G. Bulowsen7 operated a patient in
her 36th week of pregnancy with the diagnosis
of premature separation of a normally im-
planted placenta. A large quantity of blood
was found in the peritoneal cavity. A stillborn
fetus was removed by Caesarean section. After
the uterus was sutured it was seen that the
bleeding was coming from a tear in a uterine
vein located in the right horn of the uterus.
The patient made an uneventful recovery.
In 1943, Harding1 reported a woman 25 weeks
pregnant with signs of intra-abdominal hemor-
rhage. She was operated with the diagnosis
of accidental concealed hemorrhage. At surgery
the abdomen was filled with blood. Careful
search showed a small abraded area on the
posterior surface of the uterus which oozed
blood. A hysterectomy was done and a dead
fetus removed. The uterus was resutured and
the patient made an uneventful recovery.
In 1947, Lee2 reported the case of a 31-year-
old woman who was five months pregnant with
signs of intra-abdominal hemorrhage. A laparot-
omy was done and 2200 cc. of blood found in
the abdomen. The bleeding vein was at the
base of the posterior right broad ligament.
This was ligated and the abdomen then closed.
The patient, who was in shock at the time of the
operation, recovered but aborted a non-viable
fetus on the day after surgery.
In only one of the above-reported cases was
a viable infant obtained and in that case it was
necessary to remove the uterus. In the case
reported here a happy result was obtained in
that a viable baby was procured and no procedure
added to the Caesarean section except simple
ligation of the bleeding vein.
Although a preoperative diagnosis of ruptured
uterine vein would be difficult to make, it could
be suspected in the presence of intra-abdominal
hemorrhage with no external bleeding and a
baby in good condition. With the diagnosis
of intra-abdominal bleeding, operation is indi-
cated and the source of the bleeding is then
found. Caesarean section is probably advisable
if the fetus is viable, because of the potential
danger of recurrence of the hemorrhage. This
procedure is to be followed by ligation of the
bleeding vein.
Although this condition is rare its importance
is attested by the fact that half the reported
cases were autopsy findings.
BIBLIOGRAPHY
1. Harding, K. M.f and Concannon, A. B. : An Unusual
Case of Intraperitoneal Bleeding from a Ruptured Uterine
Vein During Pregnancy. Jr. Ob. and Gyn., Brit. Empire,
50:208, 1943.
2. Lee, A. F. : Intra-Abdominal Hemorrhage During
Pregnancy. Am. Jr. Surg., 74:867, 1947.
3. Miller, J. R. : Intra-Abdominal Hemorrhage from
Rupture of Uterine Vein During Pregnancy. Am. Jr. Ob.
and Gyn., 16, 103, 1928.
4. Modiano : A Case of Intraperitoneal Bleeding During
Pregnancy From a Ruptured Uterine Vein. (Quoted by
Ref. No. 1.) Bull, de la Soc. d’ Ob. and Gyn. de Paris,
18:332, 1929.
5. Falk, H. C. : Case of Intra-Abdominal Hemorrhage
from Rupture of Uterine Vein During Pregnancy. Am.
Jr. Ob. and Gyn. XXI, 118, 1931.
6. Neuman, O. : Dangerous Intraperitoneal Hemorrhage
from a Superficial Uterine Vein in Advanced Pregnancy.
(Quoted by Ref. No. 1.) Deutsche Med. Wochenschrift, 62,
578, 1936.
7. Gulowsen, G. : Case of Grave Intraperitoneal Hemor-
rhage During Pregnancy Due to Rupture of Varicose
Uterine Vein. (Quoted by Ref. No. 1.) Nord. Med. I,
678, 1939.
790
The Ohio Stale Medical Journal
Ohio Physicians in the Nineteenth Century,
a Statistical Study
PART i
FREDERICK C. WAITE. Ph. D.
TTIE earliest physicians in Ohio came with
the military expeditions or with the survey-
ing parties late in the eighteenth century.
Few, if any, of them remained to become resident
physicians.
Three physicians came with the first settlers
at Marietta in 1788 and three were in that set-
tlement in 1800. The first resident physician
settled in Cincinnati early in 1789 and two more
came later in the same year. Others came but
did not stay and in 1800 the settlement had
three resident physicians. The first resident
physician came to Chillicothe in 1796 and two
were there in 1800. The first resident physician
in the Western Reserve arrived in June 1800, the
last year of the century.
These fragmentary records do not help to
determine how many physicians were resident
in the area that became Ohio when the census
of 1800 estimated the population at 45,365. The
early settlers were much given to self-medication
and to treating their illnesses by domestic medi-
cine. Nearly every community included a woman
who acted as midwife and dosed with native
herbs. The number of resident physicians when
Ohio became a state in 1803 is conjectural,
probably only a few hundred.
Search for contemporary estimates of the
number of resident physicians in the state at
any time prior to 1850 has been futile, and
prevents giving statistics for the first half of
the nineteenth century.
EARLIEST FIGURES FROM U. S. CENSUS
The United States census began in 1850 to
list the number of persons in each of several
Read before the Committee on Medical Archives and
History of The Ohio State Archeological and Historical
Society at annual meeting, Columbus, April 14, 1950.
occupations and professions, including medi-
cine. The following table is from figures car-
ried in the census from 1850 to 1900 inclusive.
The number of the population for each resident
physician is derived by dividing the population
in each census year by the number of physicians
and has long been called a ratio.
Table I
Year
Population
Number of Physicians
Ratio
1850
1,980,329
4,274
468
1860
2,339,511
4,238
552
1870
2,665,260
4,638
575
1880
3,198,062
6,393
500
1890
3,672,329
7,034
522
1900
4,157,545
8,448
492
In 1850, New York, with 5,060 physicians,
was the only state that had more than Ohio
and only eighteen per cent more although the
population of New York was fifty-six per cent
greater than that of Ohio. The ratio in
New York was 612 compared to 468 in
Ohio. This divergence and also the fact that
the census figures for Ohio show fewer phy-
sicians in 1860 than in 1850 casts suspicion
on the census figures of 1850 for Ohio and
invites comment.
Instructions to census enumerators regarding
occupations were to list them “according to the
statements of the persons at their residences.”
Anyone could declare himself to be a physician.
Ohio was afflicted with a large number of
botanies, usually called Thomsonians, increas-
ing rapidly after 1830. Each had paid $20
for a book containing a “right” to practice
botanic medicine. It is probable that the
for August, 1950
791
census figures of 1850 and 1860 include
many of these as well as of other cultists
such as clairvoyants, euroscopists, “Indian
doctors,” magnetic healers, and mesmerists.
As late as 1880 city directories in Ohio listed
clairvoyants as a subdivision under the heading
of physicians.
FIRST NATIONAL MEDICAL DIRECTORY
The first national medical directory was com-
piled by Dr. S. W. Butler and published in
1874. It was based on the number of physicians
who had paid the Federal registration fee of
$10 in 1873. It listed 4,583 physicians in Ohio.
A second edition published in 1877 increased the
number to 4,655. The first edition of Polk’s
national medical directory was published in
1886, the compilation having been in progress
during two years. It carries the names of 4,947
physicians in Ohio. The second edition published
in 1890 shows an increase to 6,469 in Ohio. The
fifth edition was published in 1898 and shows
more care in compilation. It was the issue
nearest to 1900 and lists 8,231 physicians in
Ohio. A medical directory of Ohio privately
published in 1900 carries 6,444 names of physi-
cians and is apparently incomplete.
DIRECTORIES AND CENSUS DATA COMPARED
Comparisons of figures of the directories
with those of the census show the census fig-
ures constantly in excess, in some census years
to the extent of several hundred. The source of
these differences may be explained by two
probabilities. The compilers of directories relied
mainly upon medical societies for their figures
and are likely to have missed many practitioners.
The census enumerators probably continued to
list as physicians those who were not so con-
sidered by the medical profession. Possibly
census enumerators counted as physicians those
druggists who prescribed over the counter and
sold patent medicines. The local druggist was
addressed as “doctor” in some communities, al-
though he had no education in medicine beyond
pharmacy.
FIRST A. M. A. DIRECTORY
The first edition of the directory of the
American Medical Association was compiled in
1907 and lists 7,710 physicians in Ohio. Com-
parison with the number listed in Butler’s di-
rectory of 1877 shows an increase of nearly sixty-
six per cent while in these same thirty years the
increase of population of Ohio was fifty per
cent. The increase in census figures of physi-
cians for the entire United States for thirty
years from 1870 to 1900 was sixty-seven per cent.
CONCENTRATION OF PHYSICIANS IN CITIES
In seeking a clue to the approximate date
when such concentration began the names in
the classified lists of some city directories have
been counted for five census years. The four
larger cities of Cincinnati, Cleveland, Columbus,
and Toledo were selected and the count was
begun for 1860 because Toledo did not publish
a city directory until 1858.
These counts have been combined for the four
cities and the populations in these cities in
these years have been combined. Subtraction
of the two combined figures from similar census
figures for the state as a whole has permitted
derivation of three ratios for the five census
years.
Table II
Years
Entire state
State outside 4 cities
4 cities
1860
552
546
615
1870
575
560
684
1880
500
483
615
1890
522
524
514
1900
492
510
440
These figures indicate that although the cities
had fewer physicians in proportion to population
in 1860, 1870, and 1880, a concentration of
physicians in the cities began sometime between
1880 and 1890. The figures used for the ratios
of the first and second columns are the suspicious
census figures. The more reliable figures of city
directories are used for the third column.
WOMEN PHYSICIANS IN OHIO
The United States census of 1850 did not
include women physicians. They were included
in 1860 but not separated. Male and female
physicians were differentiated beginning in 1870.
In 1870 the number was 42, nine-tenths of one
per cent of the total; in 1880 the number was
341, over five per cent; in 1890 the number de-
creased to 287, four per cent; and in 1900 the
number was 451, five per cent. The women
were mostly sectarians because regular medical
colleges rarely accepted women as students in
the nineteenth century while the sectarian
schools urged women to study medicine and used
them to exploit their medical sects.
EDUCATION OF PHYSICIANS IN 19th CENTURY
Physicians of the nineteenth century fall into
three groups as regards their education: those
who received a medical degree in course; those
who attended a medical college but were not
graduated, either because of not attending two
sessions required for the medical degree or
from failure to pass examinations; and those
who were never enrolled in a medical college,
having received their entire medical education
by study under a preceptor. A considerable
number of the second group and a few of the
third group later received honorary degrees of
Doctor of Medicine. Conjectures were published
at various times regarding the distribution of
792
The Ohio State Medical Journal
current practicing physicians to these three
groups but lack of reliable data prevented valid
estimates.
Attendance at medical colleges was not popu-
lar in the eighteenth century either with prac-
titioners or with students. The traditional pro-
cedure of study under a preceptor was dominant.
The first medical degree in course in the Ameri-
can colonies was conferred in 1768 and from
that year to 1800 inclusive only 276 men re-
ceived degrees in course from ten different medi-
cal colleges, an average of little more than
eight per year.
In the twenty years from 1801 to 1820 in-
clusive 1,905 men received medical degrees in
course in the United States. More than 100
degrees in course were granted in each year
after 1812, and in 1819, the year that the Medi-
cal College of Ohio was organized, 261 degrees
in course were conferred. To this total number
of medical degrees in course up to 1820 should
be added a considerable number of degrees from
European institutions and also some honorary
degrees. From this combined total must be
deducted those holding a medical degree who
died before 1820, leaving approximately 2,000
holders of degrees in practice in 1820 when the
population exceeded 9,650,000, an average of
one holder of a degree to something less than
5,000 population.
Statistics of' the number of recipients of
degrees in medicine in each year throughout the
nineteenth century are not available. With the
founding of more medical colleges the proportion
of physicians holding degrees steadily increased
and also an increase occurred in the number that
attended a medical college but did not receive a
degree. The proportion of practitioners who
had received all their medical education under
a preceptor decreased correspondingly so that
by the close of the century few men of this
type were in practice.
A compilation from the lists of non-graduates
of a few medical colleges shows that of all
students who were enrolled in these insti-
tutions in the quarter-century session of 1824-
1825 approximately one-half received a degree
from that medical college or from some other
institution after migration. The corresponding
proportion for the mid-century session of 1849-
1850 was two-thirds and for the session of
1889-1890, forty years later, the proportion
was seven-eighths. These statistics represent-
ing only six different medical colleges show a
trend in the increasing value placed upon the
degree of Doctor of Medicine.
THE PROPORTION OF GRADUATE AND
NON-GRADUATE PHYSICIANS IN OHIO
Few medical practitioners in Ohio prior to
1825 held the degree of Doctor of Medicine.
Only nineteen degrees had been conferred in
Ohio up to and including 1825. Few young
men from Ohio went to eastern medical colleges
because of distance and expense. The first
medical student in an eastern medical college
giving his residence as Ohio entered Yale Medi-
cal Institution in 1815. The physicians who
came to Ohio in the early years were rarely"
holders of degrees. Men who received the de-
gree of Doctor of Medicine in eastern medical
colleges seldom migrated to new settlements in
the West but remained in the East. Those com-
ing in the first quarter of the century were al-
most entirely men who had received their entire
education under a preceptor or perhaps had at-
tended one session in an eastern medical college
without remaining for a second session to get
a degree. Biographical sketches of early phy-
sicians in Ohio support this general statement.
The first directory of Cleveland was published
in 1837. The classified list of physicans con-
tained twenty-four names of whom only six
held the degree of Doctor of Medicine, although
holders of the degree tended to locate in larger
communities.
COLLEGE ENROLLMENT GAINS WHEN
CANALS SIMPLIFY TRAVEL
The opening of the Erie Canal in 1825 and
of the Ohio Canal in 1832 simplified transporta-
tion and the number of students in medical col-
leges of New York and New England giving
their residence as Ohio steadily increased. They
were largely from northern Ohio. The number
of Ohio medical students attending Transylvania
University also increased.
A compilation of all medical students in
twenty-seven eastern medical colleges for the
sessions of 1812-1813 to 1838-1839 inclusive, ar-
ranged by the state which each student gave
as his residence shows for residents of Ohio
from 1812 to 1820 three students, from 1821 to
1830 forty-eight students, and from 1831 to
1839 one hundred and eighteen students in twelve
different medical colleges. The number of in-
dividuals was fewer because those who received
a medical degree attended two sessions and are
therefore counted twice in these statistics. The
largest total number at any one medical school
during these twenty-seven years was at the
College of Physicians and Surgeons of the
Western District of New York at Fairfield, a
total of forty-two. The next largest number
was forty-one at Jefferson Medical College.
These reliable figures show slight tendency for
Ohio young men to go east for medical education
prior to 1840.
(To be concluded in September issue)
for August, 1950
793
The Epileptic Child in School
JERRY C. PRICE, M. D.
THE epileptic child enjoys an increasing
freedom in school and summer camps.
Recent information about treatment is
presumably responsible for release from restric-
tions on his physical and mental activities.
Formerly thought to be hazardous to himself
and his friends, the epileptic person is now en-
couraged to take part in athletics and continue
with whatever academic training he may wish
to do.
The Ohio State Medical Society and The
Ohio Society for Crippled Children, Inc.,
worked out a plan with the object of attempting
to improve circumstances under which the
epileptic person lives in Ohio. Included among
other professional and lay agencies whose assist-
ance was sought are the Public Health Units,
Division of Special Education, Services for Crip-
pled Children, industrial nurses, school nurses,
hospital authorities, Nursing School authorities
and their pupils, Bureau of Vocational Rehabil-
itation and Ohio State Bureau Juvenile Research.
Initial inquiries and follow-up of cases were
carried out by the agencies interested in the
health and welfare of the epileptic person.
OHIO PLAN SUMMARIZED
The program is expedited through the “Ohio
Plan” devised by The Ohio Society for Crippled
Children, Inc. The plan in summary is as
follows:
1. The Ohio Society for Crippled Children,
Inc., selected epilepsy as one of its major
functions.
2. The president of the Board of Directors
appointed a small Steering Committee. This
committee was composed of members of the
board and its duties were administrative.
3. The Board of Directors created the Profes-
sional Advisory Committee on Epilepsy which
is composed of three members from the Board
of Directors; three representatives of the Divi-
sion of Special Education, State Department of
Education; two representatives of Services for
Crippled Children, State Department of Public
Welfare; two representatives of the Bureau of
Vocational Rehabilitation, State Department of
Education; one representative each from the
Division of Mental Hygiene, the Bureau of
Juvenile Research, the Division of Nursing of the
State Department of Public Health, Departments
of Neurology and Psychiatry, and Pediatrics,
Ohio State University School of Medicine; and
representatives of camping and recreation. Func-
Submitted June 2, 1950.
The Author
• Formerly: Consultant, Project on Epilepsy,
The Ohio Society for Crippled Children;
Assistant Attending Neurologist, Neurological
Institute, New York City; Associate Research
in Neurology, Columbia University, New York
City. Now: 9615 Brighton Way, Beverly Hills,
California.
tions of the committee are principally advisory
ones.
4. The Board of Directors also appointed
a consultant to the Project on Epilepsy after
seeking the advice of the Ohio Medical Society.
5. A secretary of the Project on Epilepsy
was decided upon, a professional person, psy-
chiatric social worker, being employed.
6. An educational -demonstration -consultation
clinic was inaugurated after a series of confer-
ences between the executive director, the consul-
tant, and secretary of the Project for Epilepsy.
In consultation with The Ohio Medical Society
an outline was devised to conform to accepted
medical ethics and the objective of the Project.
The plan of the clinic is as follows:
a. A history blank is forwarded to the family
physician after he has requested that one of
his patients be seen at the clinic.
b. The physician is requested to return the
history blank to The Ohio Society for Crippled
Children before an appointment is made.
c. The physician is urged to attend the clinic
with his patient, or requested to have some re-
sponsible person present.
d. A previously made diagnosis of epilepsy
is confirmed, or the patient is referred back to
the family physician with requests for further
information, or suggestions for diagnostic tests
are made.
e. Social, economic, and family problems are
isolated as carefully as time will allow.
f. Suggestions for medical therapy and socio-
economic readjustments are made in a letter to
the family physician.
g. The problems presented by each case are
discussed by the consultant with representatives
of other agencies after departure of the patient.
7. Information concerning epilepsy is distrib-
uted by The Ohio Society for Crippled Chil-
dren from the central office, 5 West Broad Street,
Columbus, Ohio, and its four area field secre-
taries at kindred group meetings, the State
794
The Ohio State Medical Journal
Fair, etc., and the educational-demonstration
clinics.
MATERIALS AND METHODS
An unselected group of 50 children in school
ages were chosen for study, and a spontaneous
report from each recorded. Few questions were
asked for fear of eliciting incorrect information,
the usual questions being: 1. Is your child in
school ? 2. Does he attend classes regularly
or does he miss a measurable amount of school-
ing ? 3. Have the school authorities talked
to you about him? 4. Has he mentioned the
other children to you? Similar non-specific
questions were used in case information was
meager, or to clarify school situations previously
related to the examiner, in order to obtain
uniform criteria for estimation of the school
problem.
The objective of the study is to determine if
the child is attending school and if so, how
well he is doing. If not in school: Can he
return to regular classroom activities ? Does
an attack interrupt classroom routine, and to
what extent? Does the epileptic child disturb
his classmates and the school authorities?
CASE REPORT
One patient is over 20 years of age. She
related vividly her experiences of school, mar-
riage and motherhood. Although she continued
to have occasional seizures none occurred at a
time when she was measurably inconvenienced
by it. She stated that she is annoyed rather
than depressed by the recurrent attacks. This
case is included to emphasize the clinical course
of uncomplicated epilepsy.
NOT A REPRESENTATIVE GROUP
There is no reason to believe that this group
is representative of the epileptic population.
The milder cases that respond well to medica-
tion are seldom examined in educational-
demonstration-consultation clinics. The age dis-
tribution is distorted. The etiological agents
are those common to this age group but unlike
those of the 750,000 epileptic persons in this
country.1- 2
The case material is standardized by deter-
mining the age distribution, etiology, classifica-
tion of epilepsies, types of attacks, frequency
of seizures, mental capacity, and results of
treatment.
The study is derived from information obtained
during the initial interview with the patient
and those who accompanied him to the clinic.
To complete the study a survey of the school
policies and actual contact with the patient in
school is anticipated.
The classification of epilepsy into idiopathic
and organic (asymptomatic and symptomatic)
is inadequate, and a classification for the epi-
lepsies that would give a more accurate descrip-
tion of the child is suggested.
All figures used in this report refer to
cases. Percentages may be obtained by multi-
plying the number of cases by 2.
RESULTS
AGE
Chart 1 gives the present, age of onset, and
duration of seizures. The distribution of cases
in this age group is similar to those of other
observers3 for this age group.
Years
Present
Onset
Duration of Attacks
0- 4
0
18
18
5- 9
13
13
16
10 - 14
25
15
11
15 - 20+
11
2
O
O
Unknown
1
2
2
Total
50
50
50
Chart 1 — Age of the Patient in 5 year periods.
CLASSIFICATION
Chart 2 is the classification of the cases in
both the accepted and proposed forms.
The etiology of epilepsy is generally conceded
to be unknown. A predisposition for one to de-
velop recurrent attacks may be brought to our
attention by injury to the brain, low sugar
content of the blood and other metabolic dis-
turbances which are poorly understood. Recur-
rent seizures are found and no apparent cause
is demonstrable. However, the diagnosis of
epilepsy is made in all cases. In the absence
of a demonstrable cause the group is classified
idiopathic, asymptomatic, cryptogenic and others.
Organic, symptomatic and other terms are used
to designate those in whom a cause for the re-
current attacks is demonstrable.
In effect and by practices commonly accepted
by physicians the idiopathic group includes all
cases in which no structural damage to the
nervous system can be demonstrated. All symp-
toms of the epileptic have been attributed to
disturbances in the convulsive mechanism with-
out regard to other well-known syndromes or
diseases of the nervous system that might also
be present. Influence of environment, social
and economic, has been neglected. Mental ill-
ness and personality disturbances have been
neglected both as a causative and perpetuating
agent of recurrent attacks.
Modern psychiatry is discussing vigorously
the functional or organic origin of mental ill-
ness, neuroses and personality problems. And,
too, if originally “functional” does a disturbance
later become a permanent “organic” deviation
from the so-called “normal”?
Functions of the central nervous system are
dependent on the integration of its structural
and physiological units. This scheme is similar
to other biological units and the brain is no ex-
ception. We are obligated to study separately
“epileptics” with and without other diseases
for August, 1950
795
or syndromes of the central nervous system that
may have an effect on the physiological mechan-
ism related to seizures or interfere with proper
care of the patient and prevent superimposition
of “functional” or “organic” disturbances on
recurrent attacks. 4> 5’ 6’ 7’ 8' 9’ 10' X1- 12’ 13' 14' 15' 16> 17
In order to avoid confusion in terms, let’s
consider the accepted classification as The Epi-
lepsies even though it includes etiological in-
ferences. The proposed form may then be con-
sidered a classification of the etiological or
perpetuating agents or a combination of them.
This distinction affords a better chance of evalu-
ating the significance of presumably causal or
perpetuating agents on seizures. In addition, it
draws attention to the person who has seizures
and also other problems which may be far more
important to him than
A more detailed study
be discussed elsewhere.
the recurrent attacks,
of these principles will
The Epilepsies
Etiological Factors
Idiopathic
24
Idiopathic _
12
*Organic
26
Structural Cerebral
Changes
.21
Physiological Cere-
bral Changes
15
Miscellaneous
. 0
Unknown
_ 2
50
* Cerebral Palsy — 12, Trauma — 4, Feebleminded — 2, Throm-
bosis— 1, Post-encephalitis — 2, Agenesis — 1, Undetermined
—4.
Chart 2 — Classification of the Epilepsies in Con-
trast to Etiological Factors.
The chart demonstrates that 24 children have
seizures for which there is no demonstrable
cause. Yet, those who have attacks but also
have problems that may influence the onset,
frequency and perpetuation of attacks are
reduced from the total of 24 to 12 cases. “Idi-
opathic” is a reasonable term in the classifica-
tion of these cases, namely, there- are no other
diseases or syndromes that could have an effect
on the number and types of seizures. In the
group classified as structural cerebral changes
are those usually stated to be organic in type.
Cerebral palsy, trauma and infections are in-
cluded.
In the group physiological cerebral changes
are those cases in which structural changes are
minimal or absent but who suffer from emotional,
mental and intellectual disturbances. The pri-
mary or secondary effects of these disturbances
are important in attempts to evaluate the
etiology of attacks as well as cause of social
and economic maladjustments. The group is
composed largely of children who are mentally
retarded for which there is no apparent cause,
social misfits, and “problem children.”
The miscellaneous group includes the epileptics
who have diseases of other organ systems from
which metabolites or disturbances of blood sup-
ply causes isolated or recurrent seizures. Ex-
amples are complete heart block, hypoglycemia
and uremia.
TREATMENT
Only seven, or 14 per cent, of the group had
had treatment considered to be adequate.18 The
effect of medication can be determined most
effectively after available medicines are used
in quantities that will cause overdosage symp-
toms. The amount may then be reduced slightly
so that the patient is comfortable.
Twelve children had had no medicine. Thirty-
one had had dilantin, phenobarbital, bromides
and tridione in small doses at irregular inter-
vals. Other medicines used by individual phy-
sicians are known to the profession but are
not universally prescribed in the treatment of
seizures.
Adequate
7
Control
7
Inadequate
31
75 per cent
8
None
12
50 per cent
8
None
10
Worse
0
No Medicine
12
Undetermined .
5
Chart 3 — Treatment with Medicines and the
Results.
The results confirm the opinion that treatment
is inadequate (Chart 3). Seizures were de-
creased 75 per cent or more in 30 per cent of
the group. This is in contrast to a similar re-
duction in the number of seizures in approxi-
mately 60 per cent of cases treated with a more
vigorous medical regime.19
The total number of cases that received ade-
quate treatment is too small to demonstrate
statistically whatever effect it might have on
disturbances caused by the epileptic child in
the schoolroom.
ABILITY TO PERFORM SCHOOL WORK
Chart 4 shows that the epileptic child is
similar to the average school student.
Marks Cases
A 10
C , 18
Ungraded 12
Home Teaching 2
Out of School 8
Total 50
Chart 4 — Estimated Ability to Perform School
Work.
If one considers the incidence of organic dis-
ease of the central nervous system in this group
one would have difficulty in recognizing the
epileptic child because of his ability in school,
79 6
The Ohio State Medical Journal
and that is what is found by the school au-
thorities. The problems of academic instruc-
tion for the epileptic child are similar to those
of the non-epileptic child as will be indicated
later in this report.
TYPES AND FREQUENCY OF SEIZURES
Chart 5 indicates the types
of
seizures.
The high incidence of
grand
mal
attacks,
alone or in combination
with other types of
seizures may be the result of
the incidence
of both structural and
physiological
cerebral
changes in this group.
Grand
mal
attacks
were described in 96 per
cent — petit mal alone
was found in only 4 per
cent of
the group.
One a week or more
_ 20
One per month or
less
... 13
Unknown
... 17
Total
—...50
Grand Mai
Petit Mai
Grand Mai }
—
26
2
14
Petit Mai j
Grand Mai (
3
Psychomotor
Grand Mai |
Myoclonus j
Grand Mai 1
Petit Mai >- 1
Jacksonian J
Grand Mai 1 1
Menieres-like Syndrome j
Grand Mai ( 1
Jacksonian j
Total 50
necessary before the significance of seizures
can be readily evaluated.
INTELLECTUAL DEVELOPMENT
Intellectual development was estimated and
found to be distributed as shown in Chart 6.
Cases
Normal
... 31
Abnormal
... 17
Undetermined
2
Chart 6 — Estimate of Intellectual Ability*
Psychometric studies or estimation of the I. Q<-
by psychologists had been performed in a
small number of the group. The estimates
in Chart 6 were made from the child’s ability
to answer routine questions, solve arithmetic
problems, his knowledge of current events and
similar material. Estimation of (the effect
of emotional disturbances, inattention, behavior
mannerisms, etc., on mental capacity was at-
tempted, and proper allowances made for them.
One is aware of the errors attendant to such a
method. However, the results of psychological
and clinical estimates of mental capacity were
strikingly similar.
DISTURBANCES IN SCHOOL
In many discussions about education of the
epileptic child the effect of seizures on the
child’s classmates or interruption of classroom
routine prohibits, or promotes over-cautious
placement of the patient in the private or public
school system. Chart 7 shows that only six, or
Chart 5 — Frequency and Types of Attacks.
Of the 33 cases in which the frequency of
seizures was known, twenty, 60 per cent, had
one or more seizures each week. It is sur-
prising to find that only six, 12 per cent, of
the total group are stated to be unable to
attend school primarily because of attacks
even though seizures recurred so frequently.
The unknown group is composed of those
who were uncertain or unaware of the fre-
quency of seizures. Other problems such as
objectionable mannerisms or asocial behavior
distracted everyone’s attention from the attacks.
The frequency of seizures is only one, and
perhaps the least important, of the criteria
for school placement in some cases. The
so-called “running fits” or periods of malbe-
havior often related to seizures, though fewer
in number than other types of attacks, may
be more important than frequency of seizures
in determining school placement for a child.
Mental confusion following attacks caused a
limited disturbance in this group — yet an im-
portant one. A rigorous treatment regime is
Cause
Cases
None
..... 16
Seizures
...... 6
Other symptoms ...
..... 28
Chart 7
— Causes of Disturbances
in School.
12 per
cent, have seizures upon
which the con
tinuity
of education depends.
Sixteen, or 32
per cent, cause no disturbance in school even
though nine of the children had seizures on the
grounds or in the classroom of the school.
Twenty-eight, or 56 per cent, disturb their class-
mates, or interrupt classroom routine because
of malbehavior, mental impairment, or other
symptoms resulting from an injury to or mal-
development of the brain infections and other
causes.
Among the 16 children, or 32 per cent of the
group who cause no measurable disturbance in
school, the school authorities and their fellow
students did not know about seven, 14 per cent,
of them. They had had no attacks on the school
grounds or in the classroom. The remaining
nine children, or 18 per cent, had suffered one
or more seizures while on school property.
for August, 1950
797
Three children had attacks on the school grounds
but none in the classroom. Six children had
attacks only in the classroom.
In three cases the disturbance caused by a
seizure was slight but the school authorities
brought it to the attention of the child’s family.
The teacher and pupils were concerned about
the first attack but worked out a scheme suit-
able to all so that the routine of the school was
uninterrupted by subsequent attacks. Restric-
tion from athletics was imposed on one boy
because his seizures usually occurred after ex-
ercise. He was permitted to take part in other
activities of the school and student body. One
was unrecognized as an “epileptic child” be-
cause she had had only petit mal attacks in
the classroom. Another child was well adjusted
to being teased about her attacks — teased
similarly as if she had freckles on her face or
a wart on her finger and it disturbed her as
little.
Seizures were described as the cause of the
disturbance in school in six instances. One-half
of this group were also mentally retarded but
the attacks, or post-seizure symptoms, caused
the school authorites to be concerned about the
safety of the child or morale of the other stu-
dents. One child had minor attacks that were
followed by drowsiness. He was allowed to
put his head on the desk and sleep for 20-30
minutes, the average duration of drowsiness.
His classmates also wanted to sleep when they
were drowsy — probably some of them wanted
to shun their classwork duties and others merely
wanted attention. The patient was persuaded
to struggle through the period of drowsiness
after attacks. Discipline in the classroom was
easily restored.
One child occasionally had 20 seizures in one
day. The teacher was frightened, and justi-
fiably so. Another school was found. The
teacher had had experience with “epilepsy.” She
was able to care for the child if he had an
attack, and was instrumental in directing the
child and his parents to a physician for medical
care.
Another child, unknown to have “epilepsy”
had a convulsion for the first time during a
class. The teacher and all the students left the
room. The principal of the school was called
to the scene. After the acute symptoms had
subsided he drove the patient home in his car.
The patient returned to school the next day
and has continued to attend classes regularly
and without undue comment from either the
teacher or his classmates.
Very frequent seizures in addition to mental
retardation were described as the cause for the
disturbance in school in the other 3 children.
Two of them have been removed from school.
The teacher has encouraged the other one to
continue in school as regularly as possible,
and classmates volunteer to care for him during
an attack.
CARE OF PATIENT IN CLASSROOM
Gentle care of the patient and creation of
a calm atmosphere in the classroom during
the attack has been most helpful in preventing
anxiety, tension, and fear of the seizure. One
method of accomplishing this feat, and it has
been used elsewhere, is worthy of note. A child
fell from her seat in a grand mal attack during
class. The sister in charge of the room in-
structed the children to continue with their
work. The child remained by her desk where
she had fallen until she recovered from the
acute phase of the seizure. She was permitted
to continue with her work if she was able to
do so, or to go home if she felt ill.
Even though seizures recurred frequently in
the remaining 28 cases, 56 per cent, disturbances
in school were attributed to causes other than
the attacks. The most prominent causes of in-
terruption of school routine in this group are
malbehavior and mental retardation.
Thirteen children, or 26 per cent, failed to
meet the academic standards of the school or
were so poorly behaved, or a combination of
the two, that special care is required for them.
Specific recommendations were made for four
children, all but one of whom were mentally
and physically normal. Everyone is well-
acquainted with the usual school policies of home
instruction programs or blanket elimination of
epileptics from school. They need not be dis-
cussed further except to call attention to the
small number of children (2) on home teaching
programs. One child’s cousin had objected
severely for years to the patient attending the
same school. After the patient had completed
the junior year in high school she had volun-
tarily withdrawn from school.
Intrafamily discord20, 21 was described as the
primary cause of school disturbance in six in-
stances, or 12 per cent. In some cases, fre-
quency of attacks, mental retardation and mal-
behavior are of much less importance to the
school authorities than mother dependency,
anxiety and fear of attacks. In one case a child’s
fear of an impending attack is more important
to him than friends among his classmates and
ability to perform good classwork.
Drug intoxication in three cases caused mal-
behavior and created an uncooperative aptitude
for school. Overdosage or an idiosyncrasy to
a medicine may cause malbehavior, irritability
and other symptoms that are similar to well-
known clinical syndromes, even though the child
may be physically and mentally normal.
Social discord with her classmates was the
only disturbance a senior in high school caused.
Even though she had had no seizures in school,
the president of the senior class knew of her
798
The Ohio State Medical Journal
attacks and notified her that she would not be
allowed to go on an educational trip to Wash-
ington, D. C., with the class unless her mother
would accompany her. The patient learned that
the president of the class had written to her
without consulting her classmates. A special
meeting of the senior class was called. The
president of the class was forced to apologize
to the patient for interpreting her personal
opinions as senior class policies. The patient
was then invited by her classmates to make the
trip to Washington, D. C., without being ac-
companied by her mother.
One child is mute. A special school for the
mute had rejected him because of questionable
mental ability. An opinion was sought by
those interested in him. Another child has a
severe speech disturbance and infrequent attacks.
In summarizing the primary causes for dis-
turbances in school, seizures are in the minority.
Only in three instances are seizures described
as such. In 16 instances the combination of
mental retardation, malbehavior and seizures are
causes for the disturbances in school.
In the remaining 15 out of 34 cases that
caused disturbances in school, interruptions of
the routine program are attributed to causes
other than seizures. Realignment of attitudes
about epilepsy with modern concepts of it by
the school authorities, physicians and near rel-
atives would most likely eliminate some of these
disturbances in school. Improved care of the
epileptic child would enhance the probability
that only 17 children, or 34 per cent, would cause
a disturbance in school, and that the disruption
of routine would be attributed to mental or
physical deviations from the normal rather than
attacks.
HELPFUL CRITERIA BROUGHT OUT
Criteria that would be helpful in anticipating
the disturbances an epileptic child might cause
in school are brought out in this study. The
Years
None
Seizures
Others
Present Age
0 - 4
0
0
0
5-9
1
2
9
10 - 14
11
2
13
15 - 20 and over
4
2
6
Age of Onset
0 - 4
2
4
12
5 - 9
3
2
9
10 - 14
10
0
4
15-20 and over ....
1
0
1
Unknown ..
0
0
2
Duration of Attacks
0-4
10
1
7
5-9
4
1
11
10 - 14
2
2
7
15-20 and over
0
2
1
Unknown
0
0
2
Chart 8 — Ages of the Patient, Onset and Dura-
tion of Attacks and their Influence on Dis-
turbances in School in 50 Cases.
older age group of children that seek treatment
for seizures are least likely to interrupt class-
room routine (Chart 8). The children whose
seizures first occurred at the adolescent period
caused the fewest disturbances of all. The
period over which attacks recur is directly pro-
portional to the likelihood a child will cause
disturbances in the classroom.
Chart 9 partially explains the age group distri-
bution of cause and effect of age on classroom
disturbances. One may say that children who
Classification
None Seizures Others
The Epilepsies
Idiopathic 14 1 9
Organic 2 5 19
Etiological Factors
Idiopathic 10 1 1
Structural Cerebral Changes 2 5 14
Physiological Cerebral Changes 4 0 11
Miscellaneous 0 0 i)
Unknown | 0 0 2
Chart 9 — Classification in Accepted and Proposed
Forms and their Influence on Disturbances in
School.
have no demonstrable cause for the attacks and
whose near relatives require them to lead an
active, constructive life will be of no undue
concern to the school authorities or their class-
mates. The children in whom multiple causes
or perpetuating agents for seizures can be dem-
onstrated are usually slow mentally or behaviorly
maladjusted.
RESULTS OF TREATMENT
The results of treatment and its influence on
disturbances in school are a bit confusing on
first glance (Chart 10). Only in the completely
None
Seizures
Others
C
4
0
3
75 per cent
2
1
5
50 per cent
2
2
4
None
3
2
5
No Medication
4
0
8
Undetermined
1
1
3
Chart 10 — Medication and Its Influence on Dis-
turbances in School.
controlled group is there evidence of the neces-
sity of medicines in the care of the epileptic
child. The proportion of 1:2 children in the
groups in which there is no disturbance in school,
or if so it is caused by symptoms other than
seizures, is materially altered only in those
whose attacks are controlled. The proportion
is reversed. The effect of inadequate dosage
and irregular administration of medicines on
disturbancs in school caused by the epileptic
child awaits a more vigorous and critical trial
of the anticonvulsant medicines. It is note-
worthy, however, that children may and do
for August, 1950
799
attend school much as one would expect of them
even though seizures recur at frequent intervals.
INFLUENCE OF FREQUENT SEIZURES
Frequent seizures (Chart 11) add to the prob-
ability of disturbances in the classroom. Seizures
None
Seizures
Others
1/week
5
3
12
1/ month
6
0
7
Undetermined
5
3
9
Chart 11 — Frequency of Seizures and their In-
fluence on Disturbances in School.
that recur at a rate of one per week or more
are commonly accompanied or caused by other
diseases of the nervous system, and symptoms
of which are often as likely as attacks to be
causative of schoolroom disturbances.
HOW MENTAL CAPACITY AFFECTS ROUTINE
Normal mental capacity is essential to the
least number of disturbances in school an epi-
leptic child is known to cause (Chart 12).
None
Seizures
Others
Normal
16
3
12
Abnormal ....
0
3
14
Undetermined
0
0
2
Chart 12 — Mental Capacity and its Effect on the
Incidence of Disturbances in School.
Mentally normal children may become odd from
either outside influences or whatever they might
think of themselves and become classroom prob-
lems. However, this is true whether a child
does or does not have attacks. A normal mental
capacity minimizes the likelihood that outside
influences might affect the child, or if so, he is
capable of a good readjustment with guidance.
ENCOURAGING ADEQUATE ADJUSTMENTS MADE
Children that are and have been able to make
a good adjustment to school in spite of their
seizures are unlikely to upset the routine pro-
gram of the classroom (Chart 13). Epileptic
children are capable of adjustment to the social
life of the school as well as to meet its academic
requirements when suitably endowed and should
be required to do so. A child, happily occupied,
is least likely to cause disturbances in school.
The children who are able to adjust to home or
Regular
In
Ungraded
Out
Home
Teaching
None
15
1
0
0
Seizures .....
3
1
2
0
Others
10
10
6
2
Chart 13 — Disturbances in School and School
Placement.
playmate surroundings are unlikely to interrupt
classroom routine. Intrafamily discord19 plays
a decided role in the adaptability of children and
it is prominent in the epileptic child (Chart 14).
None
Plus
Unknown
None
11
5
0
Seizures
3
3
0
Others
9
17
2
Chart 14 — Disturbances in School and Their Re-
lationship to Intrafamily Discord.
However, it is encouraging to see the number
of children who have the opportunity both at
home and school that make adequate adjustments
and cause the school authorities and their fellow
students no undue alarm about them.
The criteria that would decrease the incidence
of disturbances in a routine school program is
summarized in Chart 15.
SCHOOL PLACEMENT
Chart 16 demonstrates that 40 children, 80
per cent, are in school. It also shows that eight
children, 16 per cent, are exempt from school,
and two children, 4 per cent, have classes at
home supervised by a visiting teacher.
School attendance is surprisingly high. Credit
is due the physician, near relatives and school
authorities for their painstaking placement of
complex problems in a routine school program.
Only one of the group attended a private school
designed for the care of the epileptic child.22
The term “in school” means that the child
is enrolled in school, is assigned to a desk,
and is required to attend school regularly. The
term “out of school” means that the child has
discontinued all connections with the usual school
None
Seizures
Others
Present age
10 - 20 years
5-14 years
5-14 years
Onset of seizures
10 - 20 years
0 - 9 years
0 - 9 years
Duration of seizures
0-4 years
10 - 20 years
0 - 9 years
Classification
Idiopathic
Organic
Organic
Etiology
Idiopathic
(2)
(2) and (3)
Response to medication
Controlled
Undetermined
Undetermined
Frequency of seizures ....
1 /month
1/week
1/week
Mental capacity
Normal
?
Abnormal
School placement
Regular classes
Ungraded Classes
Out of school
Chart 15 — Summary of Criteria to Reduce the Incidence of Disturbances in School.
.800
The Ohio State Medical Journal
program within the community in which he lives.
Home teaching programs of Departments of
Education which permit children to receive in-
struction by a regularly certified teacher and be
credited with school attendance are available
in most states.
It is interesting to note in Chart 16 that of
the 80 per cent that attended school, 28, or 70 per
In School 40
Regular Classes.— 28
Ungraded 12
Out of School 8
Home Teaching 2
Chart 16 — Placement of the Epileptic Child by
School Authorities.
cent, are included in regular classroom schedules.
Sixteen of these 28 children, 46 per cent, have
caused no undue alarm to their classmates nor
have they been disturbed measurably by hav-
ing had recurrent attacks. The remainder are
in ungraded classes.
Unfortunately some epileptic children are not
allowed to continue in school with one class
from year to year. This is an unnecessary
hardship in many instances. Yet the family of
the patient, attending physician, the child and
school authorities have arranged to continue with
schooling according to chronological age or
academic progress. At times, it is necessary
to find a teacher acquainted with the care of
the handicapped child and willing to work with
him. This is true in both those in regular
and in ungraded classes. In rare instances the
family found it necessary to move to a new
community and have been willing to do it.
INTRAFAMILY DISCORD RETARDS PROGRESS
In five cases intrafamily discord has inter-
fered with an expected progress of the child.
Over-protective families of the children have
allowed them unusual liberties from studies
and other responsibilities, which tends to cause
anxiety, paternal dependency, and irrespon-
sibility. For example, the parents of one child
persuaded the teacher to allow him to develop
poor habits in both studies and behavior. An-
other child was more cooperative and happier
at school than at home principally because he
was permitted to take part in school activities
much as anyone else.
OTHER OBSERVATIONS
Toxicity of excessive doses of medicine caused
three children to have lower marks, study less
efficiently and become irritable and fussy.
Fear of the attacks by the teacher or teacher
and students caused some concern to three chil-
dren. Though not severe enough to prompt re-
moval of the child from school, and usually
with the first attack only, an adjustment to the
seizure by classmates was necessary before
routine classwork could continue without inter-
ruption.
Classroom discipline was interrupted by one
child whose seizures were followed by drowsi-
ness but which was corrected easily. Ignorance
of the relationship of “petit mal” and “epilepsy”
prevented trouble in one case. The patient had
grand and petit mal attacks but had had only
petit mal seizures in school. The attempt of
the president of a senior class to impose her
personal opinion about epilepsy upon a class-
mate has been previously described.
Mental retardation in one case is no obstruc-
tion to attending regular classes. He will be
unable to progress academically with his class-
mates. He is capable of making a passing
mark in the present school placement. Socially
he is more easily adaptable to other children
than if he had missed the experiences of asso-
ciation with his classmates.
Twelve of the 28 children in school are in
ungraded classes. All but one of them are
mentally retarded. Concern about them is a
result of their poor behavior. Seizures recur
at both frequent and infrequent intervals yet
the children remain in ungraded classes because
of inability to compete academically and socially
with other children.
Mental retardation complicated by intrafamily
discord is doubly troublesome to school author-
ities. In five cases intrafamily discord con-
ceivably prevented the child from getting valu-
able social experience from his contacts With
other children. Mother dependency, irritability
and malbehavior in a mentally retarded child is
very difficult to cope with and may even de-
crease a child’s ability to accept instruction
or profit by experience.
Physical defects that interfere with expres-
sion or reception of knowledge may retard
academic progress in an otherwise normal child.
Two of this group are in ungraded classes, and
justifiably so, yet they may be mentally normal.
One has a marked speech defect, and the other
is mute. Correction of or compensation for these
physical handicaps is indicated before it is pos-
sible to determine if they should be in regular
classes.
A sense of social adjustment is independent of
intellectual ability. Four children are carried
along in school consistent with their chronologi-
cal rather than mental ages. Academic work is
minimized or omitted. Social experiences are
encouraged with gratifying results.
Only one mentally normal child is in an un-
graded class. He has had no attacks in school.
Seizures recur about every two months. He
has had no medication.
SCHOOL EXEMPTIONS
Similar to the group in school, those out of
school are almost as perfectly selected. One
for August, 1950
801
would expect that it would be easier for the
school authorities to exempt rather than find a
place in their program for an epileptic child.
That is not the case in the public schools of Ohio.
Only eight out of 50 children were exempt
from school. Two children have teachers who
hold classes for them in their homes.
Six of the eight cases exempt from all school
programs are mentally retarded. Their be-
havior is incorrigible. Most of them suffer
frequent seizures.
Two cases deserve special attention. One is
a girl who voluntarily withdrew from school be-
cause her cousin objected to her presence in
the school building. A second child had at-
tended school for six years. Each year he
had been promoted to a higher grade. The
physician in charge of the case urged both the
family of the patient and the school authorities
to continue his education. The school authorities
objected to having him in school. The family
was afraid he would hurt himself during an
attack as he had to walk between one and two
miles for a school bus. On one occasion he had
fallen in a snow bank, his clothes became wet
and he had been exposed to severely cold
weather. A visiting teacher is unavailable to
carry out a home teaching program.
OHIO’S HOME TEACHING PROGRAM
The home teaching program in Ohio is re-
ported to be an excellent one. Only two chil-
dren have “home teachers.” Scarcity of visiting
teachers partly explains this low figure. The
majority of those formerly carried on home
teaching programs are in school even though
academic work is kept at a minimum. There are
a number of teachers and children who accept
the more unfortunate child and are undisturbed
by their peculiar habits and mannerisms. In-
deed, some children assume a parental attitude
and care for the mentally retarded, behavior
problem child more efficiently than adults.
Surely the social education for both the usual
and unusual child is well worth the program in
school as revealed in this study. For those
who are abusive and destructive, individual care
is indicated.
ERRORS MINIMIZED THROUGH ANALYSIS
Errors in placement of epileptic children in
school may be minimized by observing generally
the criteria brought out by this study. Un-
doubtedly some mistakes will be made as ex-
perience is gained by those responsible for
placement of the children in school.
SPECIAL CLASSES FOR SOME
Children, the first of whose recurrent attacks
occur during adolescence, and who are seen in
the clinic soon afterwards, are more likely to
take part in a routine school program than those
whose seizures are first noticed early in life
and who have received treatment over a long
period of time (Chart 17). The latter group
are more commonly required to attend special
classes, or if within the usual classroom schedule
Years
In
RegruJar
Ungraded
Out
Home
Teaching
Present Age
0 - 4
0
0
0
0
5 - 9
5
4
3
1
10 - 14
16
7
2
0
15-20+
7
1
3
1
Unknown
0
0
0
0
Age of Onset
0 - 4
8
6
4
1
5- 9
5
4
3
1
10 - 14
13
1
0
0
15-20+
1
1
0
0
Unknown 1
Duration of Attacks
0
1
0
0 - 4
14
3
0
1
5 - 9
7
6
3
0
10-14
5
3
3
0
15-20+
1
0
1
1
Unknown
1
0
1
0
Chart 17 — The
in School of
Age Distribution and Placement
50 Unselected Children.
allowances are
made for
them.
The
dual role
of a school program, namely academic and social
instruction, permits
including the
more
unfor-
tunate child in regular classes.
Indeed,
social
adjustment is far
too often independent of
academic ability to be ignored by
an institution
of learning.
"C
h
fca
c
£
o
cd
H
's *-
S 5?
£
c c ^
es £ 2
s
O
X
The Epilepsies
Idiopathic
21 0
2
1
Organic
7 12
6
1
Etiological Factors
Idiopathic
12 0
0
0
Cerebral Injury
6 8
6
1
Psychiatric
9 3
2
1
Miscellaneous
0 0
0
0
Unknown
1 1
0
0
Chart 18 — Classification, Accepted and Proposed
Forms and School Placement.
Chart 18 indicates that inability of the ex-
amining physician to demonstrate structural
changes in the brain enhances the probability
that a child may attend classroom activities
much as anyone else. Injury to or infections of
the brain often prohibit academic progress,
802
The Ohio State Medical Journal
and too, unstable, emotionally labile children are
equally difficult to integrate in a well-organized
classroom schedule.
Regular
In
Ungraded
-*>
s
O
Home Teaching
Control
5
0
1
1
75 per cent
5
2
0
1
50 per cent
6
1
1
0
None
3
4
3
0
Worse
0
0
0
0
No Medication
6
5
1
0
Undetermined
3
0
2
0
Chart 19 — The Results of Treatment and Its
Effect on School Children.
Control of seizures, 50 per cent or more, Chart
19, enhances the probability that a child will
attend regularly the average classroom sched-
ule. The children who receive no help from
medication, if they have had any, or who are un-
decided as to the effect of medicines on the
number of attacks are most likely to be found
in ungraded classes or excused from all con-
tacts with a school program.
The
results
are
about as one would expect them to be yet a
more rigorous medical regime
is
required
to
obtain comparable figures.
ns
bt
G
is
u
a
U
a
V
ns
o>
H
s
bj
u
bo
0)
|
0: £
u
o
n
1/week 9
6
3
2
1 /month 8
4
1
0
Undetermined 11
2
4
0
Chart 20 — The Effect of Frequency of Seizures
on School Placement.
Chart 20 demonstrates the effect of frequency
of seizures on placement. A child who has at-
tacks at intervals of once a month or less is
likely to be included in regular classes. Seiz-
ures found to recur at intervals of one each
week or more is a determent in school place-
ment; yet, some of them attend regular class-
room schedules. However, seizures recurring so
frequently are very commonly associated with
malbehavior and sub-par mental ability the
combination of which, are indications for place-
ment in an ungraded class; or the child might be
excused from school.
PLACEMENT REQUIRES GREAT CARE
Chart 21 demonstrates the importance of
mental capacity. Our school system is stand-
ardized on the basis of academic work per-
formed by the students. It is not surprising that
the normal is found in regular and abnormal in
ungraded classes or excused from school at-
tendance. However, it is surprising to find the
degree of perfection with which children have
s
Normal
Abnormal
*-•
Regular Classes ...
27
1
0
Ungraded Classes .
1
9
2 mute-speech
Out of School
2
6
0
Home Teaching
1
1
0
Chart 21 — Mental
Capacity
and
School Place-
ment of 50 Unselected Children.
been placed in school and with minimal criteria.
The general concensus of opinion by educators
has been that epileptics should be placed with
great care, if at all, except in an institution
designed for them.
REALISTIC APPROACH BENEFICIAL
Chart 22 demonstrates that children who are
able to accept epilepsy as a handicap without
undue alarm and whose near relatives are least
upset by seizures are more likely to be found
in regular classes at school. Indeed the children
In
None
Present Unknown
Regular Classes
18
10
0
Ungraded Classes
3
8
1
Out
2
5
1
Home Teaching
0
2
0
Chart 22 — Intrafamily Discord and School Place-
ment.
in ungraded classes are usually more severely
affected than those in regular classes and the
near relatives have cause for greater concern
about them. However, regardless of the severity
of seizures, or other symptoms, a realistic ap-
proach to the problem enhances the likelihood
that the average epileptic child has a good chance
of continuing with his classmates from year to
year and even the more unfortunate children
may attend school regularly.
Chart 13 demonstrates that only about one-half
of the children in regular classes cause a dis-
turbance of class routine. Behavior of children
of this age group with perhaps greater deviations
than expected is handled by school authorities
who are acquainted with it even though seiz-
ures recur. However, the “problem child” or
“conduct disorders” that cause disturbances in
the classroom more often than seizures indicate
placement in ungraded classes if not exclusion
from school. A thorough trial in school is
justifiable before a hopeless attitude keeps one
jor August, 1950
803
from properly locating the group that can be
helped and probably kept out of institutions
designed for custodial care.
A summary of the criteria is given in Chart 23.
interfere temporarily with one’s ability to per-
form whatever responsibility may be under-
taken. With some forebearance for concurrent
illnesses, symptoms common to the conditions
In
Regular
Ungraded
Out
Home Teaching
Present Age
._10 - 19 yrs.
5-14 yrs.
5-14 yrs.
Age of Onset
-10 - 19 yrs.
0 - 9 yrs.
0 - 4 yrs.
5-14 yrs.
Duration of Attacks.
.0-5 yrs.
5-10 yrs.
5-10 yrs.
The Epilepsies ...
...Idiopathic
Organic
Organic
Idiopathic
Structural
Structural
Structural
Etiology
Cerebral Changes
Cerebral Changes
Cerebral Changes
Physiological
Physiological
Physiological
Physiological
Cerebral Changes
Cerebral Changes
Cerebral Changes
Cerebral Changes
Treatment
...C - 75 per cent
None — 50%
None — 50%
C— 75%
Frequency of Seizures.
_.l /month or less
1/week or more
1/week or more
1 / week or more
Mental Capacity.
. Normal
Abnormal
Abnormal
Disturbance in School..
..None
Others
Others
Others
Chart 23 — Summary of Criteria for Placement of Epileptic Children in School.
COMMENT
An increased efficiency of placement of the
epileptic child in school under the supervision
of tolerant, understanding authorities automati-
cally minimizes disturbances in school caused by
seizures and other problems. Selection of chil-
dren for summer camp programs designed for
the average child was successfully carried out
by the National Association to Control Epilepsy,
Inc. The Association worked closely with the
E-P-I Center (formerly the Baird Foundation
Clinic). Only children well adjusted to their
illness and whose seizures were well controlled
were able to continue successfully with an eight
weeks summer camp period. The authorities,
unlike the school authorities of Ohio, were re-
luctant to accept, or keep in summer camp, any-
one except the mentally and physically normal
child.
The criteria for selecting children for school
or summer camp programs are similar and not
unlike those of employment, motor vehicle
licensure, insurance, and marriage. In some
instances, as in the summer camp program
mentioned above, complete freedom of attacks is
essential. That is not always the case as dem-
onstrated in this study. Recurrent attacks
need not interfere with one’s mental and phy-
sical ability to perform whatever duties are as-
signed to him. This study stresses the point
that one need not be free of attacks to attend
school if those in charge of the school are
tolerant and understanding.
A thorough understanding of why epilepsy
is a handicap is essential to the epileptic per-
son who hopes to be successful and happy.
Nonetheless important is the attitude of those
with whom he comes in contact. Both parties
must realize that seizures are, in the main,
unrelated to mental capacity, personality and
behavior with few exceptions. Epilepsy is an
illness with limited characteristics that may
that are stated to cause epilepsy and the result
of poor environment, the usual epileptic is
strikingly similar to the usual child. The un-
usual epileptic is, in like manner, similar to the
unusual child.
One must remember that the material pre-
sented here is obtained from the patient or a
responsible person who accompanied him to the
clinic in addition to information furnished by
the attending physician. And too, the data
presented may be the impressions the patient
or responsible person received from the school
authorities, or their self -expressed desires and
wishes for school placement. An entirely dif-
ferent point of view might be obtained from the
school authorities. If so, it is important to
know what the differences may be. A clearer
understanding and a realignment of opinions
about epilepsy are essential to proper placement
of the child in school.
Documentary evidence is presented for the suc-
cessful selection of children for school place-
ment. Only four children are malplaced in
school. One is a mentally normal boy 16 years
of age. He is in an ungraded class. He has
had no medicine. Presumably he has only one
grand mal seizure every two months. He is be-
coming disinterested in his school work and
apathetic about making friends among his class-
mates. To what extent poor habits have added
to his problems is difficult to estimate.
Two mentally and physically normal chil-
dren are out of school. One because her cousin
objected strenuously to her attending the same
school. Another, a boy, was exempt from school
over the attending physician’s objections. Ex-
emption from school was requested by the
child’s family because they feared he might be
severely injured during an attack.
Another mentally normal girl was recom-
mended for a home teaching program. Seizures
804
The Ohio State Me die al Journal
were soon brought under control but she con-
tinues to receive instruction in the home.
Review of the school program for the more
severely handicapped child is required from
time to time. Readjustments are made and cor-
rectly so as demonstrated in a surprisingly high
percentage of this group.
SUMMARY AND CONCLUSIONS
1. School attendance of fifty unselected school
children is reported. Information obtained from
the patient, his family, persons responsible for
him, and the attending physician is the basis
of this study.
2. A proposed classification of Etiological
Factors may increase the accuracy of school
placement.
3. Statistical data are presented to show that
epileptic children are in school even though
they may have frequent seizures and treatment
is inadequate.
4. The epileptic child’s ability to perform
routine school work is strikingly similar to other
children.
5. This study also demonstrates that the se-
verely handicapped child, mentally and physically,
is in the public school system in Ohio.
6. Mental capacity is similar to that expected
of this age group.
7. School placement is strikingly accurate.
Eight out of ten are in school and of this
group, seven out of ten are in regular classes.
Fewer than one in ten are assigned to home
teaching programs. The remainder are exempt
from all school programs.
8. The study indicates that seizures are less
bothersome than mental retardation, malbehavior
and social maladjustments to the school au-
thorities.
9. Four children who might be expected to
attend classes regularly were found to have
special care. Exemption from school because
of seizures, is limited to six children.
10. Placement of children in school is found
to be largely a result of cooperation of the rel-
atives, teacher and family physician.
11. Clinical criteria are offered with the
hope that, by using them, malplacement of
epileptic children in school may be minimized.
Note: The author is grateful to the officials
of the Ohio State Medical Association for their
assistance in helping formulate the program of
the educational-demonstration-consultation clinic
and to its members who so graciously supported
the clinic. The untiring efforts of the executive
director of The Ohio Society for Crippled Chil-
dren, Inc., are largely responsible for the suc-
cess of the clinic. The ease and grace with
which the program was integrated with respon-
sible persons is due the secretary of the project,
namely, Mrs. Lois T. Schneider. The recording
secretary, Mrs. Virginia Seymour, was diligent
and thorough in carrying out the objectives of
the clinic. Mr. Paul Brown’s wise guidance
and encouragement at difficult moments is ap-
preciated. Mrs. Mary Elliott assisted materially
with excellent public relations, timely placed,
and well organized. The personnel of the Office
of Vocational Rehabilitation assisted materially.
Cooperation of the Division of Special Education
was unselfishly granted to us. It is impossible
to mention many others who so energetically
participated in the program and to whom the
success of the program is largely due. How-
ever, I do hope they will now accept silent
appreciation formerly expressed to them in
person.
BIBLIOGRAPHY
1. Bridge, Edward M. : Epilepsy and Convulsive Dis-
orders in Children. 1st Edition, McGraw-Hill Book Com-
pany, Inc., New York, 1949, pp. 228.
2. Penfield, W., and Erickson, T. C. : Epilepsy and Con-
vulsive Disorders in Children. 1st Edition, McGraw-Hill
Book Company, Inc., New York, 1949, pp. 305-362.
3. Peterman, M. G. : Convulsions in Childhood, 20 Year
Study of 2,500 Cases. Am. J. Dis. Child., 72 :399, 1946.
4. Lennox, W. G., and Cobb, S. : Epilepsy. Epilepsy and
the Convulsive State (Part II). The Williams and Wilkins
Co., Baltimore, 1929.
5. Lennox, W. G. : The Physiological Pathogenesis of
Epilepsy. Brain, 59:113, 1936.
6. Schilder, Paul: Neuroses Following Head and Brain
Injuries. Chapter 12A, Brock, Injuries of the Brain, Spinal
Cord and Coverings. The Williams and Wilkins Co., Balti-
more, 3rd Edition, 1949, pp. 298.
7. Grinker, Roy R., and Weinberg, Jack: Neuroses Fol-
lowing Head and Brain Injuries. Chapter 12B, Brock
Injuries of the Brain, Spinal Cord and Coverings. The
Williams and Wilkins Co., Baltimore, 3rd Edition, 1949,
pp. 329.
8. Bowman, Karl Murdock, and Blau, Abram : Psychotic
States Following Head and Brain Injury in Adults and
Children. Chapter 13, Brock, Injuries of the Brain, Spinal
Cord and Coverings. The Williams and Wilkins Co.,
Baltimore, 3rd Edition, 1949, pp. 342.
9. Lennox, W. G., Gibbs, E. L., and Gibbs, F. A. : In-
heritance of Cerebral Dysrhythmia and Epilepsy. Arch.
Neurol, and Psych., 44 :1155, 1940..
10. Gallant, L. F. : Psychotherapeutic Evaluation of
Epileptics. Presented to the Section on Convulsive Dis-
orders. Amer. Psych. Assoc., 106th Annual Meeting, De-
troit, Mich., May, 1950.
11. Waggoner, R. W. : Behavior Disorders as Convul-
sive Equivalents. Presented to the Section on Convulsive
Disorders. Amer. Psych. Assoc., 106th Annual Meeting,
Detroit, Mich., May, 1950.
12. Deutsch, L. and Weiner, L. L. : Children with
Epilepsy, Emotional Problems and Treatment. Amer. Jour.
Orthopsychiatry, 18 :65, 1948.
13. Mittlemann, B. : Psychopathology of Epilepsy. Epi-
lepsy, Psychiatric Aspects of Convulsive Disorders. Hoch
and Knight, Grune and Stratton, New York, pp. 136, 1947.
14. Co Tui : Sackler, A. M., Sackler, M. D., van Ophui-
jsen, J. H. N., and Weinberg, M. : Endocrinologic Orientation
to Psychiatric Disorders. Symposium. Presented to the
Section on Convulsive Disorders, Amer. Psych. Assoc., 106th
Annual Meeting, Detroit, Mich.,- May, 1950.
15. Putnam, T. J., and Merritt, H. H. : Experimental
Determination of the Anticonvulsant Properties of Some
Phenyl Derivatives. Science, 85 :525, 1937.
16. Putnam, T. J. : Use of Sodium Diphenyl Hydantoinate
as an Anticonvulsant. J. A. M. A., 112 :2190, 1939.
17. Peterson, Donald B., Sumner, J. W., and Jones, G. A. :
The Role of Hypnosis in Differentiation of Epileptics from
Convulsive-Like Seizures (a Study of 50 Consecutive Cases).
Presented to the Section on Convulsive Disorders, Amer.
Psych. Assoc., 106th Annual Meeting, Detroit, Mich., May,
1950.
18. Price, J. C., and Otto, J. : Standard Treatment of
Epilepsy. Dis. Nerv. System, Vol. VII, No. 11, Nov., 1946.
19. Merritt, H. H., and Putnam, T. J. : Sodium Diphenyl
Hvdantoinate in the Treatment of Convulsive Disorders.
J. A. M. A., 111:1068, 1938.
20. Price, J. C., and Putnam, T. J. : The Effect of In-
trafamily Discord on the Prognosis of Epilepsy. Amer.
Journ. of Psych., 100 :593-598, March, 1944.
21. Price, J. C., Kogan, K. L., and Tompkins, L. R. : The
Prevalence and Incidence of Extramural Epilepsy. Epilepsy,
Hoch and Knight. Grune and Stratton, New York, 1947,
pp. 48.
22. Bowditch, Henry : The Eric Bowditch Hospital School.
Brochure. Brunswick Park, Ruxton, Baltimore 4, Maryland.
for August, 1950
805
Ohio Golf Tournament . . .
More than 90 Doctors Take Part As Dr. T. R. Shoupe of Findlay Wins
Top Honors in Twenty-Fifth Annual Tourney at Sylvania Club, Toledo
By ROBERT W. ELWELL
Executive Secretary, Academy of Medicine, Toledo
THE Silver Anniversary Tournament and
Annual Meeting1 of the Ohio State Medical
Golfers’ Association was held on June 14,
1950, at the Sylvania Country Club, Toledo. Dr.
R. C. Young, Chairman of the Local Committee
and his hard working committee members pro-
vided the excellent facilities of a difficult course
and beautiful club house. Considering the lack
of advance publicity due to commitment difficul-
ties, the attendance of 93 golfers was gratify-
ing. Twenty-six new fellows were initiated into
membership at the meeting. The fine weather, a
welcome change from many previous tour-
naments, made for many low scores.
ASSOCIATION CHAMPIONSHIP
Dr. T. R. Shoupe of Findlay toured the woody
and sand-trapped Sylvania Course in the fol-
lowing scores (38-38-42) for 118 to become the
25th champion of 0. S. M. G. A. Dr. H. T. Sargis,
Lakewood, was right behind the winner with
scores of 42-36-41 for 119 to place as runner-up.
The following doctors were also awarded prizes
for low gross in the 27-hole event. E. A. Sawan,
Akron, 121; C. Donatelli, Toledo, 123; R. P.
Pell, Sr., Cleveland, 124.
18 HOLE EVENT
The honors for low gross in the 18-hole play
went to Dr. Julian Harrison, Napoleon, with an
83. Dr. N. G. Mathieson, Toledo, was runner-up
with an 86. The following tabulation of scores
is given with net scores shown (Handicaps fig-
ured by the Peoria System):
Flight “A” Handicap (0-13)
27 Holes
J. P. Bolton, Columbus 106
D. W. English, Lima 108
W. F. Lovebury, Columbus 112
H. B. Kaufman, Zanesville 112
A. D. Piatt, Newark 112
S. O'. Zuker, Toledo 112
18 Holes
R. K. Ameter, Bryan 75
A. V. Boysen, Lakewood 76
F. T. Gallagher, Cleveland 76
Flight “B” Handicap (14-18)
27 Holes
D. J. Alsbaugh, Columbus 106
A. W. Franklin, Akron 106
J. S. Olms, Toledo 114
R. H. Hoecker, Mt. Vernon H6
R. M. Johnson, Lima 116
18 Holes
I. Colvin, Edon 72
John Cameron, Defiance 76
Flight “C” Handicap (19-30)
27 Holes
W. B. Devine, Zanesville 106
C. E. Cassaday, Mt. Vernon 108
T. L. Edwards, Van Wert 109
R. L. Adair, Lorain 109
18 Holes
J. Davidson, Springfield 72
A. A. Brindley, Toledo 74
J. Lampus, Lakewood 74
Dr. Jerome Ziegler, of Cincinnati, won the
past-president’s prize, presented by President
Wilcoxon. Dr. H. R. Mayberry, Bryan, was the
winner of the Special Event, closest to the pin
on tee shot, with a close measurement of 3 feet
8 inches.
INTER-COUNTY TITLE
The Ohio State Medical Association presented
four individual desk trophies to the winner of
the Inter-County event. The Cleveland fore-
some had low score of 339 to nose out Toledo
by two strokes. The Cleveland team had the
following gross scores — Bell, Sr., 83; Bell, Jr.,
84; Vinci, 84; and Rambousek, 88.
NEW OFFICERS ELECTED
The Annual Meeting was called to order by
the president, Dr. George Wilcoxon of Alliance.
The secretary read the minutes of the previous
meeting and gave the treasurer’s report show-
ing a balance of $182.78 on hand following the
1949 tournament.
The following officers were elected and in-
stalled into office: Dr. F. M. Green, Columbus,
president; Dr. Joseph Rinehart, Springfield,
president-elect; Dr. E. B. Young, Lima, vice-
president, Robert W. Elwell, Toledo, secretary-
treasurer.
Several cities in the State issued invitations
for the 1951 Annual Meeting. Zanesville was
awarded the honor of entertaining the Associa-
tion in 1951 by a majority vote of the fellows.
“Many enlightened scholars have expressed
doubt as to whether any government can take
more than two days in ten from the people, or 20
per cent of the nation’s income and still leave a
people able to take care of themselves. Above
that level, Socialist management becomes inevit-
able.”— Hon. Ralph W. Gwinn, Congressman
from New York.
806
The Ohio State Medical journal
Doctors Must Be Citizens!
Doctor, to discharge your duties as a citizen — especially at this time
when the election of sound, well-qualified persons to public offices is of vital
importance to the medical profession — you must perform these three simple
— but all-important — steps: Qualify yourself to vote in the November 7
General Election, learn all you can about the various candidates, and go to
the polls on November 7.
1. Determine that you are qualified to vote. If
you reside in a registration area, go to the office
of your County Board of Elections and register if
you have not already done so. If you are in such
an area, in order to vote you must have voted
within the prior two years or have registered in that
time. Better check with your Board of Elections
on these matters. Also see that members of your
family, your friends, neighbors, etc., are qualified
to vote. The deadline for registration is Septem-
ber 27 — 40 days before the election.
2. Acquaint yourself with the qualifications
and views of the candidates for office — all of
them — local candidates are important, too. Deter-
mine how each stands on matters of vital con-
cern to the medical profession. Discuss the
eligibility of each with your colleagues and
others. The legislative committee of your county
society can give you valuable pointers. Get out
and work for good candidates.
/What do you think of L
(Joe. Doakes qualifications?)
3. Vote on November 7. See to it that members
of your family, your friends, neighbors, etc., vote.
That’s the only way for you to have a voice in
what goes on in Congress and in the Ohio Legis-
lature; to have some influence over the actions
of public executives. Medical and health issues
are — will continue to be — potent issues on all fronts.
The doctor who doesn't vote this vear is a real
J
slacker.
for August. 1950
807
Licensed Through Endorsement by
State Medical Board
The Ohio State Medical Board has issued
licenses to practice medicine and surgery in
Ohio to the following physicians, through en-
dorsement of their licenses to practice in other
states:
June 16, 1950— Karl S. Alfred, Cleveland, Long
Island College; Albert W. Barile, Dayton, Loyola;
John P. Bartle, Columbus, Univ. of Manitoba;
Norman E. Berman, Cleveland, Georgetown Univ.;
Donald F. Blair, Cincinnati, Columbia Univ.; N.
Berneta Block, Sandusky, Univ. of Mich.; Ewing
T. Boles, Jr., Columbus, Harvard Medical School;
James W. Boyd, Columbus, Wayne University;
Stephen J. A. Bruny, Toledo, Vanderbilt Univ.
Dayton R. Clark, Dayton, Univ. of Mich.;
Oscar W. Clarke, Gallipolis, Medical College of
Virginia; Theodore S. Cobbey, Jr., Canton, Har-
vard Medical School; Charles Jean Cooley, Ober-
lin, Univ. of Louisville; Harney M. Cordua, Jr.,
Cleveland, Northwestern Univ.; Robert H. Davis,
Columbus, Univ. of Louisville; Edward L. Doer-
mann, Toledo, Univ. of Cincinnati; Ralph E.
Dwork, Columbus, Anderson Medical College;
Harry Feilchenfeld, Columbus, Univ. of Berlin;
Paul F. Fletcher, Cincinnati, Meharry Medical
College; Walter R. Gillette, Jr., Columbus, New
York Univ.; Leonard Gottesman, Cincinnati, St.
Louis Univ.; David Guttmann, Dayton, Univ. of
Berlin.
Gamble S. Hall, Dayton, New York Medical
College; William Myron Hall, Cleveland, Howard
University; Dean F. Hammond, McArthur, Louis-
iana State Univ.; Evelyn E. Hartman, Cincinnati,
Univ. of Helsinki; Richard B. Heintz, Gallipolis,
Indiana Univ.; Robert J. Hemphill, Barberton,
Univ. of Louisville; Mark H. Huckeriede, Circle-
ville, Indiana Univ.; Thomas R. Huxtable, Jr.,
Worthington, College of Medical Evangelists;
Melford I. Johnson, Toledo, Jefferson Medical
College.
Dorothy M. Kay, Cleveland, Univ. of Michigan;
Kay W. Kennedy, Canton, Marquette Univ.;
Emanuel J. Levin, Cincinnati, Univ. of Penna.;
Howard Levitin, Columbus, Southwestern Univ.;
Richard B. Magee, Cleveland, Univ. of Penna.;
Richard R. Lininger, Cincinnati, Univ. of Cali-
fornia; Harold W. Mammen, Toledo, Univ. of
Louisville; Harry Nenni, Kalida, Medical Col-
lege of Virginia; Harry W. O’Dell, Akron, In-
diana Univ.; Norman L. Paul, Dayton, Univ. of
Buffalo; Eugene F. Poutasse, Cleveland, Harvard
Medical School; Robert Charles Prophater, Green-
ville, Medical College of South Carolina.
Aimee Richmond, Columbus, Woman’s Medi-
cal College; John W. Rousseau, Columbus, Univ.
of Michigan; Eugene W. Rumsey, Cleveland,
Univ. of Southern California; Peter Saunders,
Dayton, Univ. of Pecs; Eugene J. Schmitt, Xenia,
St. Louis Univ.; Max Serog, Dayton, Univ. of
Giessen; H. Stewart Siddall, New London, St.
Louis Univ.; Earl C. Sifers, Cleveland, Univ. of
Kansas; Lawrence A. Stevens, Columbus, McGill
University; George G. Stitzinger, Wooster, Uni-
versity of Pittsburgh; James R. Strain, Cleveland,
Louisiana State Univ.; Charles M. Suttles, Con-
neaut, Jefferson Medical College.
James T. Taguchi, Dayton, Univ. of Colorado;
George J. Tenoever, Cincinnati, St. Louis Univ.;
John G. Thomsen, Cleveland, Univ. of Iowa;
Gordon M. Todd, Toledo, Washington Univ.;
Bernard Virshup, Canton, Long Island College;
Lewis H. Walker, Cleveland, Indiana Univ.;
Robert G. Warnock, Youngstown, Univ. of
Maryland; Richard W. Watts, Rocky River, West-
ern Reserve Univ.; Siegfried Werthammer, Co-
lumbus, Univ. of Vienna; John A. Whieldon,
Worthington, College of Medical Evangelists;
Edward J. Zyla, Dayton, Wayne University.
Navy Civilian Intern Training Program
Offers Full Pay to Applicants
The U. S. Navy has announced that it still
has a number of openings for candidates for the
Navy-sponsored Civilian Intern Program for the
year 1950-1951.
This program is open to all graduates of ap-
proved medical schools who are qualified for
commission as Lieutenant (jg), Medical Corps,
U. S. Naval Reserve, and who have contracted
for one-year rotating type internships in ap-
proved civilian hospitals.
Successful candidates are commissioned and
placed on active duty at the time of commencing
or during intern training. During the year of
internship they receive the pay and allowances
of their grade as well as other benefits that
accrue to a reserve officer ordered to active
duty— that is, transportation of dependents and
shipment of household effects from their homes
to place of internship, the regular uniform al-
lowances, etc.
Applicants for the program are required to
volunteer for and agree to serve a period of at
least two years on active duty following com-
pletion of internship. During this latter period
they receive the additional compensation of $100
per month accorded to medical and dental of-
ficers of the Regular service and of the Reserve
when on extended active duty for a period of
one year or longer.
Interested candidates should apply to the Of-
ficer-in-Charge of the nearest Office of Naval
Officer Procurement. Such offices are located
in Cincinnati, Ohio; Detroit, Mich., and Pitts-
burgh, Pa. These offices are in position to
furnish full particulars of the program, to pro-
vide the necessary application forms, to conduct
physical examinations and to assist in any
other way.
808
The Ohio State Medical Journal
• • •
Millers’ Medical Care Plan
After Temporary Suspension, U. M. W. Welfare and Retirement Fund
Is Again in Operation; Revised Instructions for Doctors Are Issued
AFTER temporary suspension last September
of payments by the Welfare and Retire-
ment Fund of the United Mine Workers
of America, it was announced recently that the
hospitalization and medical care program is
again in operation as of July 1, 1950.
In announcing resumption of the program,
Dr. Leslie A. Falk, Pittsburgh, Pa., area medi-
cal administrator, forwarded a leaflet entitled
‘‘Information for Physicians” which contains the
following data :
I. GENERAL INSTRUCTIONS
These instructions relate to the provision of
medical care benefits for members of the United
Mine Workers of America, their wives, and
their dependent children who have not reached
their eighteenth birthday. The Area Medical
Office will furnish specific information not in-
cluded in these instructions which are intended
to provide general information only.
A. IDENTIFICATION
Members of the United Mine Workers of
America and their dependents must show you
Form 85-HS to obtain service at the Fund’s ex-
pense. This form lists the names of the mem-
ber, his wife and his dependent children under 18
years of age. Please note that only those depend-
ent children under 18 years of age may receive
benefits. The birth dates of all children are listed
on the form to enable you to determine whether a
child has reached his eighteenth birthday. This
form must bear the seal of both the District and
Local Union. It must be signed by the member
and his wife before you accept it as evidence of
eligibility for service.
A child born after the member gets his Form
85-HS is eligible to receive the hospital and
medical care herein described, even though his
name does not appear on the Form 85-HS.
A widow and her children are not eligible to
receive service. The benefits herein described
are available only during the lifetime of the
member.
B. SERVICES
Services may be provided at Fund expense only
by hospitals, physicians, and other individuals
with whom the Fund has made specific arrange-
ments for such service, or when services are
authorized in advance by the Area Medical Office.
1. Hospitalization — The Fund will reimburse
hospitals for ward or semi-private accommoda-
tions unless the condition of the patient is such
that a private room is necessary. If the patient
insists on private accommodations when not
medically indicated, the patient must be respon-
sible for any difference in cost. All necessary
services may be provided except:
a. Obstetric service — unless such service is
medically indicated and is authorized in ad-
vance by the Area Medical Office. The
Area Office will advise you concerning the
information which must be submitted to se-
cure such authorization.
b. Tonsillectomies and Adenoidectomies —
unless such service is authorized by the Area
Medical Office. The Area Office will advise
you concerning the information which must
be submitted to secure such authorization.
c. Care of mental illness after diagnosis
has been established.
d. Services which the patient can receive
from other agencies, either voluntary or
governmental.
e. Services which the employer or another
third party is legally obligated to provide.
f. Personal services such as telephone
calls, radio, etc.
2. Professional Services in the Hospital — The
Fund will pay the cost of necessary medical
care in the hospital when patients are hospital-
ized in accordance with the provisions listed
above.
3. Out-Patient Hospital Care — Services may
be provided in the out-patient department of a
hospital in accordance with specific arrange-
ments established between the Area Medical
Office and the individual hospital.
4. Specialist Service — Patients requiring the
service of a specialist may be provided such
service when it is authorized in advance by the
Area Medical Office. The Area Office will advise
you concerning the information which must be
submitted to secure such authorization.
5. Dental Care — The Fund will pay for dental
services incident to the hospital care of a pa-
tient, and those which contribute toward any
illness which may necessitate hospitalization.
Such dental care must be authorized in advance.
The Area Medical Office will advise you con-
cerning the information which must be submitted
to secure such authorization.
6. Eyeglasses — The Fund will pay for eye-
glasses in those cases necessitated by surgical
procedures involving the eyes.
7. Prosthetic Appliances — Physicians who pre-
scribe orthopedic and similar appliances may
request the Area Medical Office to furnish them
for August, 1950
809
the names of suppliers with whom arrange-
ments have been made for the purchase of such
items.
8. Emergencies — In the event of an unques-
tionable emergency, the Fund will reimburse any
hospital or physician at reasonable rates for
services rendered its beneficiaries which are
within the scope indicated above. Eligibility
must be established as soon as possible. The
Area Medical Office should be notified within 24
hours of admission of the patient and should
be given factual information upon which the
emergency character of the case is based.
II. SUBMISSION OF BILLS AND REPORTS
The physician will use the Fund’s Invoice and
Report Form 101-HS (Revised 7-1-50) or au-
thorization Form 84-HS (Revised 7-1-50) for
billing. The following are the instructions for
the preparation of these forms:
1. The member’s social security number, Dis-
trict and Local Union numbers, and the pa-
tient’s name must be listed as shown on the
member’s Form 85-HS.
2. The spaces for birth date, and miner or
dependent must be completed.
3. Discharge diagnosis and surgery performed
must be entered.
4. “Patient was Hospitalized:” All appropriate
blanks must be completed in this block. The
date of admission, discharge or transfer is par-
ticularly important.
5. If this is a bill for professional services
provided in the hospital, the name and address
of the hospital must be entered in the appropriate
space.
6. The invoice must have the date of service
or inclusive dates of services rendered.
7. The type of service rendered must be
clearly stated.
8. The patient’s signature is not mandatory
on bills submitted for a physician’s services. It
must be on invoices submitted for hospitalization.
9. The vendor’s certificate must be signed.
10. The original (with stub attached) and
duplicate are to be submitted to the Area Medi-
cal Office. The triplicate is for the physician.
11. Payment will be expedited if the invoice
is submitted in sufficient detail to permit its
prompt approval. Whenever it is necessary for
the Area Medical Office to return an invoice
for additional information, there is a material
delay in payment.
PLEASE NOTE— IMPORTANT
Please submit bills promptly. It will be as-
sumed that any material delay in submission
of your bills is evidence that you are not con-
cerned about prompt payment. Bills submitted
promptly will be given priority in processing
and payment.
Failure To Vaccinate Is Not Neglect
Under Sec. 1639-3, Court Rules
“When the father of a minor child endeavors
to send such child to a proper public school
but, pursuant to a valid regulation of the board
of education, such child is excluded from that
public school because he has not been vaccinated,
and where there is no showing that the father
has done anything to prevent the vaccination
of such child, such child is not a neglected child
within the meaning of Section 1639-3, General
Code.”
The foregoing quotation is the syllabus of an
opinion rendered in June by the Ohio Supreme
Court.
In the case which originated in Hamilton
County, school authorities refused to admit the
7-year old son of the defendant until the child
had been immunized against smallpox in com-
pliance with the customary school board regu-
lation. The father attempted to return the
child to school on at least two occasions, but
each time school authorities refused to admit
him. The Juvenile Court subsequently found
the defendant guilty of contributing to the
neglect of the child under Section 1639-3, G. C.
The Court of Appeals of Hamilton County up-
held the Juvenile Court, upon which the case
was appealed to the Supreme Court.
The Court in its opinion called attention to a
section of the General Code which reads: “Boards
of health, councils of municipal corporations,
and trustees of townships, on application of the
board of education of the district, at public ex-
pense, without delay, shall provide the means of
vaccination and immunization to such pupils as
are not provided therewith by their parents or
guardian.”
The opinion further states that attention had
been invited to no law requiring a father to pro-
vide for the vaccination of his son. “There
was no evidence offered by the state tending to
prove that the defendant prevented the vaccina-
tion of his son . . .”
In an opinion concurring with the majority
opinion, the Court stated: “This concurrence is.
to make plain that we are not opposed to vac-
cination and do not criticize the board of edu-
cation for preventing the attendance in school’
of any unvaccinated child. The way is pointedl
out in the majority opinion for the correction
of this situation.”
Dr. Christopher Daniels, of London, English
physician, addressed a joint meeting of the
Rotary and Kiwanis Clubs of Columbus on July
10 on the subject, “Socialism in England.” His
tour of the country is sponsored by the national
education program of Harding College, Searcy,
Arkansas.
810
The Ohio State Medical Journal
Tuscarawas School Health Conference . . .
Medical Society Exchanges Ideas on Problems of Growing Program by
Inviting Cross Section of Local Groups To Take Part in Discussions
THE Tuscarawas County Medical Society
set an excellent example in the field of
Medicine and School health relations when it
staged a community-wide program entitled “Im-
proving Our School Health Program.”
Persons representing a cross section of the
county’s population were invited as well as out-
of-county authorities on the subject of school
health and medicine. Approximately 100 persons
attended the meeting on June 8 in the New'
Philadelphia Elks Club. They included physi-
cians, dentists, P.-T. A. personnel, county health
personnel, educators and civic leaders.
That county people are vitally concerned in
better health for their children, was voiced
by Dr. Thomas Shaffer, of Columbus, who
said that because of the cross section of people
represented, the meeting was one of the most
inspiring he had attended. Dr. Shaffer is
chairman of the School Health Committee of
the Ohio State Medical Association, is medical
director of University School and a faculty mem-
ber at the Ohio State University College of
Medicine.
Dr. Shaffer pointed out that about 85 per cent
of school children need dental care; about 20
per cent have something wrong with their
eyes; one out of ten is hard of hearing; one out
of ten has a speech problem; one out of five
shows signs of becoming neurotic or psycho-
neurotic; about half have serious health problems.
Speaking in behalf of educators, Mr. H. C.
McCord, superintendent of Worthington schools,
spoke on the subject, “The Educator’s Role in
the School Age Child.” He advocated among
other things, better lighting in school rooms,
walls painted in light shades, a follow-up pro-
Photo Courtesy The Daily Times, New Philadelphia
Taking part in the Tuscarawas County Medical Society’s School Health Program were the above persons. Left to
right, seated, are: Mr. Hart F. Page, Columbus, field secretary for the Association; Miss Edith Myers, Columbus,
nursing consultant of the Ohio Department of Health; Mr. H. C. McCord, superintendent of Worthington Schools;
standing: Harvey C. Janke, D. D. S., Cleveland; Dr. Thomas Shaffer. Columbus, chairman of the Association’s Com-
mittee on School Health; Dr. Carl A. Lincke, Carrollton, Past-President of the Association; and Dr. Paul Q. Peter-
son, Columbus, assistant director of the Ohio Department of Public Health.
for August, 1950
811
Photo Courtesy The Daily Times, New Philadelphia
Members of the Committee on Arrangements for the Conference are shown above. They are: Dr. S. H. Winston,
Dr. Elizabeth Rowland-Aplin, and Dr. R. B. Hines.
gram on dental care and a good public relations
program in the school community.
Dr. Harvey C. Janke, instructor in public
health dentistry, Department of Preventive Medi-
cine, Western Reserve University, spoke on the
subject, “Dentistry’s Participation in the Health
of the Community.” Dr. Janke pointed out that
the blame for decay and pyorrhea is largely
due to poor diet habits. He blamed the excessive
amount of sugar in the average American diet
for 97 per cent of dental diseases.
Dr. Paul Q. Peterson, assistant director of the
Ohio Department of Health, Columbus, urged
that an effective follow-up system for physical
examinations be instituted in school health pro-
grams. An examination is useless, he said, un-
less there is a follow-up through the home. Dr.
Peterson discussed the legal responsibilities of
health departments, especially in the fields of
sanitation and nutrition services.
An audience discussion followed presentations
of talks and interest was shown by the number
of questions that were directed to speakers.
Dr. Carl A. Lincke, Carrollton, immediate
Past-President of the Ohio State Medical Asso-
ciation, presided at the meeting. Dr. Lincke
was presented to the audience by Dr. William E.
Hudson, president of the Society, who opened
the meeting. In addition to Dr. Lincke and Dr.
Shaffer, the Association was represented by Mr.
Hart F. Page, Columbus, field secretary.
The committee on arrangements included
Dr. Elizabeth Rowland-Aplin, chairman, Dr. S.
H. Winston and Dr. R. B. Hines.
Dinner was provided for the group by the
Woman’s Auxiliary to the Tuscarawas County
Medical Society.
Activities of The Editor
Following are some of the activities engaged
in by Dr. Jonathan Forman, Editor of The
Journal during the first half of 1950:
He addressed Phi Theta Pi in Columbus; as
president of the organization, he presided at
the American Conclave of Allergists in St.
Louis; he held public hearings in Denver, Col-
orado, on transfer cuts as a member of the Na-
tional Forest Advisory Council; spoke before
the Lions Club of Chillicothe; attended the Na-
tional Conference on Rural Health in Kansas
City, as a representative of the Ohio State
Medical Association; spoke before the Adult
School at Farmersville.
He spoke before the Alumnae of the Grant
Hospital School of Nursing; the Collegiate As-
sembly of Medical Evangelists in Los Angeles;
the Hilltop Business Men’s Association, Colum-
bus; attended and spoke at the Friends of the
Land Conservation Forum at Memphis, Tenn.;
took part in the Ohio Valley Society of Allergists
meeting in Dayton.
He addressed the Mothers’ Club of Delaware;
the Child Conservation League of Mt. Gilead;
the Pittsburgh Garden Club; he presented prizes
to the farmers of the Farm Bureau Soil Con-
servation Contest; addressed the Child Conserva-
tion League of Marion; took part in the Health
Work Shop, Institute for Education by Radio;
spoke before the Columbus Bar Association, the
Underwriters’ Association, the Committee on
Medical History and Archives of the Ohio
Archaeological Society and the 24th Annual
Convention of Phi Rho Sigma medical fraternity
at Macatawa Lake, Mich.
812
The Ohio State Medical Jourtial
Reallocation of Federal Health Funds . . .
In Place of Former Procedure Whereby State Department Furnished
Personnel, Share to Local Units Will Be in Form of Cash Deposits
ANEW method of allocating Federal grant-
in-aid funds to local health departments
has been put into effect in Ohio, Dr. John
D. Porterfield, director of the Ohio Department
-of health, announced.
Federal monies granted for public health pur-
poses may be used to support state activities
or as assistance to local health department pro-
grams, Dr. Porterfield explained. Actually, ap-
proximately one-third of the Federal funds al-
located to the Ohio Department of Health is used
to supplement the state appropriation for support
of central department activities, one-third is
expended in direct services or professional assist-
ance to local health departments, and one-third
is reallotted to local health departments to
supplement local support.
FORMER PROCEDURE CUMBERSOME
Until the recent change was made, the reallot-
ment to local health departments has been
in the form of employment under State Civil
Service of public health personnel and their as-
signment to local units. This has been cumber-
some in that all administrative procedures rel-
ative to employment, promotion, separation, and
leave of such personnel have had to be carried
on through the State Department, Dr. Porter-
held continued.
The procedure has led to inequities in that
state-paid personnel in the same local unit, and
with the same assignment, have been on dif-
ferent pay scales. It has led to inefficiency in
that state-paid employees have not always been
understood to be under the functional direction
of the local administrator.
EFFECTIVE JULY 1
The old procedure has been discontinued effec-
tive July 1. Under the new procedure, local
health departments qualified for Federal assist-
ance receive direct cash grants. Such cash
grants are deposited with the local auditor to
the credit of the local board of health and will
be budgeted and expended by that body in
the same manner as locally derived funds are
disbursed.
This method has the advantage of providing
more flexible assistance and ensures that local
programs will be entirely under the direction of
the local boards, the director explained. A copy
of the budget of such funds must be forwarded
to the Ohio Department of Health for Federal
auditing purposes.
Payments of the grants will be made quarterly
and will be in an amount adequate to bring un-
expended Federal grant funds up to 25 per
cent of the annual grant. By this system lapsed
funds will revert to the Ohio Department of
Health and annually to the Federal government.
MUST MEET REQUIREMENTS
Local health departments must meet certain
requirements in order to qualify for Federal
aid. A department to be qualified at the pres-
ent time must meet the following requirements:
(1) It must be under the direction of a full-
time health commissioner — one who confines
his activities to the field of public health and
preventive medicine. If not a medical person,
as Ohio law permits in city health districts,
there must be available qualified medical con-
sultants.
(2) The health commissioner, one public
health nurse, one sanitarian, and one clerk
must be paid entirely from local funds (local
funds are here interpreted to include the state-
appropriated subsidy provided under Section
1261-39 of the Ohio General Code).
(3) The personnel of the health department
must be employed under a merit system, either
through civil service commission or by regula-
tions established by the local board of health.
(4) The local health department must con-
form to the requirements of state law and the
Ohio Sanitary Code and must submit the re-
quired reports to the Ohio Department of Health.
The program content of the local department is
at the discretion of its board of health with
such consultation as it may request from the
Ohio Department of Health.
SOURCES OF FUNDS
Local grants this year will be derived from
Federal grants in the categories, approximately
as follows: General health, 26 per cent; maternal
and child health, 21 per cent; venereal disease con-
trol, 15 per cent; tuberculosis control, 20 per cent;
cancer control, 12 per cent; and heart disease
control, 5 per cent. It is anticipated and urged
that local boards of health consider the original
source and intent of the grants when developing
the budgets for expenditures.
Some $616,000 will be allocated to 62 local
health departments in the coming fiscal year,
Dr. Porterfield announced. These 62 units are
jor August, 1950
813
qualified under the foregoing requirements and
have requested such assistance.
Previously the amount of financial aid ob-
tained by a local health department has been
determined on an almost completely subjective
basis, and has been conditioned by the urgency
of the request of the local health commissioner
and the frequently undocumented judgment of
the State Department.
In order to establish a fair and equitable
distribution on an objective basis, the amount to
be allocated to each qualified department has
been determined by a formula. This formula is
based on the population of the local health dis-
trict and the economic level as determined by
the per capita tax duplicate.
Additional influencing factors are the rurality
of the local district and the amount appropriated
locally for public health. In no case will the
Federal assistance be more than the local ap-
propriation.
LOCAL RESPONSIBILITY
The 1950 local appropriation has been estab-
lished as a base line and a reduced appropria-
tion in any future year will result in an equal
reduction in grant amount, Dr. Porterfield
stressed, adding in explanation that these fac-
tors are established in accordance with the
philosophy that support of local health units
is primarily the responsibility of local govern-
ment. They also prevent the conservation of local
funds by substitution of Federal assistance.
It is the principle of the Ohio Department of
Health, he continued, to provide all assistance
possible to local health departments in their
program activities with the least amount of
control compatible with the accounting for ex-
penditure of public funds.
These recent changes, the health director
concluded, were recommended by the Annual Con-
ference of Local Health Commissioners and are
approved by the U. S. Public Health Service and
the U. S. Children’s Bureau, and are intended
to strengthen that principle.
ASSISTANCE SINCE 1936
Ohio has received financial assistance in
public health from the Federal government since
1936. These grants have been made in various
categories from year to year. Programs spe-
cifically designated have included general health,
maternal and child hygiene, venereal disease
control, tuberculosis control, industrial hygiene,
cancer control, hospital facilities administration,
heart disease control and water pollution con-
trol. Other grant-in-aid funds are made toward
mental hygiene and crippled children’s programs,
but these are administered by the Ohio Depart-
ment of Public Welfare.
Some of these funds have been available only
recently, Dr. Porterfield explained, and some of
the appropriations have been discontinued.
Dr. Schriver Honored at Conference
Of State Associations’ Officers
Dr. L. Howard Schriver, of Cincinnati, was-
honored at the fifth annual Conference of Presi-
dents and Other Officers of State Medical Asso-
ciations in San Francisco on June 25, by being
presented a gavel for having made “notable
contributions to the progress” of the national or-
ganization.
With presentation of the gavel the following
citation was read:
“As a member of the first executive committee
of this Conference, and subsequently as its
President in 1947-48, Dr.
L. Howard Schriver of
Cincinnati, Ohio, made
notable contributions to
the progress of our na-
tional organization.
“Past-president of the
Cincinnati Academy of
Medicine, member of the
Council of the Ohio
State Medical Associa-
tion for several years,
and later President of
that State Association,
L. H. schriver, m. D. past-president of the
Public Health Federation in his native city, and
for several years now President of Associated
Medical Care Plans, the national Blue Shield
programs, and also president of Ohio medical
Indemnity, Incorporated, Doctor Schriver has
contributed immeasurably to the progress of
medical organization in this country and to the
development of voluntary health insurance.
“On this occasion the Conference of Presidents
would remind Doctor Schriver of its apprecia-
tion of the contribution he made to the progress
of this Conference as its President in 1947-48,
by awarding him this gavel suitably engraved.”
Michigan To Hold Annual Meeting
In Detroit, Sept. 20-22
The 85th Annual Session of the Michigan
State Medical Society will be held in Detroit,
September 20-22. Complete information may
be obtained by writing the Society at 2020 Olds
Tower Bldg., Lansing, Mich.
Among eminent physicians who will take part
in the scientific program are the following from
Ohio: Dr. Charles A. Doan, Columbus, dean
of the Ohio State University College of Medi-
cine; Dr. Earl W. Netherton, Cleveland; Dr.
Paul M. Moore, Jr., Cleveland; Dr. Charles F.
McKhann, Cleveland; and Dr. William A. Alte-
meier, Cincinnati.
Ground will be broken this summer for a
$13,600,000 addition to Henry Ford Hospital,
Detroit. The new 17-story clinic was made pos-
sible by a gift from the Ford Foundation.
814
The Ohio State Medical Journal
Medical Board Examinations . . .
Licenses as Doctors of Medicine Sought by 273 Appplicants; Osteopaths
And Limited Practitioners Also Apply ; Examination Questions Are Listed
LICENSES to practice medicine and surgery in
Ohio were sought by 273 medical school
graduates at the examination of the State
medical Board held in Columbus, June 14-17.
Eighteen applicants took the examination to
practice osteopathic medicine and surgery. Ex-
aminations in the limited practice fields were
taken by 41 chiropodists, 31 mechanotherapists,
54 chiropractors, 24 masseurs and 9 cosmetic
therapists.
Results of the examinations will be announced
following a meeting of the Board scheduled for
August 8.
Following are the written examination ques-
tions asked those applying for licenses to prac-
tice medicine and surgery:
ANATOMY
1. Discuss the anatomy of the afferent and efferent in-
nervation of the heart.
2. Discuss the anatomy and relations of the external audi-
tory canal and tympanic membranes.
3. Describe the anatomy which may be seen on anoscopic
and proctoscopic examinations.
4. Describe the innervation of the Dura mater.
5. What are the respective relations of the vagina ?
PHYSIOLOGY
1. Describe the anatomical structure and the physiological
properties of cardiac muscle that peculiarly fit it for
the function it performs.
2. Describe the part played by the various receptors
that enable an animal (cat, dog, or man) to main-
tain an upright position and a normal postural orienta-
tion with respect to its environment.
3. What is the function, and state the importance of the
plasma proteins of the blood ? Discuss their forma-
tion by the body and their fate.
4. Explain the effects of a moderately severe hemorrhage
on (a) lymph production; (b) heart rate, and (c)
urinary output.
5. It is stated that food with a high fat content is
“indigestible.” Is there any physiological basis for
this belief ?
■6. Account for the fact that the velocity of the pulse-
wave along a large artery is not the same as the
rate of flow of the blood within the vessel.
7. Discuss the factors which determine the activity of the
gastric glands.
8. Discuss the nature of spinal shock.
9. In the human being at rest, the output of the left
ventricle is about 5 liters per minute. During vigorous
muscular exercise the output may attain 12-15 liters
per minute. Account for this change.
10. Discuss the sources and energy for muscular contrac-
tion.
BACTERIOLOGY
1. List the distinctive characteristics of two pathogenic
members of the Clostridium group.
2. Name four spirochetal diseases of man, exclusive of
syphilis. List the procedures which must be carried
out to establish the diagnosis in any one of these.
3. Outline the etiology and the laboratory diagnosis of
Weil’s disease.
4. Outline the life cycle of trichinella spiralis. How
may the diagnosis of trichinosis be made?
5. List the important morphological and biochemical
characteristics essential to identification of an organism
as Vibrio Cholerae.
DIAGNOSIS
1. Give the signs and symptoms of deficient parathyroid
secretion.
2. Give the blood chemistry in chronic glomerular
nephritis and so-called essential hypertension.
3. How would you differentiate migraine from histemic
headache ?
4. What do you understand by polyendocrine disturbance ?
Name conditions in which this occurs.
5. In what bone conditions would you expect to find
Bence Jones proteinuria ?
6. Name three conditions in which free fluid occurs in the
abdomen ?
7. Give the signs by physical examination of air in the
plural cavity— also fluid.
8. Differentiate sacro-disc sprain and a dislocated inter-
vertebral disc.
9. Give findings (on physical examination) of chronic
emphysema, broncho spasm and so-called asthmatic
heart condition.
10. Differentiate Meniere’s disease and spasm of cerebral
arteries.
CHEMISTRY
1. To what extent is fat digested and absorbed from
the alimentary tract of healthy individuals ? Discuss
the factors that influence this digestion and absorption.
2. By what qualitative tests may cholesterol be detected ?
3. What is the approximate concentration of chlorides in
the blood? Under what conditions may a hypochloremia
be observed ?
4. Define gluconeogenesis. Discuss briefly one procedure
by which it is possible to determine whether a compound
is gluconeogenetic.
5. Under what conditions may the nitrogen balance be
positive ? What is the significance of a positive nitrogen
balance?
MATERIA MEDICA AND THERAPEUTICS
1. Define chemotherapy. State its object.
2. Compare the action of morphine and atropine.
3. Describe briefly the process of elimination of the fol-
lowing drugs from the body: (a) sodium phenobarbital ;
(b) opium; (c) procaine hydrochloride.
4. Name two conditions in which plasma is preferred
to whole blood.
5. Give the action of heparin in prolonging the bleeding
time.
6. Give the therapeutic effects of the methylanthines on
the circulation.
7. Outline treatment of diabetic acidosis.
8. Classify the cathartics.
9. Give the treatment of lead poisoning.
10. Give indications for the use of digitalis.
PRACTICE
1. Give symptoms of pulmonary tuberculosis.
2. Give the etiology and symptoms of Brucellosis.
3. Give the complications of diabetes mellitus.
4. Give the etiology and complications of gout.
5. Give the etiology and symptoms of Erysipelas.
PATHOLOGY
1. What is meant by the term ulcer? Name four situa-
tions in which ulcers occur. Outline the gross path-
ological characteristics of an ulcer in one of these
situations.
2. Describe in outline form the microscopic appearance
of the wall of a syphilitic saccular aneurysm of the
aorta. What portion of the aorta is most often
affected ?
3. Discuss in outline form the pathogenesis of bron-
chiectasis.
4. In a single sentence state what role, if any, the bone
marrow plays in each of the following disorders ?
(a> lymphoid leukemia; (b) acute appendicitis; (c)
carcinoma of breast; (d) Hand-Schuller-Christian
Syndrome ; (e) Phenol poisoning.
5. In outline form, distinguish between the gross ap-
pearance of a tuberculous and a typhoidal ulcer of
the ileum.
6. Outline the microscopical appearance of the kidney in
a fatal case of traumatic shock. Name two other
conditions that may have similar effects on the kidney.
7. In reference to the microscopical appearance of an
epithelial tumor of a glandular organ, outline briefly
the features that would justify a diagnosis of carcinoma.
8. Name the diseases or conditions in which the follow-
ing are observed: (a) Caseation necrosis; (b) Bence-
Jones proteinuria ; (c) secondary amyloidosis ; (d) lower
nephron nephrosis; (e) Langhan’s giant cells.
9. How may a Health Department determine whether
a sample of milk has been pasteurized ?
10. What is the mode of transmission of the following
for August, 1950
815
diseases ; (a) psittacosis ; (b) tularemia ; (c) undulant
fever; (d) anthrax; (e) Rickettsialpox.
OBSTETRICS AND GYNECOLOGY
1. Discuss the causes, prevention and treatment of post
partum hemorrhage.
2. Discuss management of placenta praevia; (a) Centralis;
(b) Marginalis.
3. Give symptoms, causes and treatment of tubal preg-
nancy.
4. Give etiology, symptoms and treatment of femoral
thrombophlebitis.
5. An eight month pregnant patient shows albumin in
the urine and a beginning hypertension- — discuss
management.
SURGERY
1. Illustrate by diagrams the positions of the bone
fragments in (a) Colies’s fracture; (b) Pott’s fracture;
(c) Intracapsular fracture of the hip.
2. Discuss briefly the important factors in the pre-
and post-operative care of a patient who has acute
intestinal obstruction.
3. (a) Discuss the diagnosis and management of car-
cinoma of the rectum. (b) Give its zones of spread,
(c) Describe briefly the operation usually performed
in the hope of a permanent cure.
4. What congenital anomalies of the heart and the great
vessels in the thorax are amenable to surgery ? Discuss
the physiological objectives of operations for anyone
of these defects.
5. A boy, fourteen years of age, comes to the hospital
in moderate collapse after a coasting accident. He
complains of pain on breathing and tenderness over
the left tenth rib in the axillary line. Discuss the
differential diagnosis and the treatment.
SPECIALTIES
1. Give the differential diagnosis between dermatitis
venenata, dermatitis medicamentosa and urticaria.
2. A married man, 36 years of age, presents himself
with a raised reddened, infected papule on his upper
lip. What procedure would you follow ?
3. Describe the chief functions of the nose.
4. True or false:
(a) The canal of Schlemm empties under the middle
turbinate bone of the nose.
(b) The plexus of Stensons is adjacent to the rods
and cones.
(c) The nose is lined with ciliated columner epi-
thelial cells.
fd) Repeated ear infections is a cause for tonsil-
lectomy.
(e) The nasal vein empties into the angular vein
which in turn empties into the superior
ophthalmic vein.
5. Discuss the causes for finding pus in the urine and
their treatment.
PREVENTIVE MEDICINE AND HYGIENE
1. Discuss amebic dysentery as to etiology, carriers, im-
munity, prophylaxis and prevention.
2. Discuss impetigo, its etiology, prophylaxis and eradica-
tion.
3. What is the period of incubation, the period of infec-
tivity and the resultant immunity in : (a) diphtheria ;
(b) scarlet fever; (c) pertusis ; (d) smallpox.
4. What is ophthalmia neanatorum — its causes, care,
handling, prevention and dangers ?
6. Draw a sketch of plan for private sanitary system of
sewage disposal, noting distances important as to water
supply, neighbors and ultimate disposal of effluence.
Ohio Nurses’ Association
Elects Officers
At the 47th Annual Convention of the Ohio
State Nurses’ Association the following officers
were elected: Mrs. Ivalu S. Brown, Dayton,
president; Marjorie Patten, Cleveland, 1st vice-
president; Lucile Pence, Columbus, 2nd vice-
president; Elizabeth A. Evans, Youngstown,
secretary; Mrs. Florence Fogle, Columbus, treas-
urer. The following were elected to the Board
of Trustees: Mrs. Edna W. Viets, Youngstown;
Mrs. Helen D. Leiser, Fremont; Frances H.
Cunningham, Cleveland; and Helen Gilligan,
Columbus.
Breast Cancer Film Available to
Medical Societies for Preview
A new movie, “Breast Self-Examination,”
a film to teach women the techniques of breast
self-examination, is now available for distribu-
tion to professional groups only. It later will
be released for showings to lay audiences.
Dr. Walter B. Lacock, chief of the Division
of Chronic Diseases of the Ohio Department of
Health, said that it is the desire of the spon-
soring agencies to have this film shown only
to medical and other professional groups until
it can be properly appraised by them. He
indicated that necessary clearances should be
obtained through medical societies before the
educational device is presented to the public.
The film has been tested before a number of
different audiences and the consensus has been
that great care has been taken to obtain the
proper level of esthetic values and dignity.
The film is produced by the American Cancer
Society and the National Cancer Institute. It
is for 16 mm. projectors in color with sound
and has a running time of 15 minutes. It is
available to medical societies through the Ohio
Division, American Cancer Society, 2073 E.
Ninth St., Cleveland, or the Ohio Department of
Health, Columbus.
Other films available through the same agen-
cies on the subject of cancer include: “The
Problem of Early Diagnosis”; “Breast Cancer”;
and “Science Against Cancer.” These three are
educational films for professional use.
Tuberculosis Association, Trudeau
Society, Elect Officers
Officers of the Ohio Tuberculosis and Health
Association for the year include the following:
Dr. Azel Ames, Hamilton, president; Dr. Joseph
B. Stocklen, East Cleveland, first vice-president;
Dr. Charles A. Doan, dean of the Ohio State
University College of Medicine, Columbus, secre-
tary. Dr. Herman J. Nimitz, superintendent of
Dunham Hospital, Cincinnati, was elected a
member of the executive committee.
The Association celebrated its 49th anniver-
sary on June 1-2 with an annual meeting in Co-
lumbus. Actually three meetings were held —
the Ohio Conference of Tuberculosis Secretaries
and the Ohio Trudeau Society held concurrent
meetings with the Association.
Dr. John A. Prior, Columbus, was elected
president of the newly organized Ohio Trudeau
Society. Dr. William Newcomer, Youngstown,
was elected vice-president, and Dr. Chester R.
Markwood, Columbus, secretary-treasurer. Mem-
bers of the executive committee are Dr. Stock-
len, Dr. James F. Busby, Newark, and Dr. John
H. Skavlem, Cincinnati.
816
The Ohio State Medical Journal
Const tpation
in the Aged . ..
The commonly encountered constipation of the older age group
may result from reduced activity, lack of appetite for bulk-pro-
ducing foods and inadequate ingestion of fluids.
By providing hydrophilic "smoothage” and gently distending
bulk, Metamucil encourages normal physiologic evacuation with-
out straining or irritation.
METAMUCIL® is the highly refined mucilloid of
Plantago ovata (50%), a seed of the psyllium group, combined
with dextrose (50%) as a dispersing agent. G. D. Searle & Co.,
Chicago 80, Illinois.
RESEARCH IN THE SERVICE
O F
MEDICINE SEARLE
for August, 1950
817
Washington Roundup . . .
A Review of Developments on Proposed Medical and Health Legislation
Before Congress; With Observations on Other Matters of Interest
A NOTHER victory for the medical profession
was realized in Washington when the House
of Representatives on July 10 voted down
the President’s Reorganization Plan 27 by adopt-
ing a resolution vetoing the plan. In a surprise
move on the part of the Administration, the
President on May 31 sent to Congress his plan
which would have created a Department of
Health, Education and Security. The plan
would have become law within two months with
no other action being taken. However, the
medical profession went into action to make
sure the plan did not “sleep through” into
law. Medical organizations throughout the Na-
tion alerted their Congressmen to what was
going on.
A majority of the members of either house
was required to defeat the plan. Because many
members of the House were not present, the
vote against the plan of 31 more than the neces-
sary constitutional majority was misleading.
Actually, of 322 members present, 249 voted
against, 71 for, and two did not vote.
The plan was practically the same as Reor-
ganization Plan 1 similarly defeated last year.
It would have subordinated health and medical
matters under a department which would have
been virtually a welfare department, presum-
ably with Oscar Ewing as its head.
Fourteen Ohio Representatives in Congress
voted for the resolution which killed Plan 27.
They are Congressmen Elston, Breen, McCul-
loch, Clevenger, Polk, Brown, Jenkins, Brehm,
Vorys, Weichel, Secrest, Hays, McGregor and
Young. They deserve the thanks of members
of the medical profession.
Five Ohio Representatives voted against the
resolution and for Plan 27. They are Burke, Mc-
Sweeney, Kirwan, Feighan, and Crosser. Not
voting or paired were Wagner, Smith, Huber
and Bolton.
>|:
Department of Commerce officials are en-
thusiastic over the cooperation they are receiving
on the survey of physicians’ incomes. This
survey is being made by the Office of Business
Economics in cooperation with the Bureau of
Medical Economic Research of the A. M. A. Al-
though those interested in the survey believe
it will be the most accurate ever made, one
note of apprehension has been sounded. There
is a possibility that physicians who have book-
keeping or clerical help, and therefore probably
those in the higher income brackets, will likely
send in the forms, while those without such
help are more likely to neglect them. This
could make the average appear higher than it
actually is.
^ >): >*:
In analyzing a report prepared for it by the
Veterans Administration, the American Legion
reached the conclusion that only 19 per cent of
V. A. hospital cases are strictly non-service
connected. It reports that 81 per cent of all
V. A. hospital patients fall into the following
classes: (1) Established service-connected ill-
ness or injuries; (2) have at one time or another
applied for pension or service-connected certi-
fication; and (3) are eligible to apply for such
certification for various reasons, principally be-
cause they are mental cases.
This analysis is in conflict with other studies
of the V. A. hospital situation which place the
percentage of non-service connected cases at
50 to 70 per cent. The Legion contends that
many veterans, particularly mental and tuber-
culosis cases, are appealing from adverse rulings,
and for this reason should not be listed as non-
service connected cases. In addition, the Legion
claims that experience shows many cases now
considered non-service later will be added to
compensation or pension rolls after more careful
study of their claims.
^ ^ >):
A Federal Security Agency publication, Re-
port No. 14 on Legislative Service, concedes
that legislation for Federal aid to medical edu-
cation is dead for this session of Congress.
The report notes that the House Interstate and
Foreign Commerce Committee voted to table
H. R. 5940, the bill on which it had worked for
six months, then scheduled hearings on a
substitute bill (H. R. 8886) for August 8. This
action, F. S. A. says “in effect tabled the bill
for the remainder of this session.” H. R. 8886
was introduced by Representative Andrew
Biemiller (D.-Wis.), a strong administration
supporter, the day after the Committee tabled
H. R. 5940, and following an urgent request from
the White House that the Committee report out
a bill to aid medical education.
* * >:=
A House subcommittee, appointed to investi-
gate activities of the Federal Security Agency,
released its report late in June in which it de-
scribes the agency as inefficient, wasteful, over-
staffed and engaged in outright and illegal
propaganda in support of national health in-
818
The Ohio State Medical Journal
AU REOMYC1N
#
CRYSTALLINE
in Infections
of the Puerperium
During the past year, obstetricians have become in-
creasingly impressed with the ability of aureomycin to
prevent or arrest infections of the puerperium. Where
infection is feared, or has appeared, this broadly
effective antibiotic is highly useful. Drug fastness and
allergy are very rare following aureomycin. It is be-
lieved that this new crystalline form of aureomycin
obviates nearly all side reactions.
Aureomycin has' also been found effective for the con-
trol of the following infections:
Acute amebiasis, bacterial infections associated
with virus influenza, bacterial and virus-like infections
of the eye, bacteroides septicemia, boutonneuse fever,
brucellosis, chancroid, Friedlander infections (Kleb-
siella pneumonia), gonorrhea (resistant), Gram-nega-
tive infections (including those caused by some of the
coli-aerogenes group), Gram-positive infections (in-
cluding those caused by streptococci, staphylococci,
and pneumococci), granuloma inguinale, H. influenzae
infections, lymphogranuloma venereum, peritonitis,
pertussis infections (acute and subacute), primary
atypical pneumonia, psittacosis (parrot fever) , Q fever,
rickettsialpox, Rocky Mountain spotted fever, sinusitis,
subacute bacterial endocarditis resistant to penicillin,
surgical infections, tick-bite fever (African), tularemia,
typhus and the common infections of the uterus and
adnexa.
Capsules:
Bottles of 25, 50 mg. each capsule.
Bottles of 16, 250 mg. each capsule.
Ophthalmic:
Vials of 25 mg. with dropper;
solution prepared by adding
5 cc. of distilled water.
LEDERLE LABORATORIES DIVISION
3°
AMERICAS
Cyanamid
COM PAXY
Rockefeller Plaza, New York 20, N. Y.
for August, 1950
819
surance. Representative John Bell Williams, a
Mississippi Democrat, is chairman of the sub-
committee.
Here are some of the findings of the subcom-
mittee :
1. “Many if not all these shortcomings and
discrepancies” are known to top Federal Security
Agency officials. Some of the officials do not
act to correct shortcomings because they “are
wary of making decisions that will reduce em-
ployment or incur the ill will of a colleague
or of a particular group with whom they dis-
agree.” Other executives are “evasive and tend
to defend the prevailing circumstances regard-
less of the preponderance of evidence to the
contrary.”
2. The Federal Security Agency is relying
heavily on the C. I. 0. to help promote the
President’s health programs, and “documentary
evidence secured in the agency reveals that
some of the field service employees feel that
a disproportionate part of their time is spent
in public relations.”
3. The Federal Security Agency does not
need all of its 34,000 employees, many of whom
are overpaid according to standards in other
government departments; since 1940 Congress
has voted four government pay raises, but
F. S. A. personnel employees received average
increases totaling $1,701 in excess of these stand-
ard increases.
4. “With few exceptions, the management im-
provement activities of the agency operate in
an atmosphere of uncertainty. The various units
are frustrated and disorganized. Under the
present arrangement they are not producing in
proportion to their cost.” In several divisions,
“the proportion of (purchasing) orders under
$20 was more than 60 per cent, and the average
cost of issuing each order was in excess of $10
. . . The average workload for each of the 197
persons engaged in processing procurement or-
ders (in one office) was less than three per
day (2.4) and half of them were for items
costing less than $20.”
❖ ❖ ❖
Passengers on some buses and trolleys in
Washington, D. C., have had to listen to “the
added attraction” of radio programs. That
might be bad enough, but sandwiched in the
programs are plugs paid for by antivivisection-
ists such as this: “Beware, beware — your pets
may wind up in vivisectional laboratories to
suffer untold agony. Beware.” When the Dis-
trict of Columbia Medical Society complained,
they were told that the Agency would be glad to
place a commercial for them on the buses and
trolleys.
^ ^
A full-scale investigation of the nation’s food
supply has been ordered by the House of Rep-
resentatives, with particular attention to ' be
devoted to determining the effect on foodstuffs
of new chemicals and compounds. One area of
the study will attempt to learn in what way
if any atomic byproduct fertilizers affect crops.
Attention will be given to possible harmful re-
sults from chemicals and synthetics used in
production, processing and packaging of foods
and the effect of pesticides and insecticides.
H* 5{C Jfc
Dr. Dean A. Clark has been named to head
the Senate Labor and Public Welfare subcom-
mittee survey of voluntary health insurance
plans. Dr. Clark, general director of the Massa-
chusetts General Hospital, was in charge of the
New York State Health Insurance Plan for
four years. The committee must report its find-
ings and recommendations to the Senate by
February 1, 1951.
43 Life Insurance Companies Announced
Increases in Fee Schedules
After considerable negotiating between the
medical profession and life insurance companies,
the Bureau of Medical Economic Research of the
American Medical Association in mid- June re-
ported that 43 companies have announced in-
creases in their fee schedules. The report states
that while the amount of increase in each case
is not on record, in general the increase is 50
per cent across the board.
Following are the names of companies which
the A. M. A. announced
of early June:
1. Aetna
2. American General
3. Bankers Life
4. Columbian National
5. Connecticut General
6. Connecticut Mutual
7. Continental Assurance
8. Control Life
9. Equitable Assurance,
N. Y.
10. Equitable of Iowa
11. Fidelity Mutual
12. Franklin Life
13. Great Southern
14. Guardian
15. Home Life
16. Jefferson Standard
17. Life Insurance of Ver-
mont
18. Lincoln National
19. Manhattan
20. Maccabees
21. Metropolitan
had raised their fees as
22. Mutual Life, New York
23. Mutual Trust
24. National Life & Ac-
cident
25. National Life, Ver-
mont
26. New England Mutual
27. New York Life
28. Occidental
29. Ohio National
30. Pacific Mutual
31. Pan American
32. Phoenix
33. Pilot Life
34. Provident Mutual
35. Prudential
36. Security Mutual
37. Southland Life
38. Southwestern
39. Standard, Oregon
40. State Mutual
41. Sun Life
42. Travelers
43. United Life & Accident
The Arthritis and Rheumatism Foundation
is offering fellowships for research in the basic
sciences related to the study of arthritis. These
fellowships carry a stipend of from $4,000 to
$6,000. Applications should be sent to the Arth-
ritis and Rheumatism Foundation, 535 Fifth
Avenue, New York 17, N. Y., by January 1, 1951.
820
The Ohio State Medical Journal
Upjohn
the probability
of thrombi . . •
Both morbidity and mortality from post-
operative venous thrombosis and embo-
lism, frequent sequelae to surgery, have
been dramatically reduced by early insti-
tution of anticoagulant therapy. Studies
of anticoagulants by Upjohn research
workers have led to the development of
many Heparin Sodium preparations, in-
cluding long-acting Depo# -Heparin So-
dium, with or without vasoconstrictors.
Heparin Sodium preparations provide
promptly effective and readily controlla-
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* Trademark, Reg. U.S. Pat. Off.
Jffedicine...IMroiiueed with eurt,...I}*,siej nt>il for health
THE UPJOHN COMPANY. KALAMAZOO 99. MICHIGAN
for August, 1950
821
• • •
A. M. A. Annual Session
Large Group From Ohio Attends Meeting in San Francisco Where House
Of Delegates Transacts Many Items of Interest to Medical Profession
THE American Medical Association Annual
Session in San Francisco, June 26-30, was
one of the most successful on record, ac-
cording to The Journal of the A. M. A. More
than 25,000 persons, including 10,119 doctors,
attended. Although the number of doctors who
attended could not compare to attendances of
meetings held in the populous East, officials were
highly pleased with results.
Ohio doctors, reported in the official registra-
tion, numbered 250, an excellent attendance.
A party of 95 Ohio doctors and members of
their families went by special train which was
arranged by the Headquarters Office of the
Ohio State Medical Association. Accompanying
this group were Mr. Charles S. Nelson, Execu-
tive Secretary, and Mr. George H. Saville, Pub-
lic Relations Director.
The Ohio State Medical Association was
represented by its eight delegates, Dr. Edgar
P. McNamee, Cleveland; Dr. Carl A. Lincke,
Carrollton; Dr. George A. Woodhouse, Pleasant
Hill; Dr. William M. Skipp, Youngstown; Dr.
L. Howard Schriver, Cincinnati; Dr. C. C. Sher-
burne, Columbus; Dr. Frank M. Wiseley, Find-
lay; and Dr. A. A. Brindley, Toledo. Dr. Paul
A. Davis, Akron, was a delegate from the Sec-
tion on General Practice.
Among doctors who served on reference com-
mittees were Dr. Lincke on the Committee on
Amendments to the Constitution and By-Laws,
and Dr. McNamee, chairman of the Committee
on Insurance and Medical Service.
A detailed report on the meeting will be
published in the September issue of The Journal.
However, following is a summary of some of
the highlights of the actions taken by the
House of Delegates:
ACTIONS OF HOUSE
Authorized establishment of a Student Ameri-
can Medical Association, an organization for
medical students; and in another action refused
to support the Association of Interns and Medi-
ical students as presently constituted;
Adopted detailed reports by committees sent
to Great Britain to study medical education and
the practice of medicine in that nation;
Adopted a report of the Committee on Hos-
pitals and the Practice of Medicine which de-
nounces systems whereby hospitals hire salaried
physicians for medical care and the hospitals
bill the patients for this care, making a profit
from the services of the physicians.
Resolved to continue support of the World
Medical Association;
Criticised the practice prevalent in some hos-
pitals whereby membership in a specialty board
is made a requisite for appointment or advance-
ment;
Approved continuation of the National Edu-
cation Campaign during 1951 with the firm of
Whittaker and Baxter as directors;
Authorized the Board of Trustees to proceed
with expansion of the A. M. A.’s Department of
Public Relations and expansion of special com-
mittees of the Council on Medical Service, in
anticipation of eventual discontinuance of the
special National Education Campaign;
Voted to provide each member with The Jour-
nal of the A. M. A., starting in 1951 by including
subscription to the magazine in membership
dues and to set the dues for 1951 at $25 —
the same as the 1950 dues;
Referred to a committee study of the status
of Fellowship with instructions for the com-
mittee to report at the December, 1950, meeting;
Chose New York City for the annual conven-
tion in 1953.
OFFICERS ELECTED
Among officers elected by the House of Dele-
gates were Dr. John W. Cline, San Francisco,
president-elect; Dr. R. B. Robins, Camden, Ark.,
vice-president; Dr. George F. Lull, Chicago, re-
elected secretary; Dr. J. J. Moore, Chicago, re-
elected treasurer; Dr. F. F. Borzell, Philadelphia,
reelected speaker of the House; Dr. James R.
Reuling, Bayside, N. Y., reelected vice-speaker.
Dr. Elmer L. Henderson, Louisville, Ky., as-
sumed office as president at the meeting to suc-
ceed Dr. Ernest E. Irons, Chicago.
Dr. Leonard Larson, Bismarck, N. D., and Dr.
Thomas P. Murdock, Meriden, Conn., were
elected to the Board of Trustees to succeed Dr.
John H. Fitzgibbon, Portland, Ore., and Dr.
James R. Miller, Hartford, Conn., whose terms
expired.
New applications for Research Fellowships
and Established Investigators will be accepted
by the American Heart Association up to Sep-
tember 15, 1950. Applications for Research
Grants-in-Aid, including grants to basic sciences,
may be filed up to December 15. Information
and application forms may be obtained from Dr.
Charles A. R. Conner, medical director, Ameri-
can Heart Association, 1775 Broadway, New
York 19.
822
The Ohio State Medical Journal
Before Treatment ( 9
days prior to Dihydro-
streptomycin therapy)
Diffuse lobular tubercu-
lous pneumonia, lower
half of left lung; thin-
walled cavity above hilus
( 3x35 cm.).
?/// ^
After 3 Mos. Treat-
ment (2 days after dis-
continuance of Dihydro-
streptomycin ) Consider-
able clearing of acute
exudative process in the
diseased lung; cavity
smaller and wallthinner.
Preferred Adjuvants in the
treatment of
Dihydrostreptomycin and Streptomycin are unquestionably the most
potent antibiotics now available for use against tuberculosis. Extensive
clinical results have defined the important role of these antibiotics in
suppressing the activity of the tubercle bacillus.
Detailed literature including in-
dications, pharmacology, dosage,
and administration is available
upon request.
MERCK & CO., Inc.
Manufacturing Chemists
RAHWAY, NEW JERSEY
Streptomycin X. Crystalline
Calcium ChlorideXv Dihydrostreptomycin
Complex Merck Sulfate Merck
for August, 1950
823
In Our Opinion:
Comments on Current Economic and Social
Questions and Professional Problems ;
Suggestions Regarding Organized Activities
DOCTORS AND THE PRESENT
WAR EMERGENCY
Any attempt to surmise the part that the
medical profession must play in the emergency
would be premature as this issue went to press.
The need for medical officers by the Armed
Forces is becoming increasingly acute as the
conflict in Korea progresses.
It may be recalled that for at least the last
two years the Armed Forces, in cooperation with
the Medical Profession, has been putting on a
concerted drive for medical officers and thereby
for the time forestalled a theatened draft of
certain categories of doctors. It was revealed
that Armed Forces, by sharply cutting back
over the last year, had succeeded in establishing
a “surplus” of doctors which acted as a cushion
when the emergency broke out
Reactivation of the Selective Service act left
the situation the same as it had been with
regard to doctors — that is, only those doctors
between the ages of 19 and 25, inclusive, can
be drafted. This, of course, is subject to change
by Congress.
With the authorized increase in the Armed
Forces strength, the need for medical officers
is paramount. Army, Navy and Air Force are
calling for reserve officers to volunteer for active
duty, but involuntary induction looms as a
decided possibility.
The largest potential group of volunteers is
made up of former Navy V-12 and Army A. S.
T. P. medical students, who had all or part of
their education financed by the government but
were not required to serve on active duty be-
cause of termination of World War II. There
is a potential of some 8,000 physicians and
dentists in this group.
A second source are men deferred from the
draft to complete their medical education at
their own expense during World War II. No
estimate of how many there are in this category
has been made.
A third group of potential volunteers is com-
posed of physicians who, for several years after
the war, were assigned to residencies and in-
ternships on active duty status, but who were
allowed to leave the service immediately upon
completion of their training. This is a small
group.
There are currently about 6,000 doctors in
the three services, including men in training
and serving internships and residencies. There
are about 30,000 medical reserve officers.
The Army already has pulled an appreciable
number of first and second year residents out
of hospitals and sent them to duty with troops.
Many young men who have just completed their
internships under the Army civilian training
program have already been sent to active duty.
Several thousand reserve medical officers in all
grades have received letters urging them to
volunteer. The Navy and Air Force also are
making similar efforts to fill their needs.
The President in his address to Congress and
later to the public revealed that he had au-
thorized the calling of reserves. The Armed
Services immediately announced that limited
numbers of reservists — primarily those with
specialty training, including doctors — were being
called to active duty.
FLORIDA COUNTY GOES ALL OUT
IN EMERGENCY CALL SERVICE
In Florida perhaps a new high has been
established in the emergency call service. The
Escambia County Medical Society in cooperation
with the District Nurses Association have estab-
lished a 24-hour exchange which answers calls
not only for doctors but for registered nurses,
dentists, druggists, practical nurses, funeral
homes, the American Red Cross and the Home
Nursing Service.
In reporting great initial success in the ven-
ture, local doctors stated: “We felt the need for
a complete health center, where people in an
emergency could get all types of medical aid
immediately.”
Whether or not the venture sets a precedent,
the doctors of that Florida county are going all
out to render a service to the public.
SOME HEALTHFUL THINKING ON THE
PART OF HEALTH PERSONNEL
In a report of a change in policy as to distri-
bution of Federal grant-in-aid funds to local
health departments, Dr. Porterfield, director of
the Ohio Department of Health, made a very
significant observation.
“These factors are established,” he said, “in
accordance with the philosophy that support
of local health units is primarily the respon-
824
The Ohio State Medical Journal
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Cartose and Drisdol, trademarks reg. U. S. & Canada
Now also milk diffusible DRISDOL with VITAMIN A
for August, 1950
825
sibility of local government. They also prevent
the conservation of local funds by substitution
of Federal assistance.”
That is healthy thinking from Ohio’s health
director. And as an indication that this kind
of thinking is widespread among public health
workers, Miss Elizabeth Lovell, director of Pub-
lic Health Education of the North Carolina
State Board of Health, spoke along the same
lines at a recent Ohio Public Health Association
meeting. Miss Lovell was speaking in terms of
individual initiative on the local level. She
pointed out the need to get the help of the people
in the community. She further stressed the point
that people in local communities can think for
themselves, can discover problems for themselves
and can do something about it on their own
initiative.
When we have more public officials and people
generally thinking in terms of local initiative
to meet local needs, we won’t have to worry so
much about establishment of a push-button
system in Washington.
IT ISN’T WHAT YOU SAY SO
MUCH AS THE WAY YOU SAY IT
Nation's Business, in an article entitled, “Pag-
ing Joe Doakes, Capitalist,” calls attention to
the report that 78,000,000 people in this country
have life insurance policies, nearly 60,000,000
have savings accounts, between 10,000,000 and
20,000,000 own stocks and about 55 per cent of
the population own bonds.
This disclosure that the much-despised “capi-
talists” are numbered among almost every family
in the nation is not news to the medical profes-
sion, but it does point up a problem in public
relations.
Perhaps some of us in our enthusiasm to dis-
credit the propaganda of the Communists and
Socialists fail to spell out our ideas and ideals
in terms that convey their real meanings to the
people we eventually wish to influence.
Our talks before luncheon clubs and other or-
ganizations which comprise principally the execu-
tive class must have two-fold purposes — first,
they must stimulate listeners to present a united
front against the encroachments of “isms”; and,
secondly, they must provide ammunition which
these hearers can pass on to the masses who
mark the ballots.
In our enthusiasm we talk matter-of-factly
about the benefits of free enterprise, our capi-
talistic system and the Constitutional rights of
individuals. Yet these, in the final analysis, are
classroom terms, and may connote many mean-
ings in the minds of those with limited educa-
cations.
Propagandists have carefully twisted the mean-
ings of such terms until many a gullible per-
son may have a grossly erroneous idea of what
they represent. “Capitalism” very often connotes
the concentration of capital in the hands of the
few rich. “Free enterprise,” in the minds of
some, brings up visions of big business exploit-
ing natural resources. The glorification of the
individual may imply restrictions on the rights
of labor to organize.
As a matter of fact, there are on record suffi-
cient examples of abuses of these fundamental
rights to give the propagandists ammunition to
back up their undermining doctrines.
The Communists and Socialists are careful not
to point out to the working man that he is a
capitalist if he buys a bond or does anything
else with his money except spend it. They do
not admit that a worker is enjoying the free en-
terprise system when he quits one job and goes
to one which offers more opportunity. They
neglect to inform their listeners that the work-
ing man is enjoying the highest type of indi-
vidual initiative when he can find the means and
the will to send his youngster through college.
We would not for a minute advocate that
speakers stoop to using a 500-word vocabulary
or otherwise address audiences as though they
were composed of morons. But each speaker
would do well to consider that his expressed
ideas go much farther than the immediate audi-
ence he is addressing. We want to reach the
so-called intellectuals, but we want also to reach
the working man, the farmer and the housewife.
The great masses of these people think, but they
think in terms of everyday living — and that’s
the level on which we must meet them.
THE SCOREBOARD IS USUALLY THE
BEST INDICATION OF THE SCORE
Those skeptics, both in and out of the medi-
cal profession, who scoff at the profession’s
campaign to tell its side of the story to the
public might take a look at the scoreboard as
it is reflected in the public press.
Being skeptics perhaps they will see the one
bad story and miss the 99 good ones, but if
they have any sense of proportion they cannot
miss the unprecedented interest the press is
taking in medical and health matters.
Throughout the nation many newspapers are
devoting whole sections to tell the story of
medical progress during the past 50 years. In
Ohio literally thousands of columns of type have
been devoted to those doctors who have served
their communities for 50 or more years. Other
hundreds and perhaps thousands of columns
have been devoted to medical and health matters
from all angles.
826
The Ohio State Medical Journal
INGLESIDE FARM INGLESIDE HOME
Hospitals for Nervous and Mental Disorders
VIEW AT INGLESIDE FARM
THE FARM - Chardon, Ohio
Telephone Chardon 355
Medical Director, Neil T. McDermott, M.D
THE HOME - 8821 Euclid Ave.
Cleveland, Ohio Cedar 5416
Mabel A. Woodruff, Director
Facilities for
Chronics and Convalescents
for August, 1950
827
In IMemoriam . . .
Harvey L. Basinger, M. D., Lima; Ohio State
University College of Medicine, 1914; aged 59;
died June 22; member of the Ohio State Medi-
cal Association and a Fellow of the American
Medical Association; president of the Academy
of Medicine of Lima and Allen County, 1950;
its vice-president in 1926 and delegate to the
Ohio State Medical Association in 1930. Dr.
Basinger had practiced his profession in Lima
continuously from the completion of his medi-
cal education, with the exception of the time
he spent with the Naval Medical Corps during
World War I. In addition to his medical af-
filiations, he was active in several Masonic
orders and the Elks Club. Surviving are his
widow, a son, a daughter, a brother and three
sisters.
Benjamin Carlson, M. D., Lorain; Western Re-
serve University School of Medicinje, 1925;
aged 57; died June 16; member of the Ohio
State Medical Association and a Fellow of the
American Medical Association through 1949;
president of the Lorain County Medical Society
in 1939. Dr. Carlson practiced medicine in
Lorain for 21 years before retiring about a
year ago. In addition to his professional work
he was active in the College Club of which he
was a former president and in the Congregational
Church. Surviving are his widow, a son, three
daughters, a brother and two sisters.
Julia M. Donahue, M. D., Massillon; North-
western University Woman’s Medical School,
1892; aged 83; died June 19; member of the
Ohio State Medical Association and the Ameri-
ican Medical Association; diplomate of the
American Board of Psychiatry and Neurology.
A former medical missionary in China, Dr.
Donahue was a resident physician at the Mas-
sillon State Hospital for 23 years and later
was engaged in private practice. A veteran
of World War I, during which she served with
the Medical Corps, she was a member of
American Legion Auxiliary. She also was a
member of the Daughters of Union Veterans,
Ladies of the G. A. R., Massillon Woman’s Club
and the Methodist Church. A brother survives.
Fred M. Douglass, Toledo; Toledo Medical
College, 1911; aged 60; died July 4 on a return
trip from the A. M. A. Annual Session in San
Francisco; member of the Ohio State Medical
Association and a Fellow of the American Medi-
cal Association; vice-president of the Academy
of Medicine of Toledo in 1936 and its president
in 1937; diplomate of the American Board of
Surgery; member of the American Association
of Obstetricians, Gynecologists and Abdominal
Surgeons; International College of Surgeons
and the American College of Surgeons. Dr.
Douglass had practiced in Toledo beginning in
1912 and had been chief of the surgical staff
at St. Vincent’s Hospital since 1926. He was
a promoter of prepaid medical and surgical
insurance in his area and was one of the founders
of Ohio Medical Indemnity, Inc. He was a mem-
ber of several Masonic Orders, the Elks Club, the
Toledo Club and Inverness Club. Surviving are
his widow; a daughter; a son, Dr. Fred M.
Douglass, Jr., with whom he was associated in
practice; a brother and a sister.
Roy P. Elder, M. D., Portsmouth; Ohio State
University College of Medicine, 1910; aged 67;
died June 12; member of the Ohio State Medical
Association and a Fellow of the American Medi-
cal Association; president of the Hempstead
Academy of Medicine, 1935. Dr. Elder was medi-
cal examiner for the N. & W. Railway. He was
a member of the Masonic Lodge, the Elks Club
and the Kiwanis Club. Surviving are his widow,
a brother and a sister.
John L. Gates, M. D., Ann Arbor, Mich.; Ohio
State University College of Homeopathic Medi-
cine, 1917; aged 60; died June 15. Survivors
include his widow, a son and a daughter.
Robert W. Hancock, M. D., Elyria; Indiana
University School of Medicine, 1922; aged 53;
died June 29; member of the Ohio State Medi-
cal Association and the American Medical Asso-
ciation; secretary- treasurer of the Lorain County
Medical Society 1925-27. Dr. Hancock had had
a long practice in Elyria where he was chief of
the surgical staff of Elyria Memorial Hospital.
A veteran of World War I, he was a member
of the American Legion. He was affiliated also
with several Masonic orders, and the Congrega-
tional Church. Surviving are his widow, a son,
a daughter, a brother and a sister.
Frank E. Hart, M. D., Canton; Medical College
of Ohio, Cincinnati, 1893; aged 77; died June 30;
member of the Ohio State Medical Association
and a Fellow of the American Medical Associa-
tion. Dr. Hart began his practice in 1893 and
had been in Canton 44 years. In 1944 he was
honored by his colleagues upon completion of
50 years of practice. Later he was awarded
the 50-Year Pin and Certificate of the Ohio
State Medical Association. He was a member
of the Christian Church and the Masonic Lodge.
Surviving are a daughter, a son and a brother.
James R. Hilling, M. D., Lucasville; Hospital
College of Medicine, Louisville, Ky., 1905; aged
72; died June 18. Dr. Hilling practiced in
Middletown before moving to Lucasville 15 years
ago. Surviving are his widow, two daughters, a
brother and a sister.
John Scudder Hull, M. D., Hicksville; Eclectic
Medical College, Cincinnati, 1896; aged 77; died
828
The Ohio State Medical Journal
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UROLOGY
A combined full time course in Urology, covering an
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anatomy and urological operative procedures on the
cadaver; regional and general anesthesia (cadaver) ;
office gynecology; proctological diagnosis; the use of the
ophthalmoscope; physical diagnosis; roentgenological in-
terpretation ; electrocardiographic interpretation ; der-
matology and syphilology; neurology; physical medicine;
continuous instruction in cystoendoscopic diagnosis and
operative instrumental manipulation; operative surgical
clinics; demonstrations in the operative instrumental
management of bladder tumors and other vesical lesions
as well as prostatic resection.
OBSTETRICS AND GYNECOLOGY
A full time course. In Obstetrics: Lectures; pre-natal
clinics; witnessing normal and operative deliveries; op-
erative obstetrics (manikin). In Gynecology: Lectures;
touch clinics; witnessing operations; examination of pa-
tients pre-operatively ; follow-up in wards post-opera-
tively. Obstetrical and gynecological pathology. Anes-
thesia. Attendance at conferences in obstetrics and
gynecology. Operative gynecology on the cadaver.
For the GENERAL SURGEON
A combined surgical course comprising general surgery,
traumatic surgery, abdominal surgery, gastroenterology,
proctology, gynecological surgery, urological surgery.
Attendance at lectures, witnessing operations, examina-
tion of patients pre-operatively and post-operatively
and follow-up in the wards post-operatively. Pathology,
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EYE, EAR, NOSE, AND THROAT
A combined full time course covering an academic year
(9 months). It consists of attendance at clinics, witness-
ing operations, lectures, demonstration of cases and
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throat on the cadaver; head and neck dissection
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choscopy, laryngeal surgery and surgery for facial
palsy; refraction; radiology; pathology; bacteriology:
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and clinics. Also refresher courses (3 months).
For Information Address
345 WEST 50th STREET MEDICAL EXECUTIVE OFFICER NEW YORK CITY 19
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for August, 1950
829
July 2; member of the Ohio State Medical Asso-
ciation and a Fellow of the American Medical
Association; vice-president of the Defiance
County Medical Society, 1940-41, 1946-48, and
president in 1942 and 1943. Dr. Hull had
practiced continuously in Hicksville beginning
in 1896 with the exception of time he spend
in graduate study. Recently he was honored
by the Defiance County Medical Society by
being presented the 50-Year Pin and Certificate
of the Ohio State Medical Association. He
was a life member of the Methodist Church,
and was a past master and 50-year member of
the Masonic Lodge, within which he was af-
filiated with several orders. He was an organizer
and director of the Hicksville Bank and a
member of the Rotary Club. Surviving are his
widow and a son.
Glover T. Keen, M. D., Cincinnati; University
of Cincinnati College of Medicine, 1933; aged
52; died June 23; member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association. Dr. Keen had practiced
in Cincinnati since completion of his medical
education. He was a member of the Smoke
Abatement League of Cincinnati, Alpha Sigma
Phi, McMillan Lodge, Masonic Lodge, Nu Sigma
Nu and the Presbyterian Church. Surviving
are his widow, a daughter, three sisters and a
brother.
William N. Mundy, III, M. D., Toledo; Harvard
Medical School, 1943; aged 32; died June 29 in
a traffic accident while returning from a vacation
trip in the East; member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association. Dr. Mundy had been
in practice for the past four years in Toledo
where he was associated with his father. His
wife and three children died with him in the
accident. Surviving are his parents, Dr. and
Mrs. Carll S. Mundy, of Toledo, and a sister.
Charles A. Neal, M. D., Norwood; Medical Col-
lege of Ohio, Cincinnati, 1907; aged 66; died
June 13; member of the Ohio State Medical
Association and the American Medical Asso-
ciation; member of the American Public Health
Association. Dr. Neal, associated with the
Veterans Administration in Cincinnati, was
formerly superintendent of the Hamilton County
Home and Chronic Disease Hospital. He served
as Hamilton County health commissioner from
1923 to 1929 and as director of the Ohio De-
partment of Health in 1929 and 1930,. He was a
member of the Catholic Church. His widow
survives.
Benjamin C. Simmons, M. D.s San Antonio,
Texas; University of Cincinnati College of Medi-
cine, 1923; aged 59; died July 3; former member
of the Ohio State Medical Association through
1942. Dr. Simmons retired in 1942 because of
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The Ohio State Medical Journal
ill health after practicing in Cincinnati for 20
years. Two daughters and a son survive.
Marcus O. Smith, M. D., Porterville; Starling
Medical College, Columbus, 1891; aged 87; died
June 10; member of the Ohio State Medical
Association and the American Medical Associa-
tion through 1945; president of the Perry County
Medical Society in 1928. Dr. Smith had practiced
medicine for 57 years, virtually all of that span
in Perry County. Recently he was presented
the 50-Year Pin and Certificate of the Ohio State
Medical Association. Surviving are his widow,
three daughters and a brother.
James C. Steiner, M. D., Willard; Ohio State
University College of Medicine, 1923; aged 62;
died June 30; member of the Ohio State Medi-
cal Association and a Fellow of the American
Medical Association; secretary- treasurer of the
Huron County Medical Society in 1934 and its
delegate in 1939. Dr. Steiner had practiced
in Willard for 27 years and was associated re-
cently in practice with his son-in-law, Dr. Walter
A. Drury. He was a member of the Evangeli-
cal United Brethren Church and the Rotary
Club. Survivng are his widow, two daughters,
two sisters and three brothers.
John T. Stonerock, M. D., Union; Eclectic Medi-
cal College, Cincinnati, 1894; aged 78; died
June 18. Dr. Stonerock had practiced in the
Union vicinity for 56 years. Surviving are his
widow, two daughters, three sons.
William I. Waters, M. D., Midland, Texas;
Ohio State University College of Medicine,
1937; aged 37; died June 26 as the result of a
traffic accident; member of the State Medical
Association of Texas and a Fellow of the
American Medical Association.
Charles N. Watkins, M. D., Fort Recovery;
Ohio Medical University, Columbus, 1904; aged
73; died June 19; former member of the Ohio
State Medical Association through 1921. Sur-
viving are his widow, a son, a daughter, a sister
and a brother.
Windsor Offers Two Residencies
In the article on “Hospital Training Facilities,”
June issue of The Journal, the Windsor Hos-
pital, Chagrin Falls, was erroneously listed
under Cleveland Hospitals, and may have been
missed by some readers. The Windsor Hospital
is approved by the Council on Medical Education
and Hospitals of the A. M. A. for two residencies
in psychiatry.
Dr. L. M. Otis, Celina, was winner of the
Maturity Event of the A. M. A. golf tournament
held at the annual session in San Francisco.
There were 311 doctors who participated in the
tournament. The winning scores were 37, 37,
38 and 41.
order your
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GUMMED FLAP ENVELOPES
Our strong, gummed flap dispensing envelope is used ex-
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Printed in blue or black ink. Size: 21/j x 3*/^, 1,000 — 3.95,
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Shipment will be made within one week after receipt of order.
MEDICO PRESS
MILLERSTOWN, PENNSYLVANIA
Established 1938 Printers for the Medical Profession
for August, 1950
831
Buckeye News Notes . . .
Ashland — Dr. A. D. Robertson was elected
president of the newly organized Ashland County
Mental Hygiene Association. Dr. C. B. Meuser
and Dr. Wayne C. Smith were among persons
elected to board of directors.
Canton — Shortcomings of British socialized
medicine were discussed by Dr. Scott E. Hill
before the Optimist Club.
Cincinnati — Dr. Stanley E. Dorst, dean of the
University of Cincinnati College of Medicine,
spoke on “Medical Education and Practice in
Great Britain” at a special meeting of the
Public Health Federation in Hotel Gibson.
Cleveland — Dr. Richard R. Renner was named
Disciple of the Year by the Cleveland Disciples
Union, for outstanding service to local, state
and national work for the organization.
Cleveland — Dr. Middleton Lambright, Jr.,
presented papers on “The Management of Gyne-
cological Infection” and “Diagnosis of Lung
Cancer” at the Lone Star State Medical Con-
vention.
Columbiana — Dr. C. W. Dewalt was guest of
honor at a meeting sponsored by the Kiwanis
Club. He was cited for these accomplishments
among others — former mayor of Columbiana, in-
stigator of the sanitary sewer system in the city,
president of the county board of health, presi-
dent of the Columbiana County Medical Society,
chief of staff at Salem City Hospital, and a
charter member of the Kiwanis Club.
Columbus — Dr. Allan C. Barnes, Ohio State
University College of Medicine, addressed the
Rotary Club on the subject, “Medical Education.”
Grover Hill — Dr. T. P. Fast was honored at a
public gathering sponsored by the Lions Club
for his long service to the community. He
has practiced in Grover Hill since 1900.
Marietta — Dr. Harry W. Hill, of Vincent, was
the subject of a human interest article in the
Marietta Times. Although past 80, he is still
in active practice and for 25 years has been
president of the Washington County Board of
Health.
Paines ville — Dr. John W. Davis is the new
Lake County health commissioner. He succeeds
Dr. W. H. Willis who resigned.
Rio Grande — Dr. Charles E. Holzer, Sr., Galli-
polis, resigned as chairman of the board of
trustees of Rio Grande College after holding that
office since 1922. He was reelected as a member
of the board.
Sandusky — Dr. Ross M. Knoble spoke on the
subject of “Socialized Medicine” before the
Junior Chamber of Commerce.
Wooster — Dr. E. E. Judd spoke on the subject
of “Socialized Medicine” before the Minute
Women of Ohio, Wooster Chapter.
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widely used mattress of its type in the world. Since it is
correctly firm it insures proper sleeping posture, gives natural
support and complete comfort, too. For patients bothered
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The Ohio State Medical Journal
Do You Know? . . .
Guest speakers at the 83rd Annual Meeting
of the West Virginia State Medical Association,
July 27-29, at The Greenbrier, White Sulphur
Springs, included: Dr. George M. Curtis, Dr.
Allan C. Barnes, Dr. Earl H. Baxter, Columbus,
and Dr. A. William Friend, Akron.
sj: ;»c
Under the direction of the Cleveland Ophthal-
mological Club, a group of Cleveland oculists
and opticians has presented Western Reserve
University School of Medicine with a gift of
$10,000 for the establishment of a special lab-
oratory of ocular physiology in the Department
of Physiology.
^ >Jc
Dr. Harry V. Paryzek, General Chairman of
the Local Committee on Arrangements for the
Annual Meeting of the Ohio State Medical
Association in Cleveland last May, who was un-
able to participate in the meeting because of
illness, has completely recovered and returned
to active practice.
^
Dr. Edward J. McCormick, Toledo, a member
of the Board of Trustees of the American Medi-
cal Association, has been named by the Board
as a member of the Coordinating Committee on
the National Education Campaign. His other
assignments include: Chairman of the Committee
on Scientific Exhibit and representative of the
Board to the Council on Industrial Health.
^
A graduate of the University of Cincinnati
College of Medicine in 1937, Dr. Francis M.
Forster, Philadelphia, has been appointed profes-
sor of neurology and director of the department
at Georgetown University School of Medicine.
^ ^ ^
Physicians who registered at the White Labor-
atories booth in the Technical Exhibit at the
A. M. A. meeting in San Francisco were given
a chance on a brand new Cadillac club coupe.
The lucky winner was Dr. Edgar P. McNamee,
Cleveland, one of the Ohio delegates.
^ ^
There were 1,697 traffic deaths in Ohio dur-
ing 1949. Of these, 767 or 45 per cent, occurred
as a result of accidents on rural state highways.
^ ^
Western Reserve University School of Medi-
cine has received a grant of $15,000 toward in-
vestigation in the field of surgery to increase
the blood supply to the brain of retarded chil-
dren. Dr. Claude S. Beck and Dr. Charles F.
McKann have been doing research in this field.
The grant, part of a total of $280,000 for re-
search on infants and children’s diseases and
disorders, was made by Playtex Park Research
Institute, sponsored by International Latex Cor-
poration.
❖ ❖ ❖
According to a report in the public press,
the late Dr. Paul H. Krebs left a fortune of
more than $1,234,000 to Lutheran Hospital, Cleve-
land. Dr. Krebs, a bachelor, practiced for 54
years from the same office in Cleveland.
^ ^ ^
The Central Ohio Heart Association has elected
Dr. R. W. Kissane as its president for another
year. Other officers include: Dr. G. I. Nelson,
vice-president; Dr. Donald L. Mahanna, secre-
tary; all are of Columbus.
^ ^ ^
Dr. Joseph H. Barach of Pittsburgh, Pa.,
spoke on the subject of diabetes at a meeting in
the Cleveland Health Museum sponsored by the
Cleveland Diabetes League.
sfc
For their research work with Compound E,
Western Reserve University awarded honorary
degrees of Doctor of Science to Dr. Philip S.
Hench and Dr. Edward C. Kendall, of the Mayo
Clinic, Rochester, Minn.
^ ^ ^
Dr. Leon Schiff, University of Cincinnati Col-
lege of Medicine, was one of 11 American doctors
invited to speak at the International Symposium
on Liver Diseases scheduled in London, England.
5-C 5|C ijc
At the recent session of the House of Dele-
gates of the California Medical Association a
resolution was adopted requiring that the of-
ficers, employees and delegates of the Associa-
tion must subscribe to an anti-Communist oath
as a prerequisite to holding office, employment
or a delegate’s seat.
* 5jC *
One of the branches of the British Medical
Association is concerned about “frivolous and
unjustified emergency calls.” The local society
has asked the B. M. A. “to take all steps to
persuade the Ministry of Health to institute
some machinery whereby a doctor can lay a com-
plaint against a patient, and whereby some
penalty can be imposed on that patient if his
conduct be deemed unreasonable.”
❖ ^
The American Roentgen Ray Society, under
the presidency of Dr. U. V. Portmann of Cleve-
land, will hold its 50th Anniversary meeting
in St. Louis, September 26-29. Further infor-
mation may be obtained by writing to the So-
ciety at 20 N. Wacker Drive, Chicago 6.
for August, 1950
833
Commitment To and Discharge From
Lima State Hospital
Since physicians frequently are faced with
the problem of what to do with the criminal
psychopath, the following comments will be of
primary interest to the medical profession. The
comments were prepared by Dr. Ewing H.
Crawfis, Cleveland, who also has a law degree,
and were published in the Bulletin of the
Cleveland Mental Hygiene Association.
1. Thirty-Day Observation Cases — Any one
accused of crime and before the Courts — either
on indictment or trial where insanity is set up
as a defense, or where sanity is under investi-
gation,— may be sent to Lima for 30 days ob-
servation. At the end of that time the patient
is returned to the Court and a report is made.
This procedure is not used frequently in
Cleveland, because there is a local psychiatric
clinic opearted by the Court, but it is frequently
used in the other counties of Ohio, where psy-
chiatric facilities are not locally available.
2. Where Insanity Is Found before Conviction
— The presumption here is, that the patient, being
mentally ill, is not able properly to defend him-
self, and under such conditions the Court com-
mits the patient to Lima, “until restored to
reason.” The patient when recovered, is returned
to the jurisdiction of the Court, and may then
be tried.
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3. Where Mental Illness Develops after Con-
viction— Prisoners from the penitentiary or re-
formatories, who become mentally ill, may be
transferred to Lima for treatment. Then, if re-
covery occurs:
(a) If sentence has expired before recovery,
the patient is committed to the Lima State
Hospital by the local Probate Court. There-
after, the patient is considered as if he were
committed to a Civil State Hospital, and if re-
covery occurs, trial visit and discharge are on
the same basis.
(b) If recovery occurs while still under sen-
tence, he is returned to the original institution.
4. Dangerous Persons in Other State Hos-
pitals, State Schools, or Institutions — Where pa-
tients are considered dangerous and homicidal
to such a degree that they are unmanageable in
the local institution, they may be transferred
to the Lima State Hospital. This is effected by
a request to the Commissioner of Mental Hy-
giene, who authorizes such transfer. If recov-
ery occurs, such patients are usually returned
to the original institution for trial visit and
discharge.
5. Persons Previously Convicted of a Felony,
who Become Mentally 111— The Probate Court
may elect to commit a patient to Lima State
Hospital, instead of to the Local State Hospital,
if the patient has a record of conviction and is
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The Ohio State Medical Journal
regarded as a dangerous person. Generally
speaking, the courts do not do this, but commit
the patient to the local hospital; transfer to
Lima can be made as described in the previous
paragraph, if the individual is found to be
dangerous. Trial visit and discharge are the
same in either of these procedures.
6. Persons Acquitted on the Ground of, “Not
Guilty by the Reason of Insanity” — This is
considered as a continuing insanity, and they are
sent to the hospital automatically without the
necessity of a finding, and commitment is
prescribed under the law on such acquittal. There
is special provision for discharge of such people
after recovery. A committee of three, consist-
ing of the Superintendent of Lima, the Judge
of the Common Pleas Court of Allen County,
and a psychiatrist as a third person, passes on
whether the patient has recovered and can be
discharged.
7. Psychopaths (the Aschermann Act) and a
Number of Special Provisions for Commitment,
as follows. —
(a) After conviction, but before sentencing,
any felony except murder, of the first degree
(premediated).
(b) When diagnosis is established by a psy-
chiatrist or a psychiatric clinic.
(c) When the Court imposes the appropriate
sentence, it can then commit the patient to the
hospital and suspend sentence.
(d) When the patient recovers or improves,
so that further hospitalization is not indicated,
one of two procedures occurs:
First, if the time spent in the hospital is less
than the maximum sentence, the sentence goes
into effect, and the patient is transferred to
the appropriate penal institution. For parole pur-
poses the time spent in Lima is counted as good
behavior time.
Second, if the time spent is beyond the
maximum sentence, then the sentence no longer
applies and the patient may be placed on trial
visit and discharged in the usual manner.
Dr. Meyer H. Fineberg, formerly on the faculty
of Western Reserve University School of Medi-
cine and a practicing physician in Cleveland, has
been appointed manager of the Veterans Ad-
ministration Hospital, Dwight, 111. He has oeen
with the hospital since 1946.
Many organization members throughout Ohio*
have heard inspiring talks by Dr. Christopher
Daniels, London physician, who has been tour-
ing the country speaking on the evils of Socialism
as it exists in England. His tour is under the
auspices of Harding College of Searcy, Ark.
Cook County
Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY— Intensive Course in Surgical Technic,
two weeks, starting Aug. 21, Sept. 25, Oct. 23.
Surgical Technic, Surgical Anatomy & Clinical
Surgery, four weeks, starting Aug. 7, Sept. 11,
Oct. 9. Personal Course in General Surgery, two
weeks, starting Sept. 25. Surgery of Colon & Rec-
tum, one week, starting Sept. 11. Esophageal Sur-
gery, one week, starting Oct. 16. Breast & Thyroid
Surgery, one week, starting Oct. 2. Thoracic Sur-
gery, one week, starting Oct. 9. Gallbladder
Surgery, ten hours, starting Oct. 23. Fractures &
Traumatic Surgery, two weeks, starting Oct. 9.
Basic Principles in General Surgery, two weeks,
starting Sept. 11.
GYNECOLOGY — Intensive Course, two weeks, start-
ing Sept. 25. Vaginal Approach to Pelvic Surgery,
one week, starting Sept. 18.
OBSTETRICS — Intensive Course, two weeks, start-
ing Sept. 11.
MEDICINE — Intensive General Course, two weeks,
starting Oct. 2. Gastro-enterology, two weeks,
starting Oct. 16. Gastroscopy, two weeks, start-
ing Sept. 11 and Oct. 23. Electrocardiography &
Heart Disease, four weeks, starting Oct. 2.
DERMATOLOGY — Formal Course, two weeks, start-
ing Oct. 16. Informal Clinical Course every two
weeks.
UROLOGY — Intensive Course, two weeks, starting
Sept. 25. Cystoscopy, ten day practical course,
every two weeks.
General, Intensive and Special Courses in all
Branches of Medicine, Surgery and the Specialties
TEACHING FACULTY — ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address : Registrar, 427 South Honore Street,
CHICAGO 12, ILLINOIS
THEAnn Arbor School
For Children with Educational,
Emotional or Speech Problems
Boys and girls are enrolled in a year round
program designed to provide opportunities
for optimal educational and emotional growth.
Excellent teaching staff. A training center in
Special Education for student teachers at the
University of Michigan.
For information and catalog, address the
Registrar, 1700 Broadway, Ann Arbor, Mich.
for August, 1950
835
Clark and Lake Counties Establish
24-Hour Emergency Services
Two more counties were added to the list
of those which are offering the public 24-hour
emergency call service when the Clark County
Medical Society and the Lake County Medical
Society announced opening of such services.
The Springfield News-Sun heralded the an-
nouncement of the Clark County Medical So-
ciety with a streamer head. More than 50 doc-
tors in the Society have volunteered to cooperate
in the call service, it was announced.
It was reported in the same announcement
that Clark County physicians had for the past
year given their services on a voluntary basis
to man the emergency room at City Hospital in
Springfield because of a shortage of interns
and residents who usually cover that service.
In announcing the service, Clark County
doctors specified some do’s and don’t’s in regard
to the service.
1. Call your family doctor first.
2. Be clear in giving the name and address of
the patient.
3. Stay by your phone until contact has been
made with the physician-of-the-day and you have
been so advised.
4. Be calm and clear in answering questions
by the operator.
5. Follow implicity any instructions given by
attending physician.
1. Don’t call the emergency medical service
until you have tried to contact your family
physician.
2. Don’t use the service for general medical
information.
3. Don’t call for emergency medical service
for persons intoxicated. The police should be
called in such cases.
4. Don’t abuse the service by calling when an
emergency does not exist..
In Lake County the emergency call serVice
was first put into effect over the 4th of July
week-end. Early reports were that the service
was "working well but that at first few emergen-
cies had developed.
Mrs. John Hurley is operating the Lake County
call service for the Medical Society from her
home in Painesville. Officials of the Society
stated that practically all doctors of the county
had signed up to participate in the service. ,
Dr. Evarts A. Graham, St. Louis, was selected
for the annual Distinguished Service Award of
the American Medical Association by the House
of Delegates at the San Francisco meeting.
Professor of surgery in Washington University
School of Medicine and surgeon-in-chief of
Barnes Hospital, Dr. Graham received world-
wide recognition in 1933 when he performed the
first successful operation for the removal of an
entire lung.
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The Ohio State Medical Journal
Activities of County Societies . . .
First District
(COUNCILOR: D. W. HEUSINKVELD, M. D.,
CINCINNATI)
CLINTON
Dr. John H. Payne, Cincinnati, spoke on the
subject, “Throat Conditions” at the June 6
meeting of the Clinton County Medical Society
in Wilmington.
Dr. W. L. Regan, member of the building
board, gave a report on the construction of the
Clinton Memorial Hospital. Dr. E. K. Yantes,
delegate, reported on the Annual Meeting of the
Ohio State Medical Association held in Cleve-
land, May 16-18.
Meetings will continue through the summer,
with the July meeting on the second Tuesday.
The August meeting will be held at the Snow
Hill Country Club.
Second District
(COUNCILOR: M. D. PRUGH, M. D., DAYTON)
MONTGOMERY
Officers elected to lead the Montgomery
County Medical Society in 1951 were announced
at the annual meeting on June 7, at the Biltmore
Hotel in Dayton. They are Dr. Fred H. Miller,
president-elect; Dr. T. L. Light, vice-president;
Dr. R. E. Zipf, secretary; Dr. A. V. Black
and Dr. W. K. Gregg, trustees for three-year
term.
The new officers will serve with Dr. Harold
M. James, elected to serve as president-elect
during 1950 and who will take office as president
at the first meeting in January, 1951.
Members of the Executive Council in 1951
will include the foregoing officers with Dr. H.
D. Cassel as the immediate past-president;
Dr. A. B. Brower as chairman of the past-
presidents’ gommittee, Dr. A. D. Cook, as trustee
(term expires in 1951), and Dr. N. C. Hockwalt
as trustee (term expires in 1952).
Also elected were the following who will
take office in January, 1951: Dr. R. C. Doan,
delegate, four-year term; Dr. Ned Shepard, al-
ternate delegate, four-year term; Dr. W. R.
Hockwalt, clinic committee, senior member, three-
year term; Dr. R. P. Stafford, clinic committee,
junior member, two-year term.
Delegates in addition to Dr. Doan are Drs. A.
W. Carley, T. L. Light and R. D. Dooley. Al-
ternate delegates in addition to Dr. Shepard
are Drs. R. E. Pumphrey, L. E. Baker and
J. M. Shaffer.
Serving on the Clinic Committee with Dr. W.
R. Hockwalt and Dr. Stafford will be Drs.
Paul Troup, chairman, E. F. Pfanner and W. A.
Stowe.
PREBLE
Two Preble County doctors were honored by
the Preble County Medical Society by being
presented 50-Year Pins and Certificates of the
Ohio State Medical Association. They are:
Dr. G. W. Flory, of Eaton, and Dr. William J.
Christian, of Verona. Dr. Merrill D. Prugh,
Dayton, Councilor of the Second District of the
Ohio State Medical Association, made the presen-
tation to Dr. Flory at a meeting of the Society
on July 31, and to Dr. Christian at his home.
Fifth District
(COUNCILOR: CHARLES L. HUDSON, M. D.,
CLEVELAND)
LAKE
The Lake County Medical Society is sponsor-
ing a weekly consultation psychiatric service
starting August 3 at the Lake County Memorial
Hospital, Painesville. Dr. F. E. Merritt, assist-
ant director at the Cleveland State Hospital,
will be the psychiatrist in charge. Doctors of
THE MARY E. POGUE SCHOOL
Complete facilities for training Re-
tarded and Epileptic children educa-
tionally and socially. Pupils per
teacher strictly limited. Excellent
educational, physical and occupational
therapy programs.
Recreational facilities include rid-
ing, group games, selected movies
under competent supervision of skilled
personnel.
Catalogue on Request
G. H. MARQUARDT, M. D.
Medical Director
BARCLAY J. MacGREGOR
Registrar
29 Geneva Rd., Wheaton.Illinois (near Chicago)
for August, 1950
837
the Society will refer patients to him for
examination.
On July 19, the medical staff of the Lake
County Memorial Hospital held its annual din-
ner meeting at the Madison Golf Club, with out-
door events scheduled for doctors and their
wives. Dr. Allan Moritz, head of the Depart-
ment of Pathology, Western Reserve University
College of Medicine, spoke on the subject, “The
Unexplained Death.” Some of the county pub-
lic officials were guests at the meeting. —
Frederick J. Dineen, M. D.
Sixth District
(COUNCILOR : PAUL A. DAVIS, M. D., AKRON)
MAHONING
Dr. Louis H. Clerf, of Jefferson Hospital,
Philadelphia, Pa., discussed bronchoscopy at the
June 20 meeting of the Mahoning County Medi-
cal Society in Youngstown. Dr. C. A. Gustafson,
chairman of the health education committee,
presented awards to winners in the contest. De-
tails of this essay contest were given in the
June issue of The Journal.
TRUMBULL
More than 50 members of the Trumbull
County Medical Society assembled for the
monthly meeting at Packard Electric Division of
General Motors Corporation, on June 21, as
guests of the Company with Mr. B. N. Mac-
Gregor, general manager, and Dr. G. A. Sudi-
mack, medical director, as hosts.
Following dinner and a tour of the plant, the
group heard a panel discussion on industrial
medicine with the following panel discussants:
Dr. M. J. Drow, Dr. F. C. LaCamera, Dr. J. M.
Glendhill and Mr. B. N. MacGregor. Dr. Sudimack
acted as moderator. At the conclusion of the
panel discussion, Mr. MacGregor presented a
talk entitled, “An Industrialist Looks at Medi-
cine.”
Seventh District
(COUNCILOR: R. J. FOSTER, M. D., NEW
PHILADELPHIA)
BELMONT
The Belmont County Medical Society in April
approved establishment of a travelling epilepsy
clinic in the county. At the same meeting mem-
bers heard reports by Dr. Fred Southerland,
Martins Ferry, and Dr. L. D. Covert, Bellaire,
on recent visits to the New Philadelphia cancer
diagnostic clinic.
Dr. James J. Arbaugh presided at a scientific
program at which Dr. Harry G. Harris, Martins
Ferry, and Dr. L. L. Liggett, St. Clairsville,
presented discussions. Three newcomers to the
county were introduced. They are Dr. Julius
W . H. MILLER, i
II J.
328 East State Street
COLUMBUS 15, OHIO
i ii
X-RAY DIAGNOSIS AND THERAPY
FEVER THERAPY
RADIUM
II
TELEPHONES
Office
Residence
MA. 3743
EV. 5644
The Wendt -Bristol
Company
Two complete ethical stores in
Columbus
51 E. State St. 721 N. High St.
for the convenience of the Physicians and
Surgeons — and the many people they serve
Two Prescription Departments
maintained in a high class manner with
twenty-one registered Pharmacists
Other Complete Departments
OFFICE EQUIPMENT
PHYSIO THERAPY APPARATUS
HOSPITAL SUPPLIES
W-B Pharmaceutical Supplies
JOBBING STOCKS ALL LEADING
MANUFACTURERS
Antitoxins and Vaccines in Special
Refrigeration Plants
Prompt Service on Phone Orders
838
The Ohio State Me. Heal Journal
Tesi, Dr. Arthur Tesi, both located in York-
ville, and Dr. Winter T. Varner, Flushing.
Eighth District
(COUNCILOR: CHESTER P. SWETT, M. D., LANCASTER)
GUERNSEY
A special meeting of the Guernsey County
Medical Society was held at the Cambridge
State Hospital on July 6, immediately following
the Woman’s Auxiliary picnic, held by invitation
of Stfpt. and Mrs. Arthur T. Hopwood. Dr. Reo
Swan was in charge.
A bounteous repast was served by the Aux-
iliary with Mrs. W. L. Denny as chairman.
Sixteen members and their wives were present;
also several guests and children.
Memberships of two doctors were approved
by vote. They are Dr. Howard Van Noate and
Dr. Elizabeth Smith. — Gordon Lawyer, M. D.,
Secy.-Treas.
Ninth District
(COUNCILOR: J. PAUL McAFEE, M. D.,
PORTSMOUTH)
MEIGS
Members of the Meigs County Medical Society
and the Auxiliary were guests of Dr. and Mrs.
E. F. Maag at their summer lodge on the Ohio
River at Long Bottom. The occasion also
marked the 30th anniversary of Dr. Maag’s
medical practice. A fish and picnic supper was
served.
Urology Awards
The American Urological Association offers
an annual award of $1000 (first prize of $500,
second prize $300 and third prize $200) for
essays on the result of some clinical or labor-
atory research in Urology. For full particulars
write the Secretary, Dr. Charles H. de T. Shivers,
Boardwalk National Arcade Building, Atlantic
City, New Jersey. Essays must be in his hands
before February 10, 1951.
Woman’s Auxiliary . . .
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
President — Mrs. George W. Cooperrider, 1828 Bryden Road,
Columbus
President-Elect — Mrs. Farrell Gallagher, 1527 W. Clifton
Blvd., Lakewood
Vice-President — Mrs. E. P. Greenawalt, 1707 St. Paris Road,
Springfield
Recording - Secretary — Mrs. Ross Knoble, 219 - 44th St.,
Sandusky
Corresponding Secretary — Mrs. Oscar Jepsen, Canal Win-
chester
Treasurer — Mrs. A. Paul Hancuff, 3551 Maxwell Road,
Toledo 13
Past-President — Mrs. C. W. Kirkland, 4805 Guernsey Street,
Bellaire
Numerous inquiries have been directed to of-
ficers about the Nurses’ Loan Fund and who
might be contacted for information about it.
The chairman of the Nurses’ Loan Fund is Mrs.
Lewis B. Stephen, 207 E. College St., Oberlin.
DELAWARE
Mrs. James G. Parker entertained the mem-
bers of the Woman’s Auxiliary to the Delaware
County Medical Society at her summer residence
on June 13. Mrs. Harold W. Davis, the outgoing
president, and Mrs. A. R. Callander, the incom-
ing president, reported on the state auxiliary
convention in Cleveland. The historian, Mrs.
George Parker, gave her annual report. It
was announced that Mrs. Davis would be one
of Ohio’s delegates at the national auxiliary
convention in San Francisco. A “pot luck sup-
per” was served on the enclosed porch of the
Parker residence overlooking the Scioto River.
JEFFERSON
The Jefferson County Auxiliary, at its lunch-
eon meeting on June 13 at the Steubenville
Country Club, elected its new officers for 1950-51.
They include: Mrs. Frank Harris, president;
Mrs. J. A. Haney, president-elect; Mrs. Robert
Puncheon, Jr., vice-president; Mrs. Albert Sun-
seri, secretary; Mrs. Stephen Hadobas, treas-
RESTHAVEN
A strictly modern convalescent hospital, specially
designed and scientifically equipped for the spe-
cialized care of the aged, convalescent, or cancer
patient.
Accredited by American Medical Association.
Complete cooperation to the attending physician.
For descriptive folder, call or write
M. YOUNG, Business Manager
Telephone FA. 2535 or FA. 4893
813 Bryden Road Columbus, Ohio
for August, 1950
839
urer, Mrs. Fred Harrington, corresponding secre-
tary. The meeting was conducted by Mrs.
David Greenberg in the absence of the retiring
president, Mrs. Walter Cunningham. The nomi-
nating committee consisted of Mrs. Stanley
Burkhardt, chairman; Mrs. S. L. Greenburg and
Mrs. L. J. Kerschgens.
Games were played, following the business
session. The social committee was headed by
Mrs. Albert Sunseri. Assisting her were Mrs.
Ernest Perri and Mrs. F. B. Harrington.
LUCAS
Mrs. Bernhard Steinberg was elected presi-
dent of the Toledo and Lucas County Auxiliary
at its annual luncheon on May 23 at the Toledo
Country Club. Other officers elected were: Mrs.
Hazen L. Hauman, president-elect; Mrs. Norman
K. Foley, vice-president; Mrs. Maurice A.
Schnitker, recording secretary; Mrs. B. V.
Scheib, corresponding secretary; Mrs. John
Dickie, treasurer; and Mrs. Joseph Hertzberg,
assistant treasurer.
A talent and hobby show followed the busi-
ness session. Mrs. Charles A. Phillips was
chairman of the show and Mrs. Robert B. Curl,
co-chairman. Antiques, quilts, needlepoint,
glass, bottle collections, copper, autographs, but-
tons, pewter and Oriental carvings were among
the many items exhibited. Ribbon awards
were made for each class of the exhibit. Fol-
lowing the luncheon, Alice E. Huebner gave a
book review.
MEIGS
Members of the Woman’s Auxiliary to the
Meigs County Medical Society were guests of
Mrs. F. M. Cluff in May when a luncheon was
held at the Little House, preceding the business
meeting at Mrs. Cluff’s home. Mrs. E. F. Maag,
president, presided. Mrs. J. J. Davis presented
her paper on “The Origin of the Woman’s
Auxiliary to the American Medical Association.”
The hostess’ two daughters played a piano duet.
The June meeting of the Meigs County Aux-
iliary was high lighted by a picnic and fish fry
at the country home of Dr. and Mrs. E. F. Maag
when the latter couple was host to the doctors
and their wives. The occasion also marked the
thirtieth anniversary of Dr. Maag’s medical prac-
tice. There was a surprise celebration, at which
Dr. Kathryn Poindexter and Mrs. D. B. Hart-
inger gave tributes to Dr. Maag — Dr. Poindexter
recalling incidents of his early life and Mrs.
Hartinger concerning his early practice in
Middleport.
SCIOTO
The Country Club provided an attractive back-
ground for the June guest day luncheon and
get-together of the Scioto County Auxiliary.
Mrs. Clyde Everett, the new president, dis-
pensed with the usual business session, to allow
for a program of special entertainment. Roses
With the Aid of Our
Measuring Blanks
LUMBO SACROL
SACRO ILIAC
and
ARCH SUPPORTS
Made to Order
May be conveniently obtained by mail
COLUMBUS ORTHOPAEDIC
APPLIANCE COMPANY
337 S. High Street
Columbus 15,
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MA. 0990 «: CERTIFIED fQ
treatment IS
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MAIL I
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THUMB
SUCKING
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Extract of capsicum in an
acetone and isopropyl base.
ORDER FROM YOUR SUPPLY HOUSE OR PHARMACIST
RADIUM and RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician-Radioloffist)
HAROLD SWANBERG, B. S., M. D., Director
W. C. U. Bldg. Quincy, Illinois
840
The Ohio Sta'e Medical Journal
and daisies “rambling” along the luncheon tables
proved a striking decoration feature. Fifty-three
members and guests witnessed an unusual hat
style show — the hats being made entirely
of items purchased in the hardware store. Tak-
ing part in the hat style parade were Mrs.
Everett, Mrs. L. B. Hatch, Mrs. George Obrist,
Mrs. Alden Oakes, Mrs. S. L. Meltzer.
Miss Jean Kline and Mr. Howard Smith, pro-
fessional entertainers, presented a rollicking
song-and-dance act. Mr. Smith also played his
accordion in leading the members in an old-time
song-fest. Members of the committee on ar-
rangements included: Mrs. Dow Allard, Mrs.
Jack Herbert, Mrs. W. E. Gault, Mrs. Obrist,
Mrs. Meltzer, Mrs. Hatch. A special group of
guests was that of war brides from several
foreign countries.
Opinions of the Attorney General
Following are the syllabi of opinions recently
made by Attorney General Herbert S. Duffy:
Opinion No. 1946 — The Board of Embalmers
and Funeral Directors of Ohio may not delegate
authority to an outside private investigator to
make an investigation and arrest.
Opinion No. 1971 — (1) Sec. 4036, General
Code, cannot be read separate and apart from
the other sections pertaining to the duties and
powers of trustees of hospital funds. (2) The
board of governors of a joint municipal-county
hospital has no authority to accept or ad-
minister cash donated to the board for hospital
purpose. (3) The board of governors of such
a hospital has no authority to accept or admin-
ister donations given for specific purposes or
for investment. These functions properly belong
to the board of hospital trustees. (4) There is no
authority permitting the merging of the board of
hospital trustees with the board of governors.
The composition and qualifications for member-
ship in these boards differ and are incompatible
due to diversity of method of appointment.
Opinion No. 1981 — (1) Prosecuting Attorneys
are the legal advisers to boards of county hos-
pital trustees as established pursuant to Sec.
3131, G. C. (2) by virtue of Sec. 2917 G. C.,
boards of county hospital trustees are without
authority to employ legal counsel. (3) Members
of boards of county hospital trustees hold office
of trust and as such become amenable to Sec.
12910, G. C.
English Newspaper Reports Revolt
In National Health Scheme
An Ohio doctor forwarded to the Head-
quarters a copy of The London Express, the
influential British newspaper founded by Lord
Beaverbrook, in which it was reported that
Britain’s National Health Scheme is in revolt.
Three hundred doctors, representing the 19,000
members of the profession, met in London to
threaten withdrawal from the scheme.
Dentists have already broken off wage negotia-
tions with Health Minister Bevan, the Express
reports.
Chemists (druggists) are pressing for im-
proved rates of pay.
Doctors want another seven million pounds
in the central pool. Some of them complain
that they receive little more than 500 pounds
a year.
Over 85 years
Since the first Hanger Limb was manufactured
in 1861, Hanger Artificial Legs and Arms have
given satisfaction to thousands of wearers. These
people, once partially or completely incapaci-
tated, have been able to return to work and play
and to take part in the everyday activities of life.
To many thousands, the Hanger seal is a symbol
of help and hope. To them, and to all, the Hanger
name is a guarantee of Comfort, Correct Fit, and
Fine Performance.
HANGERS
ARTIFICIAL
LIMBS
757 W. Washington St., Charleston 2, W. Va.
34 E. Court Street, Cincinnati 2, Ohio
541 W. Town Street, Columbus 8, Ohio
UNSCENTED COSMETICS
FOR THE ALLERGIC PATIENT
AR-EX Cosmetics are the only complete line of unscented cosmetics
regularly stocked by pharmacies. To be certain that your perfume
sensitive patients do not get scented cosmetics, prescribe AR-IX
Unscented Cosmetics. SEND FOR FREE FORMULARY.
AR-EX
FREE FORMULARY
DR.
ADDRESS
CITY
STATE_
AR-EX COSMETICS, INC., 1036 W. VAN BUREN ST., CHICAGO 7, ILL.
for August, 1950
841
Employment of the Physically
Handicapped
A great deal has been and is being written
on the subject of employing the physically
handicapped. The following facts on this subject
published in The Journal of the A. M. A., will
be of interest to doctors.
It has been estimated that there are prob-
ably seven to eight million physically handi-
capped persons in the working population of the
United States. About six million are said to
be employed and a quarter of a million are either
seeking work or can be rehabilitated and trained
for work.
Some are said to be in jobs for which they
are not best suited, and this provides a hard-
ship for the handicapped and a burden for the
employer, even the taxpayer. Obviously it can
be a cause of considerable waste.
One of the solutions is better understanding
and information, and attempts are being made
to give more attention to special aptitudes of
these persons and to increase opportunity for
training for better jobs.
Surveys conducted by the Department of
Labor and the Veterans Administration, the
Civil Service Commission, the U. S. Chamber
of Commerce, the National Association of Manu-
facturers and the Accident Prevention Depart-
ment of the Association of Casualty and Surety
Companies are claimed to produce convincing
evidence that, when properly placed, ' the phy-
sically handicapped worker can offer a per-
formance as good as or better than the unim-
paired worker.
The aid of physicians should be sought, as
proper placement in many instances will depend
on medical advice. To gain this end, members
of the medical profession can offer to advance
their services.
Postgraduate Course on General
Medicine
On September 21, 22, and 23, the Frank E.
Bunts Institute and the Cleveland Clinic will
piesent a continuation course for physicians on
“Practical Problems in General Medicine.” Dr.
M. A. Blankenhorn, professor of medicine at
Univeisity of Cincinnati, will give the evening
address September 21 on “The Rickettsial Dis-
eases.” The other out-of-town guest speakers
will be Dr. D. W. Pickering, who is director
of the Medical Unit, St. Mary’s Hospital, London,
England, and Dr. E. Braun-Menendez of Buenos
Aires, Argentina, who will speak on “Pathogenic
Basis of the Treatment of Hypertension.”
Inquiries regarding the complete program and
registration can be addressed to the Director of
Education, Frank E. Bunts Educational Institute,
2020 East Ninety-third Street, Cleveland 6, Ohio.
INDEX TO ADVERTISERS
Abbott Laboratories 769
Ann Arbor School, The 835
Ar-Ex Cosmetics, Inc. 841
Ayerst, McKenna & Harrison, Ltd 771
Bell, Kathryn S., Inc. 834
Birtcher Corporation 830
Bowen, Charles F., M. D - __ 834
Cincinnati Sanitarium 767
Clinical and Pathological Laboratory 843
Coca-Cola Company 827
Columbus Orthopaedic Appliance Co. 840
Cook County Graduate School of Medicine 835
General Electric X-Ray Corp 772
Hanger, J. E., Inc. 841
Harding Sanitarium 768
Ingleside Home, Inc. 827
Lederle Laboratories, Inc. 819
Lilly, Eli, and Company Insert between
pages 772 and 773
Maltbie Laboratories, Inc. 763
McMillen Sanitarium 767
Mead Johnson & Company . Back Cover
Medical Protective Company 836
Medico Press, The 831
Mercer Sanatorium 768
Merck & Company, Inc. 823
Miller, W. H., M. D 838
New York Polyclinic Medical School 829
Num Specialty Company 840
Oak Ridge Sanatorium 766
Parke, Davis & Company 844
and Inside Back Cover
Pogue, The Mary E., School 837
Quincy X-Ray & Radium Laboratories 840
Resthaven 839
Rupp & Bowman Company 836
i
Sawyer Sanatorium 757
Schering Corporation 759
Schmid, Julius, Inc 770
Sealy Mattress Co. 832
Searle, G. D., & Company 817
Stoneman Press 829
Upjohn Company 821
Wander Company 762
Wendt-Bristol Company 838
Wickhaven Sanitarium 768
Windsor Hospital 768
Winthrop-Stearns, Inc 825
Wyeth, Inc. 761
842
The Ohio State Medical Journal
Qlaililied /7 d.oe.'iti'ie+ne.+iti.
Rates: 50 cents per line. Minimum charge of $1.00 for each insertion. Price covers the cost
of remailing answers. Forms close 16th of the month preceding publication.
FOR SALE : Two electric sterilizers, Brown-Berger.
McCarthy cystoscopes, urethrascope, metal and glass in-
strument cabinet. Box 95, Ohio State Medical Journal.
FOR LEASE : Three-room modern office and equipment
of recently deceased physician with established practice of
39 years, in a thriving community of 1,000 with large out-
lying territory in northwestern Ohio. Complete records at
disposal of renter; also drugs for sale. Box 614, Ohio
State Medical Journal.
WANTED; By well established and older F. A. C. S., a
general practitioner for assistant ; married man ; good hos-
pital facilities. Salary first six months, then percentage.
Apartment available suburban area twin cities. Great fu-
ture. Minnesota license or national Boards. Box 612, Ohio
State Medical Journal.
ASSISTANT RESIDENT, male or female ; private 100-
bed physchiatric hospital ; approved for residency training ;
organized visiting staff ; salary and full maintenance. Open
now. Windsor Hospital, Chagrin Falls, Ohio.
FOR SALE: Used McKesson Water Metabolor, perfect
condition, $75. Write or phone, Sol S. Maggied, M. D.f West
Jefferson, Ohio ; Phone 88377.
OPPORTUNITIES FOR PHYSICIANS: Are you inter-
ested in a position of one of our county or district health
departments? Salary $5,600 to $7,200, with $70 a month
travel allowance. Public health scholarships available with
liberal stipends. Men and Women physicians eligible. Felix
J. Underwood, M. D., Mississippi State Board of Health,
Jackson, Miss.
FOR SALE: Unused portable Hawley fracture table
(Dupuy). B. W. Travis, M. D., Bluffton, Ohio.
WANTED : General practitioner in small town, Stark
County, Ohio ; 3 hospitals within 16 miles ; excellent farm-
ing community ; Lutheran, Christian and Catholic Churches ;
office and home combination. Joseph George, North Star,
Ohio.
WANTED: Thoroughly competent physician for In-
dustrial office. Must be graduate of Class A School with
adequate hospital training. Salary $6,000-00. 200 Republic
Bldg., Cleveland 15, Ohio.
FOR SALE : Established general practice of 39 years ;
also drugs and equipment ; office available ; small, progres-
sive village on Lake Erie ; physician recently deceased.
Box 114, Vermilion, Ohio.
FOR SALE : Eight-room home and five-room office
combination in northeastern Ohio community of 5,500.
Active, growing general practice. Office completely fur-
nished. Available now. Box 617, Ohio State Medical
Journal.
FOR SALE : General practice in town of 3,000 with
rich farming community and 3-room office in down-town
section ; drugs and fixtures available ; town has small
hospital and laboratory ; 25 miles from city hospitals ;
physician recently deceased. Mrs. J. S. Hull, Hicksville, O.
FOR SALE : General practice office and equipment ;
in small village with large farming area, 25 miles from
Columbus ; two young doctors leaving for military service ;
available Oct. 1. Has been doctor’s office 50 years ; no
other doctor within 8 miles. Hospital facilities near ;
special equipment includes X-ray and basal metabolism ;
drug stock available ; includes living quarters, hot water
heat and oil furnace. Box 616, Ohio State Medical Journal.
WANTED : General practitioner for permanent associa-
tion with physician grossing $30,000 per year. Percentage
basis. Box 615, Ohio State Medical Journal.
Veterans have turned out to be good loan
risks. Only seven-tenths of one per cent of the
loans were defaulted to the extent that V. A.
had to make good the guaranteed and insured
portions.
Symposium for Medical Officers
Scheduled Oct. 23-28
To keep military reserve medical officers of
the Armed Forces — Army, Navy and Air Force —
posted on the latest developments in the field
of medical science, a medico-military symposium
for officers of the Fourth Naval District will be
held at the U. S. Naval Hospital, Philadelphia,
Pa., from October 23 to 28.
Presentations and panel discussions are sched-
uled in aviation medicine, national defense in
case of disaster or attack, national preparedness,
psychiatry, submarine medicine, surgery, and
orthopedics. An outstanding panel of civilian
and military physicians are scheduled to take
part in the symposium.
All members of the medical profession are
invited to attend. Further information may be
obtained by writing the District Medical Officer,
Naval Medical Reserve Program, Fourth Naval
District, U. S. Naval Base, Philadelphia 12, Pa.
It is suggested that those who plan to attend
make hotel reservations in advance.
BLOOD vr
T SPUTUM
ALLERGY 'A /
EFFUSIONS
URINALYSIS
FECES-VACCINES
BLOOD CHEMISTRY V
X-RAY DIAGNOSIS
THROAT CULTURES
PREGNANCY TESTS
STOMACH CONTENTS
BASAL METABOLISM
SURGICAL PATHOLOGY
PNEUMOCOCCIC TYPING
AGGLUTINATION TESTS
AUTOGENOUS VACCINES
ELECTROCARDIOGRAPHY
PREMARITAL SEROLOGY
WASSERMANN & KAHN TESTS
DARK FIELD-SPIROCHETA
Clinical and P,
athological
LABORATORY
Established
1904
370 E. Town Street
Columbus, Ohio
H. M. BRUNDAGE,
M.D., Director
M. D. GODFREY, M.D.
Prompt Service
Telephone: MAin 2490
for August, 1950
843
.
In r(ai </(<(€ {odema iDmitwl
. . the diuretic drugs not only promote fluid loss but in many instances also
effectively relieve dyspnea . . . not only may the load on the heart be decreased
but there may also occur an increase in the organ's ability to carry its load . . .
With good average response the patient perhaps voids about 2000 cc. of
urine daily, but in exceptional instances the amount rises to as high as 8000 cc."1
"Not only are the diuretics of immense value in cases of left ventricular failure
. . . but where edema is marked, as it is most likely to be in failures occurring
in individuals with chronic nonvalvular disease with or without hypertension
and arrhythmia, their employment is often productive of an excellent response.
In [edematous patients with] active rheumatic carditis (rheumatic feverjthe
use of these drugs may be life-saving.”2
Salyrgan-Theophylline is effective by muscle, vein or mouth.
salyrgcm-
THE0PHYLLINE
BRAND OF MERSALYL AND THEOPHYLLINE
TIME TESTED • WELL TOLERATED
AMPULS (1 cc. and 2cc.) . AMPINS (lcc.) • TABLETS
for September, 1950
1. Beckman, H.: Treatment in General Practice. Philadelphia, Saunders, 5th ed., 1946, 704-705.
2. Beckman, H.: Treatment in General Practice Philadelphia, Saunders, 6th ed., 1948, 744 .
Salyrgan, trademark reg. U. $ & Canada — Ampins, reg. trademark of. Strong Cobb & Co., Inc
851
*7<4e PUybvciattX feaoJiAJtelf
By JONATHAN FORMAN, M. D.
Medical Ethics, by Charles J. McFadden, O.S.A,.
Ph. D., with an introduction by Fulton J. Sheen,
Ph. D., D. D. ($3.50. Second Edition. F. A.
Davis Co., Philadelphia) , sets forth in clear terms
the ethics and concepts involved in the care of
the sick according- to the Canons of the Roman
Catholic Church. While written previously for
nurses, the contents are equally valuable for the
medical student, the physician and the hospital
administrator.
Surgery for Nurses, by James Kemble, F.R.C.S.
($4.50. Williams & Wilkins Co., Baltimore,
Maryland) , is by an author with much experience
in teaching nurses. This book has 374 illustra-
tions of which many are in color. A good text
for the surgical nurse.
The Surgical Treatment of Facial Injuries, by
V. H. Kazanjian, M. D., D. M. D., and John M.
Converse, M. D. ($10.00. Williams & Wilkins
Co., Baltimore, Maryland), is based upon the
experience of these two great facial surgeons
covering two great wars and the years between.
The text is devoted, however, to their experi-
ences and so actually treats of every kind of
facial injury. Profusely illustrated with “before-
and-after” portraits, the text puts emphasis on
the psychological and sociological aspects of
these deformities and the problems of rehabilita-
tion.
Allergy in Relation to Otolaryngology, by
French K. Hansel, M. D. ($2.50. Bruce Publish-
ing Co., Minneapolis, Minn.), is an official pub-
lication of the American College of Allergists.
At the annual Congress of the College a panel is
offered and this is a transcript of one of these
panels and the discussion that ensued. It is
brief, concise and to the point.
Functional Localization in Relation to Frontal
Lobotomy, by John F. Fulton, M. D., ($3.00.
Oxford University Press, New York City), is
the book of the William Withering Memorial
Lectures at The Birmingham Medical School in
1948. Dr. Fulton reports the material derived
from the psychobiological technique of Yerkes
and the neurosurgical approaches made possible
by the pioneering efforts of Sir Victor Horsley
in Britain and Harvey Cushing in the United
States. The author outlines the fine things these
investigators have in store for all of us especially
those who without their services would stay
hopelessly mentally ill.
Mitchell-Nelson’s Textbook of Pediatrics, edited
by Waldo E. Nelson, M. D., with the collabora-
tion of 63 contributors ($12.50. Fifth Edition.
W. B. Saunders Co., Philadelphia), has been
well received ever since our own Dr. Mitchell
wrote the first edition. It is a text designed to
meet not only the undergraduate’s need but that
of the graduate physician as well. The book has
been brought up to date by a careful and complete
revision.
Histopathology of the Skin, by Walter F. Lever,
M. D. ($10.00. J. B. Lippincott Co., Phila-
delphia), places the emphasis on those diseases
of the skin in which the biopsy can be helpful.
Rich in illustrations and bibliographic references.
It is most welcome.
Digitalis and Other Cardiotonic Drugs, by Eli
R. Movitt, M. D. ($5.75. Second Edition. Oxford
University Press, New York City), is a treatise
which gives in one volume what each of us ought
to know about the history, the usefulness, and
the newer findings of these drugs.
Brucellosis, Clinical and Subclinical, by Harold
J. Harris, M. D. ($10.00. Second Edition. Paul
B. Hoeber, Inc., New York City), has stood out
as an example of the research that a physician
in a rural area can do if he puts his mind
to it. This edition has been made complete
in every chapter. Observations on an additional
450 cases have been included. This 600-page
book with comprehensive treatment and its 742
references is our best work of reference.
Problems and Emotional Difficulties of Negro
Children, by Regina M. Goff, Ph. D. ($2.50.
Bureau of Publications, Teachers College, Co-
lumbia University, New York City), is a study
in selected communities and attributed by parents
and children to the fact that they are Negro.
The study deals with the manifest difficulties
as they appear to the children themselves.
You and Your Health, by Aiken Welch ($2.50.
Pellegrini & Cudahy, New York City), is an-
other guide for women, written in the conserva-
tive manner. The book is simple, accurate and
not frightening.
Your Rheumatism and Backaches, by Joseph D.
Wassersug, M.D. ($2.50. Wilfred Funk, Inc.,
New York City), presents in 300 and some
pages the modern knowledge concerning this
subject — a very helpful mass of information
for the victim.
Hamatin Compounds and Bile Pigments, by R.
Lemberg, Ph. D., and J. W. Legge, M. Sc. ($15.00.
Interscience ' Publishers, New York City), tells
of their constitution, metabolism, and function.
The authors, two well-known Australian scien-
852
The Ohio State Medical Journal
tists, have brought us the only monograph in
English in this field. Hence, this belongs in
the library of every medical society, medical
school and hospital in this country. In text-
books of biochemistry and physiology, we do not
find this subject treated with the care and
completeness that it deserves.
Living Safely, by Earl C. Bowman and Paul F.
Boston (80 cents. The Macmillan Co., Chicago,
Illinois), strips the problem to the basic issues
involved — the proper correlation of Education,
Engineering and Enforcement. The attempt in
education must carry the development of the
necessary.
Facts for Childless Couples, by E. C. Hamblen,
M. D. ($2.00. Revised Fourth Printing. Charles
C. Thomas, Publisher, Springfield, 111.), serves
us well by making our methods logical, ethical,
and scientific. The book has the reception that
it richly deserves.
The Psychoanalyst and the Artist, by Daniel
E. Schneider ($4.00. Farrar, Straus & Co.,
Inc., New York City), is a tentative exploration
into the nature of true talent and genius and the
essential attributes of genius with some atten-
tion to the forces that inhibit or encourage its
full development. The author also points out
the personal dangers and advantages its pos-
session brings.
Slender Legs — A Home Method, by Marguerite
Benson ($5.00. The Author, 135 E. 58th St.,
New York City), is an illustrated text of ex-
ercises designed to reshape and strengthen the
legs. It insists that ill-shaped legs are not
inherited. It is the tendency to neglect this
acquired character that is inherited. It ad-
vocates manipulation, massage, foot hygiene, and
muscular activity.
When the Doctor Says It Is Nerves, by Henry
Jerome Simpson ($1.25. Morehouse-Gorham
Company, New York City), is planned to meet
the need of “nervous people” in search of help
from the printed word. It does give a simple,
brief, but factual account of how they happen
to be nervous, what it means and does not
mean, and what they can do to rid themselves
of this particular form of torture.
Principles and Practice of Therapeutic Exercise,
by Hans Kraus, M. D. ($6.00. Charles C.
Thomas, Publisher, Springfield, III.), presents
fundamental knowledge of exercise therapy and
the practical application of such knowledge to
specific conditions. Based on his broad experi-
ence and his carefully documented observations,
the author gives us the real WHY and HOW
of such programs of treatment.
The Population Upsurge in the United States,
by Joseph S. Davis ($1.00. Food Research In-
stitute, Stanford University, Stanford, Calif.),
brings out clearly how little validity there is
to predictions as to when the population of this
country will begin to decline. The changes
that already have occurred require a reorientation
of our economic thinking and a completely new
consideration of national, state, and local policies*
Public Health Is People, by Ethel L. Gins-
burg (The Commonwealth Fund, New Y^rk City),.
is the report of an institute on mental health
in public health held at Berkeley, California^
Your reviewer along with many others, has
insisted that what really matters is the health
of the public. Public Health, therefore, con-
sists of what knowledge we have applicable to
groups of peoples — to society. Certainly, then
in considering the mental aspects of the health
of the public, we are dealing with those preven-
tive efforts that have mass application. Never-
theless, those who practice in this field must
never forget that they are dealing with people.
They must approach the problem as psychiatrists
and not as engineers. They should also keep
to their own field. The great bulk of these
people who need help must get it from the
clergyman, their personal physicians, and from
such psychiatrists to whom they are sent. There
is too great a tendency nowadays to feel that it
is a function of government to train some 60,000
specialists in mental disease and maintain this
group of experts with funds out of the public
treasury. This moves toward socialism and
when we are forced to share our poverty it will
be necessary to have one psychiatrist for five
of us.
Urological Surgery, edited by Austin Ingram
Dodson, M. D. ($13.50. Second edition. C. V.
Mosby Co., St. Louis, Mo.), has 12 contributors
and 645 illustrations. It successfully presents
the everyday problems arising in its field.
Postgraduate Gastroenterology, edited by
Henry L. Bockus, M. D. ($10.00. W. B. Saunders
Co., Philadelphia), presents a course given un-
der the sponsorship of the American College
of Physicians on this subject. This should be
enough to recommend this text as one means of
keeping oneself up to date.
Plenty of People, by Warren S. Thompson
(Review edition. The Ronald Press, New York
City), discusses the world’s population pres-
sures, problems and policies, and how they con-
cern you and me. The author who is director
of the Scripps Foundation for Research in Popu-
lation Problems at Oxford, Ohio, is an ‘out-
standing authority. With the enormous rate of
population increase in all the world, food sup-
ply, health, and wars become of major personal
interest for which we as biologists should have
a positive solution rather than the usual negative
one of hoping to control birth by education or
government planning.
for September, 1950
853
Entrance to Grounds
HARDING SANITARIUM,
For Nervous and Mental Disorders
WORTHINGTON,
OHIO
NINE MILES NORTH OF STATE HOUSE— COLUMBUS
HARRISON S. EVANS,, M.D,
Medical Director
L. HAROLD CAVINESS, M. D.
GEORGE T. HARDING, M.D.
President of Board
Telephone: Columbus FR. 2-5367
CHARLES L. ANDERSON, M. D.
Clinical Director
CHARLES W. HARDING, M. D.
An institution for the study and treatment of NERVOUS and MENTAL DISORDERS
John H. Nichols, M. D., Medical, Director Herbert A. Sihler, Director Edmund V. Sihler, Assoc. Director
Approved by American College of Surgeons
WINDSOR HOSPITAL, CHAGRIN FALLS, OHIO Phone: Chagrin Falls 7347
854
The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association, a scientific society, non-profit corporation, with a definite
membership, for scientific and educational purposes.
Yol. 46 September, 1950 No. 9
Jonathan Forman, M.D., Editor
Charles S. Nelson, R. Gordon Moore,
Managing Editor — Bus. Mgr. Asst. Managing Editor
Bronchoscopy in the Newborn
C. C. ROE JACKSON, M. D.
TODAY more and more otolaryngologists
are being confronted with the problem of
endoscopy in the newborn, especially in
institutions where one is associated with a large
obstetrical and alert pediatric service. Perhaps
the advantages that endoscopy offers are not
recognized, or if they are recognized, there may
not be on hand, as yet, the proper facilities, in-
strumentaria and trained personnel to handle
the situation successfully. It is hoped that the
previous papers,1’ 2’ 3 this, and subsequent discus-
sions, may help to outline some points to aid
the younger physicians, especially otolaryngol-
ogists, to meet with dexterity this occasional
need of the newborn. It should be part of every
physician’s training to be able to recognize and
evaluate promptly, the difficulties of the newborn
so that the proper procedures may be used at
once, not only to save the life, but to preserve it
in the best state of oxygenation, for as success-
ful a future individual as possible.
To help evaluate asphyxia neonatorium4 at
least the following data should be available:
(a) the age and health of the mother; (b) the
number of her babies living and dead and
whether full term or not; (c) drugs used for
analgesia and anesthesia during labor and de-
livery; (d) presentation (breech); (e) type of
labor (long and difficult) ; (f ) the position of
the placenta with or without disturbed circula-
tion; (g) cord position; (h) manner of delivery
(version, forceps, etc.). The part that each
may play in an individual case must be duly
evaluated and the proper after-treatment carried
out. For example, when one considers the
number of adults who are allergic to drugs,
one should not be too* surprised to find these
small individuals sensitive also. Indeed an al-
Submitted March 22, 1950.
The Author
• Dr. Jackson, Cleveland, Ohio, is a grad-
uate of Jefferson Medical College of Phila-
delphia, 1928; fellow. Am. Acad, of Ophthal-
mology and Otolaryngology, Am. Laryngologi-
cal, Rhinological and Otological Society, Inc.;
assoc, otolaryngologist, University Hospitals;
fellow. Am. Broncho-Esophagological Assn.;
and asst. clin. prof, otolaryngology, Western
Reserve University.
lergy could conceivably produce a profound effect
on the lumen of an already small bronchus.9 The
ideal analgesia or general anesthetic as yet
does not exist, but at present, local or continuous
caudal anesthesia5 would seem to be most
nearly ideal.
Since the respiratory tract can contain no
air until the infant arrives in the outside world,
the first necessity is to clear the tract for the
intake of air. It has been shown that respiratory
movements occur during intrauterine life, and
if this has happened, there may be amniotic
fluid, meconium, vernix caseosa and later mucus
and blood in the upper respiratory tract,8 e. g.,
nose, mouth, pharynx and trachea. In spontan-
eous cases, nature, with the head already deliv-
ered, temporarily pauses, allowing fluid, mucus,
etc., in the upper respiratory tract to escape by
gravity, and later the compression of the thorax
during delivery of the shoulders forces more of it
out. This makes way for the entrance of air into
the respiratory tract, even before the cord is sev-
ered and the fetal circulation changes. However,
since all deliveries are not simple and spontan-
eous, this mucus, etc., must be either aspirated
869
very gently or allowed to drain out with the head
low, the 15-30° Trendelenburg position being com-
monly in use.
Most attendants at the arrival of the newborn,
have been handed down information on what
to do in a general way, for example, holding
the infant up by the feet, head down, and slap-
ping the back to stimulate the first cry. This
is a good position to allow clearance of the air-
way, but enhances the possibility of intracranial
hemorrhage. The gentler, more scientific, and
more accurate ways are supplanting the old
crude procedures. The aspiration of foreign
material (amniotic fluid, meconium, cellular
debris, mucus, blood, etc.)6 during labor and
delivery, occurs more or less in most every case,
but only a few have trouble clearing it spon-
taneously or with minor assistance. The pre-
mature baby is more often in need of help.
SPECIFIC PROBLEMS
Farber6 believes congenital atelectasis can be
divided into (A) initial type where (i) mature
alveoli have never expanded or (ii) premature
type where the lung tissue consists of immature
alveoli in varying amounts and (B) the ac-
quired type of atelectasis where the ciliary
movement of a mucous plug produces negative
pressure and local atelectasis.10 How much aid
can be given such cases, depending on the diag-
nosis and on what they may need, is the
question. Often these problems arise as an
emergency, especially in the premature infant,
and one does not always have the assistance
in diagnosis that X-ray studies give for atelec-
tasis and the cardiac silhouette. There is room
for experimental work on the ciliary activity
of the trachea and bronchi of the newborn (full
term and premature) to determine the efficiency
of this system to rid itself of such foreign
material, and just what potentiality it has for
producing atelectasis behind a plug of mucus.
The larynx may also obstruct the airway be-
cause of such things as laryngomalacia (here
the epiglottis is not only curled on itself, the
sides toward the midline, but the whole thing
tending to drop down into the glottis), partial
stenosis because of a web or large vocal bands,
and recurrent nerve paralysis possibly due to
birth trauma, or, rarely, to a congenital defect.
A direct laryngoscopy can readily detect the
presence and degree of any of these obstruc-
tive factors. Inspecting the larynx and finding
it to be within relatively normal limits, all
factors being considered, the next concern is
the trachea and bronchi.
Pressure from without, may cause considerable
narrowing of the trachea7 and interfere with the
lumen of the airway. A diffuse compression of
the trachea from in front may be an enlarged
thymus, but needs corraboration by X-ray studies
taken in the anterior and lateral positions in
inspiration and expiration. A more or less
sharply outlined compression of the trachea
or a bronchus would lead one to suspect an
anomalous vascular arrangement such as a
double aortic arch, or if lower down, an an-
nomalous pulmonary artery.
Partial atresia of a bronchus, usually the
right, can be detected easily by bronchoscopy.
Should complete atresia be found, then in all
probability one is dealing with an aplastic lung,
which in itself is not incompatible with life.
In the former case, if one were able to confine
the end of the bronchoscope to the small open-
ing and with the proper equipment aid expan-
sion6 of this lung a little, it might be of con-
siderable help, at least for that particular period.
To discover a tracheo-esophageal fistula would
be of great diagnostic aid.
Finally there may be . the lower respiratory
tract obstruction, due to thick mucus which
shows up later in cases of chronic pulmonary
infection associated with fibrocystic pancreatic
disease.8 This type tends to produce the reversed
phenomenom of laryngeal obstruction, in that
there is epigastric retraction and lower inter-
costal retraction, without significant episternal
retraction. It is indeed of help to know that
there is no other associated airway obstruction
in cases of this nature, for they in themselves
are quite a serious problem. One wonders
whether or not some additional artificial expand-
ing assistance such as elec-trophrenic respira-
tion12 at intervals, might not aid the natural
forces and produce a successful result.
TECHNIC
Some of the small premature infants have
a relatively low vitality, which makes the pro-
cedure of examining the airway by endoscopy,
a more delicate undertaking. Needless to say,
one needs all the facilities at hand for any
difficulty which may arise. Various isolation
features too may be necessary. On most oc-
casions, the infants need to be kept warm and
any lengthy procedure should not be used.
These infants with low vitality, need extra
protection from trauma to the premaxilla which
should be well padded with guaze. The less the
vitality, the less difficulty one has with the base
of the tongue, but one annoying difficulty with
endoscopic procedures in the newborn, espe-
cially in the more rugged cases, is the tremen-
dous motility of the tongue and its ease of
defeating the examination of the larynx, espe-
cially by the inexperienced. For this reason,
it is more advisable to choose a completely
round-bladed infant laryngoscope, or else a type
that opens on the side, as is used for inserting
intratracheal anesthesia tubes.
Any type of anesthesia is completely contra-
indicated, because the accurate observation of
uncomplicated respiratory movements at all
870
The Ohio State Medical Journal
times, is absolutely necessary. If at any time
during1 laryngoscopy, a laryngeal spasm should
occur, astute judgment as to the elapsed time,
for the spasm to relax and the institution of
treatment such as “mouth-to-mouth” breathing,
which is always available, (the operator wearing
a mask), or other means of artificial respira-
tion, restores the respiratory movement and
exchange.
Having overcome the tongue difficulty, the
introitus of the larynx may be difficult to see,
because of a poorly developed epiglottis, which
tends to drop down and backward, through lack
of cartilaginous rigidity to keep it up and the
indrawing of air tending to pull it more into
the opening. The symmetry of the larynx,
arytenoids, cords, etc., are of immediate con-
cern, however, a normal triangular contour of
the glottis on inspiration, removes a certain
amount of possible hazard. The cords of the
larynx are observed in movement — occasionally
one will appear to be fixed while the other is
normal, but varying positions, tensions and
pressure changes with the examining instrument
should occur before settling on that diagnosis.
If there is lack of movement of one cord, other-
wise normal to inspection, it suggests that
trauma may have occurred during labor or de-
livery, or that there may be a congenital defect
along the recurrent nerve and its muscle dis-
tribution. However, this occurrence appears to
be rare.2
The introduction of the bronchoscope through
the laryngeal opening should be carefully and
gently tried. The tissues of the newborn infant
traumatize easily and one need not add to the
problems of respiration by inducing subsequent
laryngeal obstruction. The angled lip on the
bronchoscope if turned slightly sideways, slides
between the cords more easily than if straight
direct pressure is used on the cords.
Once the bronchoscope enters the trachea and
the danger of laryngeal spasm is past, the
sense of touch of the operator’s hands becomes
of great value, and, in view of this, the matter
of asepsis, I believe, can be overlooked enough
to allow the operator to use scrubbed ungloved
hands. The grasping of the bronchoscope with
the fingers at the open mouth, guides its rate of
introduction, and the harmony of finger motion
with accurate observation of mucosa moving
past the end of the bronchoscope tells the
operator all is well. When a certain degree of
resistance arises and there is no moving mucosa,
this indicates the bronchoscope has reached a
point where it fills the lumen, so that to push
any further would push the mediastinal struc-
tures down, stretch the trachea, and do untold
damage. Thus with the utmost care, one rec-
ognizes the limit to which one can safely in-
troduce the bronchoscope. The airway should
be aspirated and cleaned during introduction.
If the lumen is large enough to allow the
bronchoscope to reach the carina, it may be
easily moved to such an angle that a fairly
good view of each bronchus can be obtained.
Then, a small suction tip can be gently and
carefully passed beyond the end of the broncho-
scope into each main bronchus, to aspirate any
secretion and further establish a clear airway.
If respiratory distress persists after the bron-
choscopy has established the presence of a clear
visible airway, one could suspect distal bronchi-
olar obstruction. Before removing the broncho-
scope then, one sees the need of a resuscitator
which could be attached to the bronchoscope
to give additional aid to the natural respira-
tory effort. If unilateral peripheral bronchiolar
obstruction is present, the end of the broncho-
scope might possibly be engaged so that the
assistance could be directed to the involved part.
SPECIFIC PROBLEMS WITH CASE REPORTS
Should compression of the trachea exist, due
to congenital heart factors,7 it would be interest-
ing to see what effect an open airway would
have on the cyanosis. If, with an open airway,
one gets no improvement in the cyanosis, or if
it is made worse, the deduction may be made
that the difficulty is due to some congenital heart
factors.' Since so much is being done in heart
and vascular surgery, there is greater need for
more and more complete information.7 The bron-
choscopist’s observations can contribute a great
deal to the cardiac surgeon’s analysis of the de-
formity.
CASE REPORTS
Case 1. B. B. This was the first baby of
a 22-year-old white woman who went into labor
spontaneously at the 36th week of gestation. For
three months prior to labor she had lost small
amounts of discolored amniotic fluid. Analgesia
consisted of demerol® and scopolamine. Anes-
thesia for delivery was spinal. The dur-
ation of labor was 19 hrs. 48 min. and delivery
was low forceps with a central episiotomy.
The baby was cyanotic but cried spontan-
eously. The mouth and pharynx were cleaned
by catheter suction. Since the baby was pre-
mature and in respiratory distress, he was put
in an incubator with continuous oxygen and
transferred to the pediatric service. At this
time he appeared almost moribund with intense
mottled cyanosis of the arms and legs. The
respirations were paroxysmal and gasping.
There was an intermittent systolic murmur
over the precordium. No breath sounds could
be heard. The liver was not enlarged. There
was no peripheral edema. No gross deformities
were noted. Some positive pressure resuscitation
was used by the pediatrician.
At the age of 2 hours and 15 minutes, a 3mm
bronchoscope was passed easily through the
larynx and into the trachea where secretion
blocked the lumen of the bronchoscope. This
was removed by suction and more grayish fluid
was removed from the walls of each main
bronchus. The airway appeared clear as far as
could be seen -and the trachea was cleaned as
for September, 1950
871
the bronchoscope was removed. The breathing
seemed easier but there was no improvement in
the cyanosis even with oxygen. Positive re-
suscitation with oxygen was used at intervals,
but the baby expired at 6 hours of age.
Autopsy findings revealed complete fibrosis
of the left side of the endocardium, almost com-
plete stenosis of mitral and aortic valves, and
an aneurysm extending from the left ventricle
into the ventricular septum, but not into the
right side of the heart. The right side of the
heart including the pulmonary circuit was nor-
mal. There was no expansion of the lung bases.
❖ ❖ ❖
Case 2. R. C. This colored baby had respir-
atory difficulty starting 24 hours after birth. The
respirations had been noisy, labored and rapid.
There was suprasternal, epigastric and inter-
costal retraction on inspiration. The child had
a weak cry. At intervals there was a hard dry
cough. He seemed to take nourishment fairly
well but failed to gain weight in 7 weeks.
On examination he appeared poorly nourished
and in respiratory distress even with intercostal
retraction on inspiration. He had coarse rales
throughout both lungs. He had a left hydrocele
and hypospadius. Laboratory findings were
essentially normal. X-ray studies of the chest
showed an 8mm narrowing of the esophagus and
trachea just below the level of the aortic arch,
and it was believed to be due to an anomaly of
the great vessels. Another film showed a pos-
terior indentation of the trachea at the level of
the aortic arch.
Under drop ether anesthesia, a mouth gag
was inserted; the pharynx was cleaned with
suction and an infant sized laryngoscope in-
troduced. It was impossible to see into the
larynx and at the same time allow any air to
pass through it due to the curled short epig-
lottis which produced an antero-posterior en-
trance to the glottis. A few drops of lipiodol
were placed in the arytenoid area and with the
head and upper chest elevated it was aspirated
into the trachea. X-ray study now showed
partial filling of the trachea and there was slight
posterior compression of the trachea at the
aortic arch level. A tentative diagnosis of
double aortic arch was made.
The heart surgeon felt that it would be wiser
to wait for a better state of nutrition before
exploring the chest. However, after one month
of hospitalization and no gain in weight it was
decided to explore the mediastinum. At oper-
ation a large thymus gland was removed to ob-
tain better exposure. The left carotid artery
came from the right and crossed over in front
of the trachea. Because the heart stopped
beating six times during the procedure, each
time requiring cardiac massage, the exact nature
of the vascular ring could not be determined.
The child’s temperature became subnormal and
the operation was finished by anchoring the
carotid artery to the anterior chest wall. Four
hours later the child suddenly expired.
Autopsy demonstrated a vascular ring enclos-
ing and constricting the trachea and esophagus.
This was formed in a clockwise fashion by a
right aortic arch, the left subclavian artery, a
patent ductus arteriosus and the pulmonary
artery. In retrospect it was felt that, had the
child’s condition not been critical, ligation and
division of the ductus arteriosus would have
released the constriction and allowed the expan-
sion of the trachea and esophagus to the left.
* * *
Cases of atelectasis due to bronchial obstruc-
tion present progressive dyspnea with cyanosis,
more evident on exertion (crying) but which
improves under administration of oxygen. Di-
minished expansion occurs over the involved area
with suppressed breath sounds and there is also
evidence of a diaphragmatic tug at the costal
margin. Areas of localized emphysema with
coarse rales may be detected. With the show-
ing of progressive fatigue and X-ray evidence11
the diagnosis of this type of atelectasis should
be fairly conclusive providing some other dif-
ficulty may not be present also.
Case 3. B. S. This full-term baby was the
third child of a 27-year-old white woman whose
2 hours 55 minutes labor was induced by rup-
turing the membranes. A central episiotomy
was done and delivery was by low mid forceps.
Analgesia was by use of demerol® and scopol-
amine, and the anesthesia used was nitrous
oxide and oxygen.
The baby weighed 3500 Gm. (8 lbs. 214 oz.)
and started to breathe spontaneously. He had
a lusty cry. One-half hour after birth his
hands and feet became cyanotic and oxygen in-
halations were given. At 2 hours of age grunting
respirations were noted. At age of 6 hours
he had retraction and at 9 hours breath sounds
were heard only in the infrascapular areas. In-
termittent cyanosis was present. At 13 hours
of age there was no improvement and the
pediatrician noticed signs of fatigue developing.
He had established the diagnosis of congenital
atelectasis on (1) progressive dyspnea with
cyanosis, (2) diminished expansion, (3) supra-
sternal retraction, (4) diaphragmatic tug at
lower costal margin, (5) suppressed breath
sounds, (6) dehydration, (7) progressive fatigue.
X-ray studies of the chest were not done at
this time but certainly would have lent addi-
tional confirmation.
Without anesthesia a 3mm Jesberg broncho-
scope was passed through a normal appearing
larynx and trachea to the carina. Some mucus
was aspirated from the lower trachea. A small
suction tip was passed down each main bronchus
and a small amount of clear mucus was as-
pirated. No definite plug was discerned. A
clear airway was observed far down into each
main bronchus and no anatomical abnormalities
were found. The bronchoscope was removed and
immediately afterward the breath sounds were
heard much better throughout the chest.
The next day there was less retraction on
the left side on the chest. An X-ray study of
the chest showed mild congenital disseminated
atelectasis with emphysema of the peripheral
portions of the lungs. On the third day breath-
ing became much easier, but breath sounds were
still poorly heard over the right chest anteriorly.
On the fourth day the breath sounds were heard
well throughout. An X-ray study on the fifth
day showed a few remaining areas of atelectasis
and decrease in the emphysema. Subsequent
progress was normal.
* * *
Aspiration of formula or regurgitated gastric
contents may occur, especially in the premature
872
The Ohio State Medical Journal
infant. This not only produces the symptoms
and signs of a foreign body in the respiratory
tract, but may cause considerable mucosal
reaction with subsequent infection in an already
sub-par constitution. Bronchoscopy and aspira-
tion, if done promptly and carefully, remove
this hazard without injury.
Case 4. G. E. This premature infant (weight
1315 Gm, less than 3 lbs.) was a 31-week gesta-
tion and was delivered by low forceps. Breath-
ing started spontaneously but was sluggish.
Physical examination was essentially negative,
and blood studies normal. The baby was put
in an incubator and on routine premature care.
On the 18th day the baby had a period of
respiratory distress and cyanosis following a
feeding. Aspiration of the pharynx and re-
suscitation were done. Several hours later there
began frequent episodes of cyanosis requiring
resuscitation and stimulation. Auscultation of
chest revealed numerous inspiratory rales over
right chest. With the possibility of aspiration
of some formula, it was considered advisable to
bronchoscope the patient and remove any foreign
material present. A 3mm bronchoscope was
passed through the larynx and some whitish
mucoid material was aspirated from the trachea.
The bronchoscope could not be passed down to
the carina, but by moving the head and neck
for the correct angle, both main bronchial open-
ings could be seen and no plugs could be
detected. A small aspirator was passed down
into each bronchus, then the bronchoscope was
removed, being sure the trachea was cleaned on
the way out.
For about 10 days the baby required careful
observation, frequent pharyngeal aspirations and
resuscitations because of cyanosis and respira-
tory irregularity. From then on the baby im-
proved rapidly.
Chest X-ray on 35th day showed findings
which probably represented moderately severe
disseminated atelectasis of the newborn, al-
though the aspiration factor could not be ex-
cluded. X-ray 15 days later showed chest within
normal limits.
* *
With no history of aspiration, and the upper
respiratory tract sounding clear, but with cyan-
osis still present, one is led to suspect that
there is not enough lung tissue functioning to
give normal balance. Physical signs point to
obstruction of a bronchus and X-ray studies show
one lung non areated. Bronchoscopy in such
a case should lend no risk, remove the possibil-
ity of a lumen plug and confirm the diagnosis
of bronchial atresia with aplasia of the lung.
Case 5. G. P. This was a full-term baby
boy delivered by low mid forceps after a central
episiotomy had been done. The birth weight
was 2670 Gm. The baby made frequent at-
tempts at respiration and was put in a warm
water bath with a respirator over the mouth
and nose. Cyanosis was quite marked. Feeble
efforts at respiration occurred when removed
from respirator. The pharynx was kept clean
by aspiration.
Forty minutes after birth a 3.5 mm broncho-
scope was passed through the larynx into the
trachea to the bifurcation. A small amount of
secretion was aspirated from the right bron-
chus. Only a depression marked the expected
left bronchial orifice. The trachea seemed de-
flected to the right suggesting an atresia of
the left bronchus and possibly aplasia of the
left lung. Due to the poor condition of the
baby, bronchoscopic examination was done with
dispatch but this did not alter his condition.
Use of the respirator and heat were continued.
Death occurred one and one-quarter hours later.
Post-mortem examination revealed a massive
left diaphragmatic hernia with hypoplasia of
the lungs and marked pulmonary atelectasis.
Due to extrinsic pressure the left main bronchus
was compressed so that its lumen existed only
as a longitudinal slit with the axis in the antero-
posterior plane. The abdominal viscera protruded
into all of the left and part of the right thoracic
cavities.
It was evident that death resulted from anoxia
as a result of hypoplasia and atelectasis of the
lungs. This in turn was caused by the massive
left diaphragmatic hernia, obviously a develop-
mental defect present during most of the in-
fant’s life in utero.
He ^
If physical signs indicate one lung to be
less well ventilated and bronchoscopic examina-
tion reveals the bronchus of the involved side
to be one-third or one-half the size of the
normal side, one may be able successfully to
engage the distal end of the bronchoscope over
it, and, with some mouth-to-bronchoscope breath-
ing, succeed in attempting to dilate the bronchus
and expand the atelectatic lung. This might be
enough to help the infant over the difficult period
to where the natural forces could carry on suc-
cessfully. The quantity and pressure of air
needed for safe expansion of the newborn’s lungs
in vivo is probably not too well known. Vary-
ing degrees of prematurity accordingly would
each need special consideration. Yet, we know,
some premature babies have survived against
tremendous odds, while others, with all avail-
able help, and with conditions much more favor-
able for survival did not.
Case 6. G. H. This baby girl weighing 3125
Gm was delivered by low forceps. Fifteen,
minutes later there was cyanosis of face, hands
and feet with grunting respirations. The mouth
and pharynx were suctioned and she was put
on oxygen inhalations by mask. She was placed
in an incubator one-half hour later. A large
amount of mucus was aspirated by catheter
with slight improvement in the cyanosis. At
age of 2 hours respirations appeared slower,
more difficult and grunting was present. She
was seen by a pediatrician who noted that the
baby was lethargic; chest movements were ir-
regular in rhythm and depth with retraction at
the costal margins; breath sounds came through
fair anteriorly but were of poor quality over
both upper lobes posteriorly; no dulness or
rales; she had a systolic heart murmur.
At age of 8 hours, there was no improvement
— the cyanosis was present in the extremities
and the head and over the left chest to the
midline. There was slight intercostal retraction.
A 3mm bronchoscope was passed through a
normal larynx into the upper trachea. More
for September, 1950
873
mucus than was expected was aspirated from
the trachea. The right main bronchus was
of good size and clear. The left main bron-
chus was about half the size of the right.
Both were aspirated. The end of the broncho-
scope was engaged over the opening of the left
main bronchus and some forced mouth - to -
bronchoscope breathing done. Following this
the left main bronchus appeared more like the
right in size. The color and breathing im-
proved following bronchoscopy.
The next day the baby was much improved
with better color. Three days later respira-
tions were normal and there was no cyanosis
and from then on the baby progressed normally.
sfc %
If the X-ray study should show a pneumo-
thorax following the use of a mechanical resusci-
tator, then we have, in addition to the airway
and pulmonary alveoli not allowing sufficient
air exchange, another factor, which prevents ex-
pansion and complicates the procedures of treat-
ment. Obviously this necessitates treatment
to remove the pneumothorax, and to allow ex-
pansion of the lung, followed by the gentle in-
troduction of oxygen to the main airway.
So many times the infant’s anoxia is too much
a responsibility for the obstetrician and he
immediately calls the pediatrician, who, after
assessing the problem, grasps for any avail-
able help to get more pulmonary ventilation.
One of the various types of resuscitators may
be on hand, and at present the positive and
negative machine seems to be in a phase of
popularity. Although the positive and nega-
tive pressure this machine produces is less
than the physiologists say is safe or necessary
to expand the lung of the newborn, they do not
synchronize with the respiratory movements of
the baby and in fact may be just the reverse
so that the positive pressure may be greater
than is safe. Assuming that the nose, pharynx,
and trachea are clear of mucus, etc., one may
be dealing with a laryngomalacia and the posi-
tive phase could easily be forced into the
stomach, and the negative phase create more
negative intrabronchial pressure. Since the de-
sired results do not appear, it seems that an
endoscopic examination could eliminate some
of these uncertain factors and allow more ef-
ficiency in establishing an airway, thus avoiding
at least some of the dangers associated with
the indiscriminate use of the mechanical re-
suscitators. Goff3 states that he believes posi-
tive-negative pulmotor type of resuscitators have
injured more babies than all other types of treat-
ment combined. At present, my feeling is that
with the bronchoscopist’s mouth to the end of
the bronchoscope the positive and negative
phase of added positive and negative ventila-
tion can be synchronized with the diaphragmatic
movements by watching the abdomen and done
with safety.
The question of whether or not we can
safely and successfully use positive and negative
pressure in resuscitation of the newborn, espe-
cially the premature, needs a great deal of
research, which will of necessity combine the
efforts of obstetrician, pediatrician, physiologist,
endoscopist, pathologist and manufacturer of
equipment. It seems that with so much effort
being expended in many special branches of
medicine, this one too, should be developed, so
that many a potentially useful citizen could
be given some needed help on his start in the
world. A small room adjacent to the obstetri-
cal delivery rooms, for this specific purpose of
meeting the respiratory emergencies of the
newborn, could be equipped and ready at small
expense, in every hospital. This would greatly
assist progress in this field.
CONCLUSIONS
1. With the advance of knowledge and im-
provement in instruments one can safely broncho-
scope all full-term newborn infants and many
premature babies with safety.
2. More widespread work in bronchoscopy
of the newborn should be done so that we may
not only dispel its traditional danger but use it
freely and advantageously when indicated.
3. By watching the diaphragmatic movements
(abdomen) the bronchoscopist with his mouth
over the end of the bronchoscope can safely
synchronize what added positive and negative
ventilation he may feel is indicated with that
of the natural effort.
4. Greater cooperation amongst the obstetri-
cians, pediatricians and otolaryngologists is
needed as well as greater education, training and
experience for those concerned.
BIBLIOGRAPHY
1. House, H. R., and Owens, H. : Atelectasis of the New-
born : Treatment by Bronchoscopic Drainage. Jour. Ped.,
28 :207, 1946.
2. Heatly, C. A., and Emerson, E. B. : Bronchoscopy in
the Newb'rn. An Analysis of Fifty Cas^s. Annals of
Otology, Rhinology and Laryngology, 57 :802, 1948.
3. Goff, W. F. : Respiratory Emergencies in the New-
born. Western Journ. of Surg. Obst. and Gyn., 57 :49, 1949.
4. Little, D. M., and Tovell, R. : The Physiological Basis
for Resuscitation of the Newborn. Surg. Gyn. and Obst.,
86 :417, (International Abstracts of Surgery) 1948.
5. Sage, E. C. : The Care of the Parturient Woman in
Relation to Neonatal Mortality. J. A. M. A., 124:339, Feb.,
1944.
6. Farber, S., and Wilson, J. L. : Atelectasis of New-
born ; Study and Critical Review. Am. Jour. Dis. Child.,
46:572, Sept., 1933.
7. Holinger, P. H., and Johnson, K. C., and Zoss, A.
R. : Tracheal and Bronchial Obstruction Due to Congenital
Cardiovascular Anomalies. Annals Otology, Rhinology and
Laryngology, 57 :808, Sept., 1948.
8. Atkins, J. P. : Bronchoscopic Observations on the
Pulmonary Aspects of Fibrocystic Disease of the Pancreas.
Annals Otology, Rhinology and Laryngology, 57 :791, Sept.,
1948.
9. Davidson, F. W. : Bronchopulmonary Infections in
Allergic Individuals. Annals Otology, Rhinology and
Laryngology, 57 :884, Sept., 1948.
10. Hilding, A. C. : Some Further Experiments in the
Production of Negative Pressure in the Trachea and
Frontal Sinus by Ciliary Action. Annals Otology, Rhinology
and Laryngology, 54 :724, 1945.
11. Martin, J. : The Roentgen Findings in Atelectasis in
the Newborn with Special Reference to Changes in the
Cardiac Silhouette (to be published).
12. Whittenberger, J. L., Sarnoff, S. J., and Harden-
bergh, E. : Electrophrenic Respiration. II. Its Use in Man.
Jour. Clin. Invest., 28 :124, Jan., 1949.
874
The Ohio State Medical Journal
Preliminary Report on “At Birth'’
Diphtheria, Pertussis and Tetanus Immunization
HERBERT D. CHAMBERLAIN, M. D., and RICHARD E. BULLOCK, M. D.
THE active immunization of young children
for diphtheria, whooping cough and tetanus
is an accepted procedure; but just when
this prophylaxis begins is, in itself, another
question.
In a rural general practice such as ours, it
has always been a problem to get healthy chil-
dren into a doctor’s office to start immunization
at the recommended ages of three or six months.
As the usual run of things, we see a child
after attending its birth only when it is ill, and
that obviously is not the time to begin an
immunization program. All this has led, in the
past few years, to an unfortunate situation
in which the rural child, unless it has an ex-
ceptionally intelligent mother, ends up at school
age with no inoculations. Various surveys have
brought to light the fact that a large popula-
tion of children have not had their inoculations,
with our area being no exception. The implica-
tion was that it was the doctor’s fault and,
therefore, the so-called well baby clinics have
been established and lay organizations have
taken over a function which we feel properly
belongs in the doctor’s hands.
PRACTICAL PROCEDURE WORTH CONSIDERATION
Because of the extreme severity of pertussis
and its complications in the infant, we searched
around for some logical procedure to prevent the
very severe illness and even death of the young
babies that we have in this community. Any
procedure to be satisfactory must fit in with
the general routine of the family life. Under
present-day methods the parents are apt to
forget or, for one reason or another, not to con-
tinue a planned series of inoculations.
It occurred to us that an extremely practical
w-ay for all concerned would be to give the
first shot while we were in attendance at the
delivery; the second shot at six weeks at the
time of the routine postpartum check; and. the
third shot at the age of three months when we
normally see the children to change their feeding
habits. We have made no study in the present
literature as to the pros and cons of beginning
diphtheria, pertussis, tetanus immunization at
various ages. We may be repeating something
which has already been done, and may be re-
porting something which has been previously
reported valueless; however, we shall attempt
to show in our way that the procedure is defi-
nitely worth further consideration.
Submitted February 6, 1950.
The Authors
O Dr. Chamberlain, McArthur, Ohio, is a
graduate of Ohio State University College of
Medicine, 1933; member, Amer. Medical Assn.;
Ohio Academy of General Practice; Amer.
Academy of Gen’l. Prac. Since 1933 engaged in
genl. practice.
• Dr. Bullock, McArthur, is a graduate of
University of Cincinnati College of Medicine,
1943; member, Amer. Medical Assn.; President,
Vinton County Med. Soc. On Staff, Hocking
Valley Hospital.
For the past fourteen months we have, at
the time of delivery, given 1/2 cc. diphtheria,
pertussis, tetanus toxoid to all newborns. We
have had no untoward effects from these inocu-
lations; we have seen no abscesses, general
systematic reactions nor change in feeding or
living habits of the neonatal infant. At six
weeks the second 1/2 cc. is given. This is the
time when the mothers normally return for
their postpartum checks and they have been
instructed to bring the babies with them so
that they, too, may be checked. This produces
no change in a previously established routine.
At this age, also, we have seen no untoward
effects. Furthermore, this procedure is less
costly to the patient since it coincides with the
proper postpartum care of the mother. At this
time we gently insist that the mothers return
when their babies are three months old for the
third shot, and in order that we may also check
the baby and change its feeding schedule. Our
plan, so far, has worked very well.
ENCOURAGING RESULTS NOTED
We are not long on mathematics nor do we
have the time or the inclination to prepare
elaborate tables. Our results so far are very
encouraging. We have, at this writing, inocu-
lated 151 newborns and in none have we seen
a reaction. Sixty-eight of these have completed
all three of their inoculations and some 20 are
in the process of completion. The balance have
had at least one, and in most part, tw*o injec-
tions. Of the 68 who have completed their
injections, we have spot checked 23 with Schick
test and with a simple pertussis agglutination
test. All of the children tested were Schick
negative and all the children tested showed
for September, 1950
875
high titers on the pertussis agglutination re-
action. The ages of these 23 children have
varied from four to twelve months. We have
had no pertussis in any of this group of 151
children that have had at least one injection.
We have had at least one baby who has been
definitely and directly exposed to pertussis when
the disease was in the family in older brothers
and sisters, without contracting any of the
signs or symptoms of the disease. We have
had many mothers tell us of their children’s
having been exposed to pertussis directly and
indirectly, without contracting the disease. We
are also extremely impressed with the general
health of this group of children. It has been
Tare indeed to see one of our infants with
the so common complaint of running nose, cough
and fever that has plagued the general prac-
titioner.
Because of the apathy on the part of numerous
parents to have well children seen by the doc-
tor, we send the mothers reminder postcards
at the time of the second and third shots, to
which we have had perhaps a better response
than had we not done so.
CONCLUSIONS
Our conclusions, although not validated by
percentages, controls and averages, are that
three injections of 1/2 cc. of diphtheria, pertussis
and tetanus toxid, one at the time of delivery,
one at six weeks and one at three months of
age, have protected these children against these
three diseases, pertussis in particular; and that,
strangely enough, the general upper respiratory
infections of the infant child have decreased in
this group.
We intend, because of our results, to continue
this procedure and feel that it is worthy of
further consideration. We hope to report on it
again as our series becomes larger.
Failure To Learn from Experience
People fail to learn from experience for three
reasons. First, because they have not learned
the habit of thought. They bolt their impres-
sions without savouring them, as a dog bolts his
food. They do not take their raw material into
the factory, but let it pass straight from the
delivery gate to the refuse dump. They never
classify — that is, they never say to themselves,
“Something like this happened before in the
same circumstances.” Thus they never take the
next step, from experience to experiment, to de-
ciding, by repeating the circumstances, whether
the likeness observed between two experiences
was an accident or a consequence.
Secondly, because they have classified too
much, or rather because they have allowed their
habits of thought to become automatic. They
have organized their factory for mass produc-
tion, so that it cannot deal with the unusual
order. They unconsciously shut out all new
experience by classifying everything under head-
ings already fixed. Thus astronomers dismissed
for years the observed experience of the varia-
tions in the perihelion of Mercury by classifying
them under the heading of instrumental error,
and correcting for them by averaging observa-
tions. Thus scientists" in the last war boosted a
valueless antiserum for gas gangrene because
it had been proved in the laboratory to protect
mice from the effects of the intraperitoneal in-
jection of cultures of Clostridium welchii, and
supported their advocacy by a series of mean-
ingless observations in the field, while ignoring
the significant experience that men transfused
early and adequately with whole blood seldom
got gas gangrene.
Thirdly, because, having made the whole of
one branch of knowledge their province, they
fail to attain that last achievement of education,
the knowledge of where their experience is in-
adequate, of where their knowledge ceases and
their ignorance begins. Having acquired su-
preme mastery of one department of learning
they are apt to assume that the whole is theirs,
to forget that the highest wisdom is the realiza-
tion that no man can know everything, that he
is indeed wisest who knows his ignorance and
where to turn for help when he needs it. One
of the greatest physicists since Newton died
needlessly and before his time because he treated
his own strangulated hernia with household
remedies and turned oply many hours too late
to those who had made such ailments their life’s
study and who could have saved him.
The beginner fails to use experience because
to him it is so multitudinous that he cannot
handle it until he has acquired some of the
technique of the warehouseman or filing clerk.
The learned man is often blind to new experience
because the mass of knowledge he has acquired
seems to him complete, and he sits, old, weary,
and disinterested, among his hoards, looking with
lack-lustre eyes on any new treasure that is
offered to him for acceptance. The ideal is
the man of learning and wide classified experi-
ence who is yet able to see and appreciate at its
proper value the new fact which does not fit into
its 'appropriate niche. Such are our geniuses.
Such was Hunter. Such are Einstein and Fleming,
— Sir Heneage Ogilvie, British Medical Journal,
No. 4629, September, 1949.
Iodine for Histamine
It is suggested that the post iodine hyper-
acidity which is a result of the stimulation of the
parietal cells can be used as a substitute for
histamine stimulation. Furthermore, iodine is
less harmful than histamine. — G. Papayan-
nopoulos, M. D., in Brit. Med. J., March 4, 1950;
pp. 520-521.
*7 6
The Ohio State Medical Journal
Recent Concepts in the Study of Infertility*
HUBERT D. CLAPP, M. D., and DAVID R. WEIR, M. D.
The Authors
• Dr. Clapp, Cleveland, Ohio, is a graduate
of Western Reserve University School of Medi-
cine, 1939; diplomate, American Board of Ob-
stetrics and Gynecology; and clinical assistant
of obstetrics and gynecology, St. Lukes Hospital,
Cleveland.
• Dr. Weir, Cleveland, Ohio, is a graduate
of Harvard Medical School, 1936; assistant phy-
sician, University Hospitals; and senior clinical
instructor of medicine, School of Medicine,
Western Reserve University.
THROUGHOUT the period of recorded his-
tory the childless couple has been a major
social problem. It is a complex one and
its solution extends beyond mere conversation,
encouragement and indefinite expectancy. In-
vestigations of the past twenty to thirty years
have opened new approaches concerning our
knowledge of the factors responsible for both
male and female fertility.
For centuries, people have sought cures for
sterility. Mystic measures, aphrodisiacs, love
potions, and baths were used extensively as
therapeutic measures. Evidence of organother-
apy appeared in Biblical times. As the result
of Paracelsus’ teachings, normal organs and
juices of man and animal were used to treat
sterility from the Sixteenth to the Eighteenth
Centuries.
The basis of modern endocrine therapy can be
accredited to the work of Berthold in 1849, when
he proved the effect of the removal of the
testicle on physical and psychologic reactions.
Along with advancement of endocrinology much
work has been done in the field of mechanical
and microscopic procedures to effect the treat-
ment and ascertain the causes for sterility.
At the outset it is well to define the term
infertility and its relationship to the term ster-
ility. The terms are sometimes used synony-
mously. Meaker, however, stated that infertility
is an all-inclusive term embracing any degree of
conceptive capacity below the level of physiologi-
cal perfection, and so includes relative fertility,
relative sterility and absolute sterility. Rela-
tive sterility is that condition in mating in which
conception may take place, although unlikely
until the existing precluding factors in either
mate are overcome. Absolute sterility is that
condition in which there is failure of production
of gametes in either sex.
From the clinical standpoint, sterility in a mat-
ing is the inability to reproduce. Moench
states, “If we consider the ideal fertility of
an individual as ten, then the combined fertility
of two such individuals would be ten times
ten, or one hundred per cent. Clinical sterility
is present when fertility sinks below sixty per
cent. Sixty can be made up roughly of various
figures, 9x7, 8x8, etc., and thus one sexual
partner can within reasonable limits make up for
the infertility of the other.” Therefore, it is
obvious that the fertility of a couple is to be
considered, and not merely that of an individual.
* Clinical studies referred to in this paper were
made possible by grants from the Brush Foundation. Sub-
mitted December 6, 1949.
The majority of the couples with the com-
plaint of “childlessness” present themselves in
the person of the wife to a general practitioner
or family physician. This doctor must appreciate
the complexity of such a problem and should
know the basic physiology of fertility to advise
these patients properly.
It is futile to start any type of investigation
of infertility unless the husband and wife ap-
preciate that the aid of several physicians will
undoubtedly be needed before a complete study
can be done. The couple should be cooperative
and willing to undergo any procedure recom-
mended by their physician. A simple explanation
of the physiology of menstruation and concep-
tion should be given to the patients as well as
a description of the major factors which might
be contributing to their infertility. If time is
taken to explain these with the aid of models
and diagrams the patients apprecate the neces-
sity for an exhaustive investigation and are
more willing to undergo the procedures rec-
ommended by the physician.
The factual data presented in the following
paragraphs have been obtained from the records
of 125 consecutive couples studied at the In-
fertility Clinic of the Maternal Health Associa-
tion of Cleveland. No couples have been ac-
cepted unless they had been infertile for at
least eighteen months, not including periods of
separation or the use of contraceptives. In all
cases complete examinations of both husband
and wife have been done and all have been fol-
lowed for a period of at least six months.
The requisites for normal fertility in the
female may be summarized as follows:
1. Normally functioning ovaries, in which
there is cyclic maturation of Graafian fol-
for September, 1950
877
licle with ovulation and subsequent corpus
luteum formation.
2. A normal uterus, reactive to stimulus
of the sex hormones.
3. A patent and receptive genital tract
which permits migration of the sperm and
ovum and subsequent travel of the fertilized
ovum to its site of nidation.
4. Protection and nourishment of the
developing embryo.
The requisites for normal fertility in the male
are:
1. Production of adequate numbers of
normal sperm.
2. Secretion of a fluid medium favorable
for conveyance of sperm.
3. A patent ductile tract, permitting
transport of the sperm to the vaginal canal.
4. Adequate performance of coitus.
The complex problem of infertility should be
routed through several physicians whose dis-
tinctive abilities in internal medicine, gyne-
cology and urology will enable them to contrib-
ute their special talents to the problem. In
many cases the radiologist, psychiatrist and
endocrinologist must enter into the investi-
gation.
The Role of the Internist
The function of the internist is to investigate
the constitutional factors which may make up
a large percentage of the factors contributing
to lowered fertility in both sexes. They can be
classified as follows:
ENDOCRINE DISORDERS
In our experience true endocrinopathy as
evidenced by hormonal imbalance is a rare cause
for infertility. In 125 couples we have not en-
countered a single case where ovarian or testic-
ular dysfunction has been clearly associated
with dysfunction of other endocrine glands. In
all cases of severe oligospermia, azoospermia,
very irregular ovulation or anovulation, the in-
dicated hormone output assays are done. In
one anovulatory woman the gonadotropin output
was below normal but exhaustive search failed
to reveal any other evidence of pituitary failure
In two women having very irregular ovulation
there was moderate hirsuitismn and a tendency
to masculinization but their 17-ketosteroid out-
puts were normal and there was no other
evidence of hyperadrenalism. Not a single man
with severe oligospermia or azoospermia has
shown an abnormally low or high gonadotropin
output or any other clinical evidence of pituitary
dysfunction. Testicular biopsies in these patients
show varying degrees of arrest of maturation
of tubular elements without hyperplasia, and in
the great majority of cases there simply is no
explanation for the anatomic abnormality.
In approaching the problem of treatment with
these facts in mind we have come to be in ac-
cord with the general opinion of careful investi-
gators in the field. Gonadotropins have little if
any place in the treatment of male or female
infertility. It is illogical to think that, if the
pituitary is producing normal amounts of gonado-
tropin, there is any need to provide it in
excess. A few of our patients, often on their
own insistence, have been treated with various
commercial gonadotropins. No benefit was
derived in any case. The one anovulatory
female with low gonadotropin output was given
large amounts of several preparations without
the production of ovulation. In such a case we
do believe that gonadotropins should be given
a thorough trial. We agree with Tyler who
stated that the effectiveness of endocrine therapy
in sterility is limited by the important facts that
the majority of cases of infertility are not of
endocrine origin, many of the preparations avail-
able are clinically ineffective, and exact diagnoses
of some endocrine disturbances are most dif-
ficult to establish.
In the investigation of possible thyroid dys-
function we have not had a single case of florid
hypothyroidism or hyperthyroidism. The basal
metabolism of all patients is determined and on
all borderline cases blood cholesterol levels are
done. In many patients we have used desiccated
thyroid extracts empirically, but are not yet in a
position to make a statistical analysis of the re-
sults. In women we are not impressed by the
results. In men with moderate oligospermia
some show increase in counts on the exhibition
of thyroid extract. In two of these conception
resulted when the counts had exceeded 60 mil-
lion; and in one, after conception had taken
place and thyroid had been discontinued, the
count returned to the pretreatment level of
30 million. Perhaps an observation wrhich we,
again, cannot yet confirm by statistical analysis
may be very important. A number of patients
treated continuously for several months or more
with thyroid extract have shown a marked fall
in their counts, sometimes preceeded by a tem-
porary rise. We are beginning to believe that
prolonged thyroid therapy does more harm than
good, and that brief treatment with high doses
is the method of choice. Again there is no col-
lateral clinical evidence to support the theory
that oligospermia is sometimes due to lack of
thyroid substance.
Estrogenic substance has a limited usefulness
in the treatment of infertility. We have used
cyclic estrogen therapy in anovulatory women
in an attempt to reestablish ovulation. If ovula-
tion does not occur after four courses of therapy
the attempt is abandoned. An oral preparation
has been very effective in producing the artificial
menstruation and we see no reason to give par-
enteral preparations. The results have been
878
The Ohio State Medical Journal
very disappointing and in only one case has the
cyclic estrogen therapy coincided with the
reestablishment of ovulation.
In the evaluation of any type of endocrine
therapy it must always be kept in mind that the
therapy preceeding conception may have had
nothing to do with the event. Conception often
occurs for no reason that can be discovered,
even after many years of infertility. Many
variables always exist and they must all be
taken into account before valid conclusions can
be drawn.
DIETARY FACTORS
There is no positive evidence in human beings
that deficiency of known vitamins or other con-
stituents of the diet has anything to do with
infertility. In animals deficiency of Vitamin E
or of vitamins of the B group does impair
fertility, and it is not unreasonable to believe
that in human beings vitamins or vitamin like
substances may play a role in the maintenance
of normal fertility. In our clinic the patients
submit a detailed dietary history covering a
two-weeks period. These histories are analyzed
by a dietitian who then instructs the patient
in the correction of any deficiencies which may
be found. A real attempt is made to provide the
patients with foods which contain adequate
amounts of all vitamins and vitamin-like sub-
stances. We see no reason to give supple-
mentary vitamin preparations unless clinical
vitamin deficiency exists. We believe that na-
tural foods provide enough of the known vitamins
and also include unknown vitamins which may
be necessary and which may not exist in the re-
fined commercial preparations.
OTHER PROBLEMS FOR THE INTERNIST
Every effort must be made to discover and
correct any condition such as anemia, infection,
obesity, malnutrition, alcoholism, chronic fatigue
or disease of any kind. A brief assessment of
the psychiatric status of the patients may un-
cover a need for counselling, psychiatric consulta-
tion or psychotherapy.
In many reports of infertility studies great
stress is laid on the importance of the so-called
constitutional factors. Certainly they should be
corrected if possible, but there is no positive
evidence that they are of definite importance.
We believe it to be not at all unlikely that these
constitutional factors occur just as frequently
in the population as a whole or in the group
with a high fertility index as they do in the
subfertile group.
The Role of the Gynecologist
The investigation of the female genital tract
should be conducted by the gynecologist. Gross
abnormalities quickly will become apparent and
may allow the diagnosis of absolute infertility to
be established. In the great majority of cases
the abnormalities found could ordinarily be con-
sidered to be minor in nature if the problem
were other than one of infertility. The gyne-
cologist must do a thorough pelvic examination,
Huhner’s test, Rubin’s test, and salpingograms if
necessary. By basal body temperature determ-
inations he must determine if ovulation is oc-
curring and its time of occurrence. Vaginal
smears or endometrial biopsy may be done to
supply confirmatory evidence but are rarely
necessary. The patient must be instructed in the
timing of intercourse so that it will coincide with
ovulation.
CERVICAL FACTORS
Pommerenke has determined the amount and
characteristics of the endocervical secretion at
various times during the menstrual cycle. At
the time of ovulation he found it to be in-
creased in amount with lowered viscosity, di-
minished cellularity, and increased glycogen con-
tent. In this secretion the motility of sperma-
tozoa is preserved for a longer time than it
is in secretions obtained at other times in the
cycle. The postcoital examination of the endo-
cervical secretions at the time of ovulation,
‘‘Huhner’s Test,” is essential and gives much in-
formation. It may reveal the presence of an
undiscovered endocervicitis which requires treat-
ment. Not infrequently a negative test may be
made positive by the use of a precoital douche
containing 10 per cent dextrose in Ringer’s solu-
tion. The usual cervical abnormality is a simple
cervicitis which yields readily to treatment. We
have not had any cases of stenosis of the cervix
and believe that dilatation is rarely if ever in-
dicated.
UTERINE FACTORS
A considerable number of infertile women have
a small uterus. We do not have information to
show whether this occurs any more frequently
in infertile women than in nulliparous fertile
women. Usually attempts are made to correct
the abnormality particularly if anteflexion is
present. Estrogen therapy may be of some value
in increasing the size of a small uterus or in
preparing it for nidation of the ovum. Douglas
reported evidence of enlargement of the small
uterus with the use of a stem pessary for a
period of one to three months. In our series we
have not encountered a single infantile uterus.
Retroversion of the uterus is another prob-
lem which is frequently encountered. It should
be corrected although there is no good evidence
that it contributes to infertility.
Obvious ovarian pathology must be corrected
by surgical measures if necessary. A not un-
common cause of anovulation is the development
of multiple small cysts in the ovaries. Ap-
parently the basic defect is the failure of the
follicles to rupture. The ovaries may be pal-
pably enlarged. Partial removal of the cap-
for September, 1950
879
sules or wedge resection of the organs may
reestablish normal ovulation. The use of the
culdoscope facilitates the establishment of the
diagnosis and the diagnosis of endometriosis and
other pelvic conditions without the necessity of
performing laparotomy. (Our experience with
this instrument is still very limited.)
TUBAL FACTORS
Great emphasis is always laid on the factor of
tubal patency. In our experience tubal oc-
clusion is an uncommon finding. In our series
of 125 couples bilateral tubal occlusion has been
found only six times. Unilateral occlusion has
almost invariably been due to surgical removal
of the tube. A negative Rubin’s test does not
mean tubal occlusion. Routinely if the Rubin’s
is negative we repeat it twice, using sedatives
as indicated. Then salpingograms are done. As
regards surgery to correct tubal occlusion we
are in agreement with the majority of careful
workers in the field. It is rarely indicated. It
is a major surgical procedure, the results even
in the best of hands are poor, and there is real
danger of preparing the ground for a tubal
pregnancy. Too often it is forgotten that any
degree of tubal occlusion may well mean that
the functional integrity of the entire tube is
damaged. A decision to perform surgery should
be made only by a gynecologist who has had
wide experience with the problem.
OVARIAN FACTORS
In 1904 Van de Velde first reported variations
in the temperature of women during the men-
strual cycle, and in 1929 he confirmed his find-
ings with additional data. In 1938 and 1939 Zuck
published the results of basal body temperature
studies in 278 cases. He demonstrated that
fertility was highest on the twelfth, thirteenth,
and fourteenth days of the normal 28-day cycle,
coinciding with the observed temperature shift.
In recent years the daily charting of basal body
temperatures has been accepted as the most re-
liable, easily available means of determining if
ovulation occurs and when it occurs.
The greatest disadvantage of this method is
evident when the attempt is made to predict
the ovulation time of a woman who does not
ovulate and menstruate regularly. For the vast
majority of women the interval between ovula-
tion and the onset of the next menstrual period
remains standard and varies in different indi-
viduals from 13 to 16 days. If a woman’s
menses occur irregularly the variation in num-
ber of days will all be taken up in the period
between the onset of menses and the occurrence
of the next ovulation, the period between that
ovulation and the next menstruation remaining
standard. With irregular menses, therefore, the
physician is unable to predict when ovulation
will occur at the time when it is important that
he do so, namely, in the postmenstrual, pre-
ovulatory period. With regular menstruation
this period also remains standard so that ovula-
tion may be predicted accurately. Recent work
by Farris using immature female rats as test
animals may solve the problem of predicting the
time of ovulation in women who menstruate
irregularly.
Routinely our patients record their basal body
temperatures for three to four months, or until
the time of the temperature shift is accurately
established. They abstain from intercourse for
at least four days before the temperature shift
and then have intercourse on alternate days. If
conception does not occur, the initial intercourse
after abstinence may be one or two days before
or after the beginning of the temperature shift.
Farris’ work indicates that ovulation actually
may occur just before, during, or just after the
temperature shift. The above schedule takes
into account this probable fact and also the
survival time of ova and spermatozoa. There
is evidence to show that neither of these prob-
ably survive as viable gametes for longer than
twenty-four to forty-eight hours.
The Role of the Urologist
A thorough examination of the external and
internal genitalia is necessary to discover evi-
dence of testicular atrophy, epididymitis, pros-
tatitis, or abnormalities of the duct system.
Semen analyses must be done and in a few
cases testicular biopsies are indicated.
SEMEN ANALYSIS
The semen must be collected in a clean glass
jar either by withdrawal at the end of the
intercourse or by masturbation. It should be
kept at approximately room temperature and
delivered promptly to the doctor’s office. The
analysis should include volume determination,
an accurate count, observation of the motility of
the sperm and a differential count of the stained
smear to show the number of abnormal forms.
The most important part of the analysis is the
count per cubic centimeter and this should exceed
60,000,000. The total count is less significant.
There is considerable controversy at present
about what values actually are normal for
semen, but space does not permit a discussion of
the various factors. Usually normal or abnormal
motility or morphology closely parallel the count
per cubic centimeter. A number of cases are
on record where conception has taken place with
counts well below 60,000,000. We have had one
with a count of 30,000,000.
Often it is most important to repeat the
semen analysis. A high count is good, although
not necessarily conclusive evidence of the man’s
fertility, but a single low count may be of no
significance. An error may have been made in
the technique of collection and the second count
880
The Ohio State Medical Journal
may be perfectly normal., Sometimes too fre-
quent intercourse may deplete the specimen.
TESTICULAR FACTORS
If the testicles are small and flabby with
deficient semen we consider the prognosis to be
hopeless. However, in the majority of our cases
of oligospermia there is no gross evidence of
testicular atrophy. Biopsy usually reveals a
maturation defect in the germinal epithelium.
Adult sperm are produced in very small num-
bers. Sometimes there is thickening of the
basement membranes of the tubules. Why there
is a failure of maturation remains entirely un-
explained, and at present there is no form of
therapy which consistently will correct it.
In a small percentage of cases of azoospermia
the testicles are grossly and microscopically nor-
mal. In such cases a blockage of the duct
system must be suspected with the hope that
it may be corrected and fertility restored by an
operation such as vasoepididymal anastamosis.
OTHER FACTORS
Chronic, non-specific prostatitis and seminal
vesiculitis are frequently encountered. In a few
of our cases appropriate treatment has been ac-
companied by a rise in semen count with result-
ing conception. However, in many, the counts
failed to improve and it is well known that
chronic prostatitis may exist in highly fertile
men. The whole problem of infertility in the
male is very poorly understood. Multiple un-
known factors must exist and at the present
time we must admit that these are far more
important than the factors that are known.
CLINICAL RESULTS
The following table gives the results of the
study and treatment of the 125 couples who
have been under observation for at least six
months. All of them had been infertile for at
least eighteen months before they were accepted
in the clinic.
Per Cent
Total cases 125
Pregnancies 27 21.6
Discharged not pregnant 42
Absolute sterility — male 15 12.0
Absolute sterility — female 9 7.2
Incomplete study 12 9.6
Complete study, no absolute
factor found 6 4.8
Active cases, not pregnant — 56 44.8
The group classified as incompletely studied
were patients that had had complete initial
studies, but did not return for follow-up for
six months, and did not show a factor of ab-
solute sterility or achieve a pregnancy. If this
group is excluded from the total number of
cases the percentage of pregnancies rises to 23.9.
In the male the diagnosis of absolute sterility
was made on the basis of persistent azoospermia
or severe oligospermia with counts uniformly
below 20,000,000 and testicular biopsy material
showing irreversible changes. In the female it
was made on the basis of anovulation or complete
occlusion of both tubes. It is interesting to
note that absolute sterility in the male is almost
twice as common as it is in the female. It is
also much easier to establish the diagnosis in
the male. Therefore, if an incomplete study
of an infertility problem is contemplated, it is
logical that the man should be the first one
to present himself for study. The examination
of the male is much simpler, more conclusive,
and more apt to reveal decisive information.
Thus the women may be spared a prolonged, un-
comfortable, and expensive investigation. In the
woman grossly irregular menstruation or a his-
tory of known pelvic disease may lead one to
suspect that she is absolutely infertile; whereas
in the man there is rarely any clinical evidence
to indicate the existence of severe oligospermia
or azoospermia. These conditions are usually
unsuspected even by the urologist, until he
has done a semen analysis.
SUMMARY
We have reviewed briefly, the history of in-
fertility, and discussed the current concepts
of this problem. In this discussion we have
incorporated our experience as we have seen it
in our own clinic, and have explained in con-
siderable detail how each problem has been
attacked and presented some of the results of
our investigations. We hope that we have con-
tributed something from our experience which
will be of value to those interested in this com-
plex problem which is still a challenge and wide
open for research.
BIBLIOGRAPHY
1. Farris : Prediction of the Day of Ovulation by Rat
Test. Am. Jour, of Ob. & Gyn., 347, August, 1948.
2. Newman : Ovulation Studies with Direct Current
Potentials. Am. Jour, of Ob. & Gyn., 901, November, 1948.
3. Beechman and Sigman : Technique for Reestablish-
ing Tubal Patency. Am. Jour, of Ob. & Gyn., 935, Novem-
ber, 1948.
4. Siegler : Fertility In Women. Textbook. J. B. Lip-
pincott Co., Philadelphia, published in 1944.
5. Greenhill : 1948 Year Book of Obstetrics and Gyne-
cology.
6. Zuck : The Relation of Basal Body Temperature to
Fertility and Sterility in Women. Am. Jour, of Ob. & Gyn.,
998, December, 1938.
7. Zuck : The Time of Fertility and Sterility During the
Human Menstrual Cycle. O. S. M. J., Vol. 35, November,
1939.
S. Pommerenke : The Sterility Problem. Western Jour,
of Surgery, Obstetrics and Gynecology, 295, July, 1944.
9. Meaker and Glaser : The Hydrogen Ion Concentra-
tion of the Endocervical Secretion. Surgery Gynecology
and Obstetrics, 73, January, 1929.
10. Weir: Results with the Intra-uterine Stem Pessary.
Am. Jour, of Ob. & Gyn., February, 1937.
11. Tyler: Use and Misuse of Endocrine Therapy in
Sterility. J. A. M. A., 560, February 26, 1949.
for September, 1950
881
Case Report: Eclampsia in a Fourteen-Year Old Negress
with 252 Recorded Convulsions
EDUARD EICHNER, M. D., and LLOYD P. MALLIN, M. D.
ECLAMPSIA is a convulsive disorder occur-
ring primarily in young primigravidae. There
are many reports in the American literature
of eclampsia in women whose ages range “from
fifteen to but only three in which patients
aged under 15 are mentioned. Rucker, in a dis-
cussion of an article by Ware and Noblin5 re-
ports eclampsia in a twelve-year-old. A survey
by Arnell2 mentions patients aged from 13 to 41,
while Adair1 quotes Hinselmann, whose series
starts at 14. Peckham4 in his modification of
Eden’s classification states that “more than
twenty convulsions” is of grave prognostic
significance. The case reported here is of in-
terest because of the patient’s age, the extent
and duration of her coma, as well as the severity
and number of her post-partum convulsions.
Other authors agree that in general prognosis is
better in the younger age groups, despite the
presence of other grave criteria.
CASE REPORT
M. G. C., R-7001, was admitted to Mt. Sinai
Hospital in a convulsive state at 7:30 p. m., Dec-
ember 28, 1938. She had had three convulsions
before admission, and had been unconscious
since the first one. She had had no prenatal
care, and had denied her pregnancy to her
parents. She had never had any convulsive
disorder before the afternoon of admission.
Morphine sulfate, one-quarter grain, was given
immediately, and the convulsion was controlled
by drop ether. A Pezzar catheter was inserted
into the bladder, and a modified Stroganoff
routine was begun. Therapy consisted of mor-
phine sulfate and 50 per cent magnesium sulfate
intramuscularly, chloral hydrate rectally and
50 per cent glucose in distilled water -intrave-
nously.
Physical examination revealed an uncon-
scious, gravid negress, fourteen years old, with
slight infra-ocular and peripheral edema. Ex-
amination of the ocular fundi was normal. The
uterus was enlarged to the size of an eight
month pregnancy, with a single fetus in vertex
presentation. Fetal heart tones were audible,
and the presenting part was engaged. Blood
pressure was 168/110, temperature 101°F, pulse
128 and respirations 18. Urinalysis revealed 4
plus albuminuria, but no casts or cellular ele-
ments were present. Specific gravity was not
reported. Emergency blood chemistries were re-
ported as follows:
Nonprotein Nitrogen — _• 25 mgm per cent
Blood Urea Nitrogen 11.3 mgm per cent
Uric Acid 4.6 mgm per cent
Creatinin 1.5 mgm per cent
Glucose — 106.0 mgm per cent
CO2 Combining Power 57 vol. per cent
Total Protein 4.75 Gms. per cent
Albumin 2.85 Gms. per cent
Globulin 1.9 Gms. per cent
From the Division of Obstetrics and Gynecology, Mt. Sinai
Hospital, Cleveland.
The Authors
• Doctor Eichner, Cleveland, Ohio, is a grad-
uate of the School of Medicine, Western Re-
serve University, 1929; fellow of the Amer.
College of Surgeons; diplomate of Amer. Bd-
of Obstetrics and Gynecology; member of Cen-
tral Assn, of Obstetricians and Gynecologists;
and Cleveland Obstetrical and Gynecological So-
ciety; senior visitant, dept. Obstetrics and
Gynecology, Mt. Sinai Hospital, and consult-
ant in Obstetrics and Gynecology, Cleveland
State Hospital.
• Doctor Mallin, Cleveland, is a graduate of
the College of Medicine, University of Cin-
cinnati, 1937; diplomate, Amer. Board of Ob-
stetrics and Gynecology; junior visitant, dept,
of Obstetrics and Gynecology, Mt. Sinai Hos-
pital.
Admission spinal fluid pressure was 28.0 cm.
water. The Pandy reaction was negative, and
the cell count was zero. Spinal fluid protein was
36 mgm per cent, the gum mastic curve was
flat, and the Kline test was negative on blood and
spinal fluid.
Spontaneous labor started four hours after
admission, and ended under ether analgesia
with the delivery of a healthy, four pound pre-
mature infant at 6:02 a. m. on December 29,
1938. The placenta was easily expressed, and
bleeding was minimal. No oxytocics were used.
Blood pressure after delivery was 140/110. There
were no convulsions during labor and delivery.
Despite continuation of the modified Stroganoff
regime, the first post-partum convulsion oc-
curred 10 hours after delivery. Within the
next two hours thirteen additional convulsions
were recorded. These were not influenced by
medication or drop ether. In addition to a 300
cc. phlebotomy and the removal of 50 cc. of
spinal fluid, the patient received 25 cc. of
50 per cent sucrose, 4 cc. of 50 per cent
magnesium sulfate and one-half grain of mor-
phine intravenously during this period. By
midnight of the day of delivery, there had
been 25 convulsions. Blood pressure had dropped
to shock level (70/50), and anuria had developed.
The patient finally responded to cardiac and
respiratory stimulants, and to intravenous fluids.
Convulsions continued despite all therapy, and
the patient remained in coma. By the morning
of December 31, the second post-partum day,
213 major convulsions and innumerable attacks
of localized or unilateral twitchings (not always
in the same extremity) had been recorded. A
neurologist in consultation advised a revision of
therapy: paraldehyde was to replace chloral,
lumbar punctures were to be limited to one or
two daily, and all other than supportive therapy
882
The Ohio State Medical Journal
was to be discontinued. Before this change was
made, 239 convulsions had been charted. Only
nine occurred within the next twenty-four hours,
and none thereafter. Blood pressure finally
stabilized at 110/70. At 2:00 p. m. of the third
post-partum day the patient could be roused for
the first time, but she did not respond to ques-
tioning. She was still stuporous and unresponsive
on the fifth day, but had had no convulsion for
over 36 hours. Frequent muscular twitching
was still present. All sedation was discontinued
on January 4, the sixth postpartum day. Blood
chemistry and spinal fluid studies remained
normal. Albuminuria gradually decreased.
As the effects of sedation wore off, she began
to answer simple questions, but it was evident
that she could not identify objects by touch or
sight. She was considered to have a receptive
type (cortical-sensory) aphasia. At no time did
the ocular fundi show any pathological changes.
Neurological examination on her twenty-first
post-partum day revealed an apathetic but well-
oriented patient who responded to questions.
Ocular movements were normal, and there was
no nystagmus. Pupils reacted well to light and
accommodation. Vision was only slightly bet-
ter than light perception. Progress was con-
tinuous from this time, and she was discharged
from the hospital on January 31, 1939, the
thirty-third postpartum day. She was able to
get about without assistance, and her aphasic
disturbance had disappeared. Perimetric field
studies were considered normal. Blood chemistry
was reported as normal. There was no albumin-
uria, although an occasional hyaline, granular or
cellular cast was seen. Blood pressure on the
day of discharge was 110/80.
During the next nine months her progress
was followed in the outpatient department.
Vision was 20/50 in each eye, unimproved by
glasses. There was a slight bilateral temporal
constriction in the visual fields, worse in the
left eye. A weak Achilles tendon reflex, as
well as a questionable plantar response, was
present in the left leg. On November 24, 1939,
about eleven months after delivery, the patient
reported that she was in her regular grade (9A)
at school, doing normal work. She complained
only of defective vision.
In the seventh month of her second pregnancy,
she was admitted to the Mary B. Talbert Salva-
tion Army Home, and was delivered there on
January 8, 1941. Blood pressure and urine re-
mained normal throughout this pregnancy. Re-
examination at our dispensary in November,
1941, revealed no change from the previous find-
ings. The third pregnancy ended uneventfully
at the Mary B. Talbert Home on June 13, 1942.
Restudy of this patient during and after this
pregnancy showed only that vision had im-
proved, and could be corrected to 20/25.
Late in her third pregnancy she complained
of fainting and dizzy spells suggestive of petit
mal. Hadley3 mentions permanent brain damage
as an infrequent sequela of eclampsia. Follow-
ing neurologic, psychiatric and gynecologic con-
sultation, she was again admitted to Mt. Sinai
Hospital (V-8696) on November 16, 1942, where
supracervical hysterectomy and right salpingo-
oophorectomy were done. All laboratory tests
during this admission were reported as normal.
She was last seen on December 18, 1942, in
the outpatient department. Follow-up was dis-
continued during the war, and has been un-
successful since then. We have learned from
her father that she is now married, and ap-
parently in good health.
SUMMARY
A case of eclampsia in a fourteen-year old
negress with 252 recorded convulsions (4 ante-
partum) is reported. Brain damage was
evidenced by the presence of aphasia, and the
delayed development of attacks suggestive of
petit mal. Immediate recovery was almost com-
plete and she had two additional uncomplicated
pregnancies and deliveries within the next three
years.
REFERENCES
1. Adair: Obstetrics and Gynecology. Yol. I, page 750.
2. Arnell, R. E. : A Therapeutic Regime for Eclampsia.
Am. J. Obs. & Gyn., 49:49, Jan., 1945.
3. Hadley, H. G. : Convulsive Seizures Following Eclamp-
sia. Journal Nervous & Mental Disease, 92 :638, Nov., 1940.
4. Peckham, C. H. : An Analysis of 127 Cases of Eclampsia
Treated by the Modified Stroganoff Method. Am. J. Obs. and
Gyn., 29:27, Jan., 1935.
5. Ware, H. H., Jr., and Noblin, F. E. : A Review of
Eclampsia at the Medical College of Virginia’s Hospital.
South. M. J., 30:53, Feb., 1937.
Effect of Anticonvulsant Drugs on
Retinal Metabolism
3-5-5 trimethyloxazolidine, 2-4 dione (Tridione,
Abbott) and 5 ethyl, 3-5 dimethyloxazolidine,
2-4 dione (Paradione, Abbott) are anticonvulsant
drugs used in the treatment of epilepsy, parti-
cularly petitit mal. Both drugs have similar
ocular side-effects. In a clinical study with
Tridione, Sloan and Gilger described temporary
impairment of acuity, brightness sensitivity,
color discrimination, and sensitivity to flicker
at illuminations of a high brightness. These
workers concluded that the site of action of the
drug was at the retinal level. Since it would
be expected that drugs producing clinical defects
would cause inhibitions of retinal metabolism,
this study was undertaken.
Utilizing isolated beef retinae, over-all
retinal respiration was inhibited 50 per cent by
0.05 M. Paradione and by 0.10 M. Tridione.
At these concentrations glycolysis was not
measurably affected. Dehydrogenase reduction
of methylene blue was not affected by the drugs;
addition of cytochrome did not reverse the drug
inhibition of oxidation; and the drugs showed
no inhibition of cytochrome oxidase activity.
Thus at least part of the inhibition of oxidation
seems to be exerted on the flavoprotein link
in the oxygen transport chain. Further investi-
gation of this aspect is in progress.
In a preliminary study retinae of white rats,
after a month of daily sublethal drug injections,
showed an over-all inhibition of respiration by
approximately 50 per cent. — A. P. Gilger, M. D.,
A M.. Potts, Ph. D., M. D., Lorand V. John-
son, M. D., Cleveland, Ohio.
for September , 1950
883
Unusual Ovarian Cyst Developing Post Partum:
Case Report
MARION E. BLACK, M. D.
MRS. D. H., age 26, para 0, gravida 1, pre-
sented herself at five months of preg-
nancy. The last menstrual period was
November 13, 1947; estimated date of delivery
August 20, 1948. The patient had no complaints.
Past History: There were no previous opera-
tions and no serious illnesses.
Family History: There is no history of fami-
lial diabetes or tuberculosis. The patient’s mother
and father both have hypertension. One sister
had toxemia of pregnancy with her first
pregnancy.
Physical Examination: The patient was a well-
developed and well-nourished white female
weighing 103 pounds. Blood pressure was
110/70. The thyroid was palpable; the chest
was clear to auscultation; the heart sounds were
normal and heart size was within normal limits.
The thoracic and lumbar spine straight. The
kidneys, liver, and spleen were not palpable.
Fundus was two fingers above the umbilicus.
Pelvic measurements and internal measurements
revealed an adequate pelvis. There was no pelvic
pathology palpable; the cervix appeared normal.
Laboratory Findings: Hemoglobin was 90 per
cent; red blood count was 4.3 million; the urine
was negative and blood Wassermann was nega-
tive. The blood was found to be group AB and
Rh positive. X-ray of the chest was negative.
The patient’s pre-natal course proceeded un-
eventfully; blood pressure varied within a normal
range; the total weight gain was 20 pounds.
Labor. August 12, 1948. Patient had a two-
hour easy labor. Medication used was Demerol®
and Scopolamine® and a light Gas-Oxygen-Ether
anesthesia. The fetal head was on the per-
ineum; delivery was effected by low forceps
and a right medio-lateral episiotomy. The pla-
centa separated spontaneously. Gross examina-
tion revealed no abnormalities of placenta or
membranes. There was no excessive uterine
bleeding.
Hospital Course. The patient’s hospital post-
partal course was uneventful. No morbidity;
no excessive lochia. Patient successfully breast
feeding her baby. The newborn baby, a girl,
menstruated on the third and fourth days of life.
Six- Weeks Follow-Up Examination. Septem-
ber 25, 1948. Patient still breast feeding her
baby. There had been no menstrual period;
no excessive vaginal discharge.
Pelvic examination revealed a firm perineum;
cervix posterior; uterus anterior, normal in size,
freely movable; both ovaries were palpable and
normal in size; no adnexal pathology palpable.
Small eversion of the cervix on inspection.
Reexamination. October 12, 1948. Patient
complaining of abdominal distention and fatigue.
Slight vaginal discharge; No menstrual period;
patient still breast feeding her baby.
Abdominal examination revealed a soft mass
Submitted December 27, 1949.
The Author
• Dr. Black, Cleveland, Ohio, is a grad-
uate of the University of Pennsylvania Col-
lege of Medicine, 1934; formerly on resident
and teaching staffs at University Hospitals,
Cleveland; present acting director of the De-
partment of Obstetrics and Gynecology at Uni-
versity Hospitals and Western Reserve Uni-
versity School of Medicine.
filling the abdomen and extending slightly above
the umbilicus. On pelvic examination the cervix
was soft; uterus normal in size and position.
By sterile probe the uterus was measured at
7 cm. Left ovary palpable; cyst palpable as
noted in abdominal examination; the cul-de-sac
was empty.
Six days later, October 18, 1948. Patient
complained of shortness of breath. Abdomen
tense and the cystic mass extended up to the
xiphoid process. Pelvic findings same as on
last examination. Patient was admitted to the
hospital gynecology service with a diagnosis of
serous cystadenoma of the right ovary.
Operation. October 27, 1948. Under sodium
pentothal and Gas-Oxygen-Ether anesthetic, right
salpingo-oophorectomy was performed. Through
a low midline incision the abdomen was opened.
The cyst, filling the entire abdomen to the xiphoid
process was tense and grayish-white in color.
It was first emptied by suction, approximately
two gallons of serous, straw-colored fluid being
removed. The collapsed cyst was then re-
moved, along with the right tube, by ligation
and sharp dissection.
Pathological Report. “Multilocular cyst of
ovary, probably theca lutein cyst.” Urine ob-
tained on the fourth postoperative day gave
a positive Friedman test. Patient was dis-
charged on her eighth postoperative day in good
condition.
Postoperative Examination. November 23,
1948. Patient had no complaints. On pelvic
examination the cervix was posterior, and there
was a small eversion. Uterus anterior, normal in
size; left ovary palpable, normal in size. Preg-
nancy test was negative.
December 18, 1948. Pregnancy test still neg-
ative. Pelvic examination the same.
February 14, 1949. Repeat Friedman test
negative. Patient had a normal menstrual period
on February 3, 1949.
May 31, 1949. Menstrual periods have been
regular for the last four months. No complaints.
Pelvic examination the same.
December 1949. Periods have remained reg-
884
The Ohio State Medical Journal
ular; no vaginal discharge; no complaints.
Pelvic examination same as on last visit.
DISCUSSION
This is a case report of a rapidly growing
ovarian cyst in a recent postpartum phase of a
young primiparous woman. Because of its rapid
Multilocular cyst of ovary, probably theca lutein cyst
growth and easily demonstrable fluid wave,
preoperative diagnosis was serous cystadenoma.
The finding of lutein cyst, with a positive
Friedman test on the fourth postoperative day
(the 84th postpartal day) is difficult to explain.
This is certainly too late to occur from a hydatid
degeneration of the placenta. Since the placenta
was not saved reexamination of it could not be
made.
There is the possibility of a retained hydatid
degeneration in the uterus. However, the pa-
tient had a normal sized uterus by palpation
and by measurement. Patient did not have a
bloody discharge and had not passed the usual
hydropic chorionic villi. A curettage was not
done as such a diagnosis was not suspected
and was not done postoperatively as the pelvic
findings did not warrant it.
CONCLUSION
In conclusion, this case is presented as a
theca lutein cyst, its origin not to be explained
by the usual clinical symptoms or findings.
Hyaluronidase : An Aid to Local
Anesthesia in Ophthalmology
Hyaluronidase, when added to procaine per-
mits the same to spread much more rapidly
through the tissues. It affords a definite ad-
vantage in block anesthesia, as well as in in-
filtration anesthesia. Intraocular operations are
accomplished with smaller amounts of novocaine®
and the onset of the anesthesia is more rapid and
more profound.
—Harvey E. Thorpe, M. D.,
A. Steinberg, M. D., and
L. Greenfield, M. D.,
Pittsburgh, Pa.
- Brief authors’ abstract of paper presented at charter
session of the Association for Research in Ophthalmology
East-Central Section, held in Cleveland, Jan. 10 1950
The Story Behind the Word
Some Interesting Origins of Medical Terms
Artery — The ancient Greeks believed that all
arteries carried air because they never found
blood in the arteries of cadavers. They felt that
the “pneuma” or vital air kept the blood out of
the arteries and that whenever an artery was
cut in a living person the vital air or “pneuma ’
escaped and was replaced by blood. The terro
artery comes from the Greek word “arteria/'
literally a windpipe. The Greek word for air
being “aer.”
Hermaphrodite — A term of mythological origin-
Hermes, the messenger of the Greek Gods, as the;
male counterpart in combination with the Goddess'
Aphrodite, presents us with that anatomical
anomaly, the hermaphrodite.
Cholera — Celsus in his book De Medicina writ-
ten about 30 A. D., explained that this disease
owes its name to the vari-colored or bile-like
appearance of the watery discharges from the
bowels. The term cholera is derived from the
Greek word “chole” or bile.
Sciatica — A word which has been reduced by
time from the Latin term “ischiadicus.” This in
turn coming from the Greek “ischias,” a pain
in the hips and from “ischion,” the hip joint.
Aspirin — This commonly used drug had its
name coined from its chemical composition.
The “a” portion coming from acetyl and the
remainder of the name coming from “spiraeic
acid,” which was the old terminology for salicylic
acid.
Rickets — A term of uncertain and controversial
origin. Various authorities stating that it is
derived from: (1) The Latin term “rachis,”
the spine; (2) the old English word “wrickken”
to twist; or (3) the Anglo-Saxon word “hryey”
meaning back or ridge. Daniel Whistler in
1645 used the term rickets stating that the name
was said to have been taken from the surname
of a quack who was among the first to treat
the condition. Another and somewhat fanciful
explanation is that it arose in Dorset County,
England, where those who were short of breath
were said in the native dialect “to rucket.”
Francis Glisson in 1650 gave a classic description
of the condition and used the more technical
and Latinized term of “rhachitis or rachitis.*”
Herpes — A term used from the time of Hip-
pocrates to the present. It is descriptive of the
course and type of the skin lesion and comes
from the Greek word “herpo,” meaning “I creep
along.”
Koplik’s Spots — Henry Koplik of New York
City in 1896 first described the initial lesions
of measles on the mucous membranes which now
bear his name.
— Harry Wain, M. D., Mansfield, Ohio.
for September, 1950
885
The Advantages of Ocular Implants in Enucleation Surgery
DAVID E. ROLF, M. D.
DURING the past three years, the popularity
of the integrated implant has advanced
markedly as the experiences of surgeons
have proved quite favorable with regard to the
use of these implants in enucleations, eviscera-
tions, and secondary operations. This procedure
is approximately four years old, and from a
surgical standpoint, it has not been used long
enough to really evaluate it conclusively.
Nevertheless, it has demonstrated many ad-
vantages and such a high percentage of good
results as to warrant its continued use and
study.
The great advantages of an integrated implant
in enucleation surgery lie in the improved cos-
metic appearance of the patient; the psychologi-
cal “lift” which the patient enjoys as a result;
the increased motility and the more natural
type and scope of ocular excursions; and the ab-
sence or diminution of lid lag and eversion
of the lower lid. Furthermore, the popularity
of plastic protheses together with improvements
in the technique of their construction has added
to the favorable cosmetic results which are now
obtained with this type of surgery.
The operation itself, when properly per-
formed, requires little more time than a stand-
ard enucleation procedure and when its ad-
vantages are considered, the slight increase in
.operating time is certainly worth the effort.
DESCRIPTION
An integrated implant is usually composed of
methyl methacrylate and tantalum or vitallium,
in the form of a globe somewhat simulating
the human eye. It is placed in the socket and
the conjunctiva is attached around it. However,
it is not completely covered because it is con-
nected to the prothesis by means of a small,
central peg, which is usually made of gold,
tantalum, or plastic. This imparts a degree
of motility to the prothesis which can never be
obtained with the old type of buried implant
where much of the motility is lost because it
cannot be transmitted properly to the prothesis
which rests on the closed conjunctiva. The
excursions of integrated implants are enhanced
markedly by the direct attachment of the extra-
ocular muscles to them. These implants, in
turn, move the protheses.
Ocular motility is much greater with these
types of implants for several reasons. To
begin with, none of the conjunctiva is lost, so to
speak, and enough space is left during the
Submitted November 22, 1949.
The Author
• Dr. Rolf, Cleveland, Ohio, is a graduate
of Marquette University School of Medicine,
Milwaukee, 1932; diplomate, American Board
of Ophthalmology; fellow, American Academy
of Ophthalmology and Otolaryngology; on
staff. Doctors Hospital; and chief of eye depart-
ment, Glenville Hospital.
closure to preserve an area on the surface which
would correspond to the area of normal cornea.
Secondly, the prothesis can be made smaller
because it does not rest on the conjunctiva of
the lids, but rests instead on the peg in much
the same way that a wheel will rest on an axle.
In this way, a much smaller prothesis can be
used, and this, of course, diminishes both its
weight and size. The cosmetic appearance of
the patient is thus improved, and there is a
great increase in ocular motility.
When integrated implant operations were first
attempted, many questions were raised regard-
ing the possibility of infection as the result
of the retention of an implant within a socket
which had not been completely closed. How-
ever, hundreds of these implants have been
used during the last few years, and yet there
have been very few reports of infection. As a
matter of fact, the entire socket seems to be cov-
ered with a mucoid type of membrane that seems
to resemble epithelium somewhat and this change
in Tenon’s capsule seems to account for the
absence of infection in practically all cases.
Another problem which presented itself was
that of allergy. It is also true that perhaps
there are patients who are allergic to methyl
methacrylate or even tantalum for that matter.
However, clinical reports of this have been fewr
and far between. The methyl methacrylate is
now heat treated and furthermore, tantalum
seems to act as a barrier in some way so that
there are practically no definite instances of al-
lergic reactions as a result of the inclusion of
an integrated implant following enucleation.
The chief problem with this type of procedure,
however, has been the possibility of extrusion,
and various implants have been devised to pre-
vent this complication.
The first implants were those devised by
Ruedemann and Cutler, and later implants were
produced by Hughes, Guyton, Stone, Jardin,
Rolf, and others. All these men have attempted
variations in design of one type or another in
886
The Ohio State Medical Journal
an effort to minimize the percentage of extru-
sions. In the implant which I devised, the
neck was made somewhat smaller so that the
tissues could be gathered around it in a firm
type of closure. Muscles, Tenon’s capsule, and
epithelium were closed in such a manner that
the body of the implant had a much wider
diameter than the narrow neck at the surface.
It was thought that this would act as a
mechanical barrier to extrusion and retain the
implant somewhat more firmly.
I am at present preparing a new implant of
improved design which I hope will simplify the
operation, increase ocular motility, and prevent
extrusions.
In general, the implants which have been
devised to date fall into four main types:
1. The implant and the prothesis are con-
structed as a unit. It is inserted in the socket
and the muscles are attached to it by means of
sutures which are sewed to tantalum mesh.
This type of implant has certain disadvantages.
a. It is difficult to align the muscles
properly so that there will be no postoper-
ative strabismus.
b. It is hard to match the eye at the
time of operation.
c. If the prothesis chips or becomes discol-
ored, one has to literally re-operate the
patient.
2. The second type of implant consists of a
globe of methyl methacrylate with a ring
around its center and a double layer of tan-
talum mesh on the surface. The muscles are
reflected around the ring and each tendon is
sewed to the belly of the muscle. Tenon’s
capsule and conjunctiva are attached to the
tantalum mesh.
3. The third type of implant does not have
a ring, but instead the muscles, Tenon’s capsule,
and conjunctiva are attached to the implant by
means of sutures imbedded in a double layer
of tantalum mesh.
4. A magnetic implant which holds the pro-
thesis by means of magnetic attraction.
Constant improvements are being sought with
the following objectives in mind:
a. Reduction in length of operating time.
b. An improvement in the cosmetic ap-
pearance of the patient.
c. The prevention of extrusion.
d. Increased motility.
e. Prevention of retraction of the con-
junctiva and Tenon’s capsule from the tan-
talum mesh which surrounds most of these
implants.
In view of the fact that there have been
few extrusions, that the operation is not too
difficult, and the cosmetic result is so definitely
superior, I think it advisable to insert an in-
tegrated implant in almost every instance.
KEEPING UP WITH MEDICINE
• An impaired appetite is a satisfactory early
guide to digitalis poisoning.
* * *
• Man’s perversions from the biologic norm
make him pay with discomfort, invalidism, and
death.
^ ^
• Absolute rest is the main cause of pulmon-
ary embolism and as many patients die from
this cause in The New York Hospital as from
cancer of the stomach. Maybe we ought to
start a society aimed against rest in bed?
*J* JjC 5jC
• As a means of securing absolute rest the
chair is superior to the bed.
* * ❖
• Alcoholism represents a human being who is
escaping from intolerable stresses and strains.
* * ❖
• The best evidence indicates that in edema
there is no primary trouble with the excre-
tion of water. It is the sodium not the water.
Plain water to a patient with edema may not only
fail to increase the edema but if given a large
enough amount of water, the edema will actually
diminish.
* * *
• Interstitial edema may occur in the lungs
without causing any rales.
?*C
• Prickly heat seems to be due to excess salt
intake and is rapidly dispelled when large
quantities of distilled water are administered.
^ ^ ^
• The most common bone disease is nonspecific
and can be produced in experimental animal by
withholding any one of 40 essential nutrients.
* sjc
• It is becoming clear that the concentration
of potassium is fully as important as that of
sodium.
❖ * *
• In most patients requiring an intravenous solu-
tion, Ringer’s solution would be better than
normal saline solution.
* * *
• Overdosage of desoxycorticosterone may be
fatal. This material must be given with great
caution and every effort made not to give an
overdose.
* * *
• Although sensitivity to allergens is, of
course, the immediate cause of allergic rhinitis
and allergic sinusitis, the sensitivity itself may
be but a symptom of a chemical imbalance aris-
ing from dietary deficiencies.
* * *
• Our fighting forces against infectious dis-
eases depend upon our protein intake. — J. F.
for September, 1950
887
A Case of Splenic Neutropenia Complicated by Infectious
Mononucleosis After Splenectomy
CARL I. WYLER, M. D., and EUGENE H. STERNE, Jr., M. D.
IT has been known for many years that
derangement in the normal physiology of the
spleen was closely associated with certain
hemolytic or thrombocytopenic states, but it
remained for Wiseman and Doanla>b to emphasize
that the white cells may be similarly affected.
-From these studies there has grown the con-
cept of hypersplenism and there are a num-
ber of cases on record in which an acute or
chronic neutropenic state has been shown to
be secondary to overactivity of an otherwise
normal spleen and which have been cured by
-splenectomy .2a> b> c> d> e
-Doan and Starr- Wright3 have pointed out that
in congenital or acquired hemolytic anemia,
thrombocytopenic purpura, and primary splenic
neutropenia, a definite secondary decrease some-
times occurred in one or more of the cell types
not primarily involved. There are therefore
varying hematological syndromes ranging from
a panhematopenia3 to any combination of anemia,
neutropenia, and thrombocytopenia.
If the diagnosis is based on the sound hema-
tological principles as originally set forth by
Wiseman and Doan,lb splenectomy is curative
in most cases. The following case of primary
splenic neutropenia and anemia was followed
over a period of three years and resulted in an
adequate clinical and hematologic recovery
subsequent to splenectomy. The postoperative
period was complicated by an illness strongly
suggestive of infectious mononucleosis.
CASE REPORT
J. P., an eighteen-year-old student nurse, was
seen on June 25, 1946, complaining of a pain-
ful swelling in the right axilla which had
appeared subsequent to a hair follicle infec-
tion. Two months previously she had visited
the personnel physician for an aphthous sto-
matitis and later for a cellulitis of the right
knee following a minor trauma. The cellulitis
healed uneventfully with wet dressings and
penicillin. There was no history of exposure
to any of the usual leucopenic agents.
At the time of admission she complained of
severe headache, backache, and general prostra-
tion. Temperature was 101.6. Examination
showed only a cherry-sized area of induration
in right axilla surrounded by moderate
cellulitis. Initial white blood count, four hours
after admission, was 1900 with 11 per cent
neutrophiles. (Detailed blood studies done at
From the Department of
Health Service Hematology
Cincinnati College of Medicine,
Submitted Dec. 28, 1949.
Internal Medicine, Student
.Laboratory, University of
Cincinnati General Hospital.
The Authors
• Dr. Wyler, Cincinnati, is a graduate of
University of Cincinnati College of Medicine,
1937; fellow, Amer. College of Physicians;
member, Amer. Board of Internal Medicine,
senior attending, dept, of Internal Medicine,
Jewish Hospital, Cincinnati; instructor, dept,
of Int. Med., College of Medicine, University
of Cincinnati.
• Dr. Sterne, Cincinnati, is a graduate of
Harvard Medical School, Boston, Mass., 1937;
member, American Board of Internal Medi-
cine; formerly, director Hematology labora-
tory, Cincinnati General Hospital and asst,
chief medical out-patient clinic; is now at
Veterans’ Administration regional office.
this and on subsequent occasions are listed in
table I.) Because of this finding, sulfamerazine,
of which 2 grams had been given on admission,
was discontinued. The axillary abscess eventually
became fluctuant and was drained. Culture of
this pus showed staphylococcus aureus. The
fever, which ran an irregular course with peaks
of 103°, gradually subsided over a period of
eight days. At no time was the spleen palpable
during this admission. Therapy, which included
1500 cc. of whole fresh blood, folic acid, and
liver extract, had no effect on the neutropenia.
However, she was discharged symptomatically
well on the 19th hospital day.
The second admission was on August 1, 1946,
because of a severe pharyngitis. Temperature
was 101.6 and total leucocytes 2200 of which
28 per cent were neutrophiles. With penicillin
therapy there was rapid improvement and she
was discharged on the fourth day. An aspira-
tion biopsy of the sternal marrow on this ad-
mission showed a normal cytology except for
slight maturation arrest of the neutrophilic
series.
Approximately one month later a soft and
non-tender spleen became palpable one finger
breadth below the costal margin. She was re-
admitted on September 16, 1946, to determine
the cause of the persistent neutropenia. Blood
studies on this occasion showed for the first
time a macrocytic anemia. A bone marrow
aspiration now showed, both on smear and fixed
button preparations, a normoblastic hyperplasia
without alteration in the leucocytic series. An
adrenalin® test showed a rise in the leucocyte
count from 2600 to 4400 one-half hour after
the intramuscular injection of 1 cc. of adrenalin,®
with a rise in the absolute neutrophile count
from 550 to 2225.
Because of the patient’s prolonged clinical
888
The Ohio State Medical Journal
course together with the blood studies, a diag-
nosis of hypersplenism seemed likely and, ac-
cordingly, on September 26, 1946, a splenectomy
was performed by Dr. Louis G. Herrmann. At
operation the spleen was described as “enlarged”
and firm adhesions which bound it to the dia-
phragm made its removal difficult. After care-
ful search a small accessory spleen was found
and removed.
Postoperatively there was an immediate rise
in the leucocyte count with a subsequent fall
to 1800 the following morning. The convales-
cence was uneventful and there followed a
gradual increase in total leucocyte and ery-
throcyte counts. She was discharged on October
10, 1946.
Four days later she was readmitted because
of a brief history of chills, malaise, headache,
and sore throat. Physical examination revealed
tender swollen cervical lymph nodes and a
moderate pharyngitis. Atypical young lympho-
cytes appeared in the blood smear for the first
time on October 18, and the percentage of
these cells continued to increase. The hetero-
phile agglutination one week after admission
was 1-8. This subsequently rose to 1-64 three
weeks after admission. Two weeks later it
was 1-32.
Clinically this admission was marked by high
fever, severe sore throat, and persistent head-
ache. In contrast to previous and subsequent
attacks of pharyngitis, penicillin was unavail-
ing. She was discharged on November 12, 1946,
fever free, but weak and tired.
Since that time there have been no symptoms
with the exception of four attacks of pharyngitis.
She has continued to follow her nursing career,
has regained her weight and strength, and
feels well.
DISCUSSION
Despite the failure of the total and differen-
tial leucocyte count to return completely to
normal, there are good reasons for classifying
this case as ideopathic hypersplenism.
All the criteria currently necessary for the
diagnosis of hypersplenism are developed as
the result of primary or secondary hyperactivity
-of the reticuloendothelial system, particularly
in the spleen.lb-3 This case, which showed:
(a) A severe neutropenia at the time of the
first examination for axillary abscess, (b) per-
sistence of the neutropenia for four months,
(c) the development of a macrocytic anemia
with slight reticulocytosis, (d) a bone marrow
active for both myeloid and erythroid elements,
but without evidence of maturation arrest or
abnormal cell forms, (bone marrow aspiration
of September 19), (e) the appearance of a
palpable spleen while under observation, and
(f) a suggestive adrenalin® test3*4- fulfills these
criteria. Further, the failure of any of the
diseases known to produce neutropenia or sec-
ondary hypersplenism to appear over the three
year period of observation, together with a spleen
of normal anatomy, effectively eliminates such
possibilities. For the reasons listed (a through f),
a splenectomy was performed.
It is of interest to comment on the pathologi-
cal appearance of the removed spleen. It is
not intended to enter into a discussion as to
whether the primary defect is essentially a
mechanical one, i. e. hyperphagocytosis and
sequestration of white and red cells within the
structure of the spleenla*b or rather, one of a
distant humoral effect of the spleen on the bone
marrow.5a*b Touch preparations made at the
time of surgery and stained by supravital and
Wright’s methods, failed to reveal increased
clasmatocytic activity as described by Wiseman
and Doanlb though such of course may well
have existed in vivo, or in the unexamined
portions. Fixed sections of the spleen were
interpreted as being within normal limits. The
spleen was not greatly enlarged, although at
the time of surgery some increase in size was
noted by the operator. A weight of 165 grams
may be normal or slightly heavy for a spleen
in this small young woman.6 Unquestionably,
considerable reduction in size took place during
the manipulation necessary to removal. The
palpability of the organ developing during the
course of illness certainly indicates increasing
size, as is usual in this syndrome.
Also to be considered is the failure of the
neutrophile count completely to return to normal
values following splenectomy. That the ulti-
mate stabilized total and differential leucocyte
count is not entirely adequate in this instance is
indicated by the recurring episodes of upper res-
piratory infection. Apart from these brief
illnesses, however, the patient can be considered
as well. This is demonstrated by the successful
completion of her arduous nurse’s training pro-
gram, the maintenance of her usual body weight,
and above all, her entire freedom from signs and
symptoms of illness.
It is, of course, possible that a small amount
of accessory splenic tissue may be present, and
that the patient, therefore, still suffers from a
mild degree of hypersplenism. While accessory
splenic tissue was carefully searched for at
the time of operation (and in fact one such
small bit was removed), it is well known that
small amounts may be exceptionally hard to
find. However, the return of the preoperative
anemia to normal, together with the sustained
maintenance of normal erythrocyte count and
the considerable increase in the number of
neutrophiles suggest that no significant amount
of such tissue can remain.
The possibility of some other disease causing
the persistent moderate neutropenia need not
now be seriously considered in view of a period
of over three years without development of
evidence of such disease.
The concept that the reticuloendothelial ele-
ment of the spleen is the cell type actually re-
sponsible for this syndrome is an attractive one.
If this be so, it is not too difficult to hypothesize
that in removing the spleen we are removing
for September, 1950
889
only a considerable portion of these cells, and
that the' residual neutropenia may be ascribed
to overactivity of the remaining elements.
Hyperreticuloendotheliosis, then, rather than
hypersplenism, would better define the nature
of the process.
POSTOPERATIVE COMPLICATION DISCUSSED
This case is made doubly interesting by the
appearance, after three weeks of normal post-
operative convalescence, of an acute febrile
illness, clinically and hematologically indistin-
guishable from infectious mononucleosis. So
far as can be determined from the literature
and inquiry, 7a infectious mononucleosis in a
splenectomized person has not previously been
reported. Clinically the presence of high fever,
moderate prostration, severe pharyngitis, and
considerable tender cervical adenopathy, to-
gether with the sudden and rapid increase in
the leucocyte count from 3000 to the un-
precedented level (for her) of 16,800 with ap-
proximately 50 per cent of the cells being
atypical young lymphocytes of the type charac-
teristic of infectious mononucleosis, are sufficient
to make the diagnosis. Though the heterophile
agglutination did rise from 1:8 to 1:64, it re-
mains in the equivocal range. With an adequate
clinical and hematological picture, a high titer
of heterophile agglutination, though pleasing, is
not considered essential to the diagnosis of in-
fectious mononucleosis. Indeed one might spec-
ulate that the failure of the heterophile agglu-
tination to reach a higher titer might conceiv-
ably be associated with a role of the spleen in
antibody formation.
The uniqueness of this episode is made more
significant when it is appreciated that such
a cellular reaction and cervical adenopathy
was associated with none of her many bouts of
pharyngitis nor other infections. Further, while
other febrile episodes responded excellently to
penicillin therapy, on this single occasion, large
doses of penicillin were entirely unavailing.
Though splenectomy itself is known to produce
certain changes in the leucocyte counts a
TABLE I
REPRESENTATIVE BLOOD COUNTS*
Dale
WBC.
N
L
M
RBC.
HG.
MCV.Ret.
Pts.
Remarks
p
o
June
25, 1946
1,900
11
43
43
4.12
13.8
94 .09
560
27
1,700
6
54
36
i- .gs
29
1,500
12
36
38
S 2
July
6
3,200
26
54
10
◄
10
3,000
38
42
12
c
Second
Admissio
Aug.
1
17
20
2,200
2,000
2,100
28
12
64
46
8
32
4.14
14.4
1.2
405
Bone marrow : slight neutrophilic
maturation arrest.
Sept.
16
2,550
20
52
25
2.64
11.9
125
3.2
741
19
2,600
26
37
29
3.19
12
121
3.6
313
Bone marrow : normoblastic hyperplasia.
Adrenalin® test done.
c
23
2,600
3.08
12.7
1.5
498
"5'S
26
2,400
3.38
13.2
1.3
560
Pre-operative
5,700
3.26
12.8
After tying splenic vein.
h|
3,050
3.46
13.3
6 hours post-operative.
27
1,800
8
16
71
4.19
16.5
2.6
1,118
Transfusions given.
28
1,850
28
31
45
4.04
15.7
2.1
383
30
2,250
31
29
33
4.10
14.5
.5
625
Oct.
3
4,100
44
35
14
4.00
16
107
.2
616
7
6,200
43
38
8
4.10
16.1
109
1.2
1,113
Oct.
15,
1946
2,400
9
32
46
3.89
15.1
99
.4
474
s
18
3,650
16
54
33
4.40
15.9
.9
748
9% Atypical young lymphocytes
x.S
19
3,800
12
58
23
16% Atypical young lymphocytes
i n
3
21
6,100
13
81
5
51% Atypical young lymphocytes
o E
24
12,800
2
89
6
50% Atypical" young lymphocytes
<<
28
16,800
8
87
5
42% Atypical young lymphocytes
Nov.
4
9,900
8
77
14
20% Atypical young lymphocytes
12
4,950
15
57
18
3.53
11.6
.8
840
2% Atypical young lymphocytes
Dec.
26
6,100
4.55
13.5
728
Jan.
7,
1947
3,800
12
69
13
4.28
13.3
98
2.6
1,147
Feb.
27
3,100
14
55
23
4.85
12.8
84
1.2
805
May
17'
2,750
10
80
10
Pharyngitis
Dec.
4
5,250
10
90
Pharyngitis
Jan.
2,
1948
4,350
26
66
2
Sept.
14
5,100
2
89
8
Pharyngitis
Feb.
24,
1949
4,700
28
70
2
Pharyngitis
April
18
3,750
31
41
13
4.38
13.8
91
1.3
438
* Explanation of abreviations : WBC — Total white count ; N — Neutrophils ; L — Lymphocytes ; M — Monocytes ; RBC — -
Total red count in millions ; HG — Hemoglobin in grams ; M CV — mean corpuscular volume ; Ret — Reticulocytes in per
cent ; Pts. — Platelets in thousands.
890
The Ohio State Medical Journal
similar lymphocytic leucocytosis is nowhere re-
ported from this cause alone.
SUMMARY AND CONCLUSION
1. A case of persistent neutropenia with
anemia developing in a young woman and fav-
orably modified by splenectomy is presented.
2. The concept of hypersplenism and pos-
sible reasons for failure of the complete hema-
tological recovery are discussed.
3. The development of a postoperative com-
plication strongly suggesting infectious mononu-
cleosis is described.
BIBLIOGRAPHY
1. (a) Wiseman, B. K., and Doan, C. A.: A newly rec-
ognized granulopenic syndrome caused by excessive splenic
leucolysis, successfully treated by splenectomy. Jr. Clin.
Invest., 18:473, 1939.
(b) Wiseman, B. K., and Doan, C. A. : Primary splenic
neutropenia : A newly recognized syndrome, closely related
to congenital hemolytic reterus and essential thrombocy-
topenic purpura. Ann. Int. Med., 16:1097, 1942.
2. (a) Moore, C. V., and Bierbaum, O. S. : Chronic
neutropenia treated by splenectomy. Internat. Clin., 3 :86,
1939.
(b) Meuther, R. O., Moore, L. T., Stewart, J. W.,
and Brown, G. O. : Chronic granulocytopenia caused by
excessive splenic lysis of granulocytes. Jr. Am. Med. Assoc.,
116:2255, 1941.
(c) Rogers, H. M., and Hall, B. E. : Primary splenic
neutropenia. Arch. Int. Med., 75 :192, 1945.
(d) Langston, W., White, O. A., and Ashley, J. D., Jr.:
Splenic neutropenia. Report of a case with splenectomy.
Ann. Int. Med., 23:667, 1945.
(e) Weiss, H. A., and Collins, W. T. : Chronic neutro-
penia : Favorable response following splenectomy. Blood,
4:278, 1949.
3. Doan, C. A.; and Wright, C. S. : Primary congenital
and secondary acquired panhematopenia. Blood :1, 10, 1946.
4. Doan, C. A. : Clinical Implications of Modern Phy-
siologic Hematology. St. Paul, Bruce Publishing Co., 1936.
5. (a) Dameshek, W. : Editor’s footnote. Blood :1, 12,
1946.
(b) Dameshek, W. : Editorial. Blood :1, 173, 1946.
6. Krumbhaar, E. B., and Lippincott, S. W. : The post-
mortem weight of the “Normal” human spleen at dif-
ferent ages. Am. Jour. Med. Sci. :197, 344, 1939.
7. (a) Wintrobe, M. M. : Private Communications, 1949.
(b) Wintrobe, M. M. : Clinical Hematology, Phila-
delphia, Lea and Febiger, 1946.
Protein Transport
in Ocular Structures
The aqueous humor under normal conditions
contains only traces of protein, but in certain
pathological states aqueous protein becomes
elevated and diffusion to other ocular structures
occurs.
To evaluate and quantitate this phenomenon,
human plasma albumin, and beef gamma globulin
labeled with radio-active iodine were injected in
experimental animals either intraocularly or
intravenously. After a given time samples of
ocular fluid and tissues were removed and radio
activity determined.
— Albert M. Potts, Ph. D., M. D.,
Lorand V. Johnson, M. D.,
With the Technical Assistance of
Mildren Orchen and Doris Goodman,
Cleveland, Ohio.
Brief authors’ abstract of paper presented at charter
session of the Association for Research in Ophthalmology,
East-Central Section, held in Cleveland, Jan. 10, 1950.
Radiography and Clinical Medicine
There are signs that the degeneration of clini-
cal medicine is spreading with the aid and at the
expense of radiology; it will ultimately bring
radiology into disrepute. In a recent English news-
paper it was stated that “one in every 20 people
in Britain — or over 2,000,000 — suffers from
rheumatism. So it has been decided to mass-
radiograph the joints of groups to ascertain the
extent of the disease. When the unit is in oper-
ation it is proposed that every one of the 73,000
miners in the area will be X-rayed whether he
ha>s rheumatism or not.” As pointed out by an
orthopedic surgeon in a letter of appreciation
of my opposition to this type of activity, “The
whole thing is really an attempt on the part of
some people to increase the number of attend-
ances of their patients to astronomical figures
and to increase similarly the work of other de-
partments, and on the strength of this to in-
crease the number of staff. The result of this
is, of course, that with a very large staff the
man in charge must be a very great person.”
Mass radiography of the stomach is being used
in one famous American hospital (surprisingly
enough, in one to which a former physician
brought great fame by his contributions to
clinical medicine) for the detection of early
malignant disease, and claims have been made of
:ests which reveal its presence. This might
well incite further extensive mass radiological
investigations. I believe one’s energies in this
direction could favourably be reserved until a
cure for malignant disease has been discovered;
then it could be applied enthusiastically with
all skill.
There are other spheres in which the use of
radiology not only fails to spare the patient
pain but actually incites the infliction of pain
by the performance of investigations, including
surgery, which can be regarded as little else
than meddlesome. I heard a professor of medi-
cine at one of the universities urge that ventric-
ulography was a useful, harmless, and pain-
less method of investigating the cause of head-
aches. I saw the exhibition of radiographs of
a patient with three aneurysms of the aorta,
one of which showed radiographic evidence of
erosion of the sternum and ribs. This patient
sought the doctor because he had pain, and it
should be our first duty to relieve that pain,
yet this evidence did not incite the observer to
pity, but to inject the aneurysm with opaque
media to provide spectacular evidence of the
extent of the lesions — knowledge which could
not be of the slightest use to the patient, but
which apparently satisfied the callous inquisitor.
— James F. Brailsford, M. D., British Medical
Journal, No. 4630, October 1, 1949.
jor September, 1950
891
Tuberculosis Abstracts
A Review for Physicians Issued Monthly by the National Tuberculosis Association
COUGH may be distressing and purposeless
but more often it is a necessary and useful
act. Cough can be produced voluntarily
but more commonly it is a reflex response
frequently reinforced by volition.
The act of coughing can be divided into three
phases, namely: inspiratory, compressive, and ex-
piratory. During the inspiratory phase there is
a deep, often quick inspiration, followed by clos-
ure of the glottis. This results in an increase
in intrapulmonary pressure, the compressive
phase, immediately preceding expiration. During
the expiratory phase the air is forced out with
the production of characteristic cough sounds.
The function of cough is the removal of mucus,
inflammatory exudate and other material from
the air passages, or foreign bodies and other ma-
terials which may have been aspirated into the
tracheobronchial tree.
Cough is a complex act which depends for its
effectiveness on a number of factors. Impor-
tant among these are bronchial movements which
are dependent upon the ability of bronchi to
elongate and increase their diameter during
inspiration and to shorten and decrease their
diameter during expiration. During the expira-
tory phase there is also forcible compression
of the lung through action of the diaphragm
and the chest wall.
The narrowing of the bronchus is greatly ac-
centuated in asthmatics and in cases of pulmonary
emphysema. It is observed least in persons
with pulmonary fibrosis or anthracosilicosis.
This compressive action forces secretions upward
into the larger bronchi.
Ciliary function is important in the elimina-
tion of secretions from all portions of the air-
way except the terminal bronchioles. During
acute infections with excessive or tenacious
secretions, activity of cilia may be greatly im-
paired.
The establishment of a condition of tolerance
may lessen or obliterate temporarily the reflex
cough. This is commonly observed in patients
with bronchiectasis who are able to go without
coughing for hours. When cough is initiated
volitionally they may evacuate several ounces
of pus before again relapsing into a state of
tolerance.
What are the causes of cough? In the com-
mon respiratory diseases such as pulmonary
tuberculosis, pulmonary abscess or other pul-
monary diseases, cough is a frequent symptom,
and the cause can be demonstrated by roentgen
study and physical examination. Excessive smok-
ing and chronic alcoholism produce local con-
gestive changes in the pharynx, larynx and
tracheobronchial tree which give rise to cough.
Exposure to dust and fumes exerts an unfavor-
able influence on the respiratory tract. An
extrarespiratory cause of cough may be ir-
ritation of the external auditory canal, or nasal
and pharyngeal obstruction. Cough may be
associated with the taking of food or fluid, in
paralysis of the larynx, or in laryngeal disease.
Severe productive cough occurring when one
changes position suggests either pulmonary
abscess, bronchiectasis or empyema with bron-
chopleural fistula. In investigating this symptom
a careful history of the onset and character of the
cough, the precence and appearance of sputum,
the time of occurrence and associated symptoms
are important.
A study of the chest and the cardiovascular
system should be made. The more common
causes of cough should be excluded first. One
should then proceed with an examination of the
ears, nose, mouth, throat, laryngopharynx,
larynx and neck, which can be done by any phy-
sician who has a reasonable knowledge of the
upper air and food passages. The inveterate
smoker should be encouraged to discontinue
smoking and the worker in dust or fumes should
minimize exposure in the absence of any definite
localizing evidence of disease. Unexplained
radiographic shadows or localized physical signs,
indicate bronchoscopy if the patient is an adult
male. Cough with or without slight sputum is;
a common early symptom of bronchogenic car-
cinoma.
Bronchography is indicated if there is any
suspicion of increased bronchopulmonary mark-
ings suggesting bronchiectasis. With a history
of allergy, appropriate tests should be made.
The patient may be contented with the effects;
of a cough sedative or intralaryngeal instillations*.
The physician, however, should be interested in.
determining the cause of the cough.
Cough is necessary to rid the tracheobronchiaL
tree of excessive secretions as in pulmonary ab-
scess or bronchiectasis and in these narcotics,
should be used sparingly. In carcinoma, cough
commonly is purposeless and is an early mani-
festation of bronchial irritation. In the post-
operative case the cough “reflex” should not be
suppressed. There must be adequate drainage
of the tracheobronchial tree to prevent bronchial
obstruction with secretions and postoperative pul-
monary atelectasis.
If cough is purposeless, cough sedatives may
be indicated. When cough is inadequate so-
called stimulating expectorants are recommended.
Inhalations of carbon dioxide and oxygen in-
crease the quantity of sputum, and have been
highly recommended. — Cough, Louis H.. Clerf >
M.D., The Mississippi Doctor, July, 19 U9.
892
The Ohio State Medical Journal
Ohio Physicians in the Nineteenth Century,
a Statistical Study
PART II
FREDERICK C. WAITE, Ph. D.
( Concluded from August Issue )
APPROXIMATELY 2,000 medical degrees had
r-\ been conferred by medical colleges in Ohio
^up to 1850 inclusive, when the United States
census showed 4,274 physicians in Ohio. By no
means all of these graduates of Ohio medical col-
leges remained in the state for practice. A con-
jecture is that not much more than one-fourth of
the physicians in Ohio in 1850 held the degree of
Doctor of Medicine.
Butler’s directories of 1874 and 1877 make no
pretense of indicating whether a physician held
a degree or not. The first edition of Polk’s
Medical and Surgical Register of the United
States, published in 1886, lists 4,947 physicians
in Ohio of whom 3,257, nearly sixty-six per cent,
are credited with a degree. The second edition,
published in 1890, credits nearly seventy-four
per cent of those listed with a degree. How-
ever, many names are marked with a symbol
indicating that no reply was received to the
inquiry of the compilers. Doubtless some of
those who failed to reply held a degree so that
it may be stated that in 1890 three-fourths or
more of the practitioners in Ohio held the de-
gree of Doctor of Medicine.
The first edition of The Directory of the
American Medical Association was published in
1907 and lists 7,710 physicians in Ohio of whom
199, or two and six-tenths per cent, are not
credited with a degree.
SECTARIAN PRACTITIONERS IN OHIO
No reliable figures for sectarian practitioners
in Ohio are available until the appearance of
medical directories in the final quarter of the
nineteenth century. Thomsonians increased
rapidly from 1830 to 1845 and the eclectics and
physio-medicals, derived from the Thomsonians,
began to appear before 1845. The homeopaths
came a little later.
The History of Homeopathy and its Institu-
tions in America, published by William H. King
in 1905, states that 188 different homeopaths
practiced in Ohio prior to 1860 and gives figures
for four years, namely: 120 in 1857, 422 in 1875,
498 in 1885, and 968 in 1899. Comparison with
figures from medical directories noted in the
following paragraphs shows an exaggeration of
claims over the information in the directories.
Statistics for sectarian practitioners in the
state are derived from three medical directories.
Butler’s national medical directory published in
1874 lists 4,583 practitioners in Ohio. It carries
symbols indicating irregular practice attached
to 790 names, more than seventeen per cent.
These are divided into three groups, namely:
241 homeopaths, 300 eclectics, and 249 who
were suspected of being irregular in their
practice. This third group included physio-
medicals and men on the fringe of medicine such
as clairvoyants, magnetic healers, and mes-
merists. Doubtless it included some homeopaths
and eclectics.
The second edition of Polk’s national medical
directory was published in 1890 and contains
6,469 names of physicians in Ohio of which
1,736, twenty-seven per cent, did not declare
their system of practice, mainly from failure
to reply to the inquiries of the compilers. There
were 4,733 who did declare of which 959, or
twenty-seven per cent, were sectarians, divided
into 501 homeopaths, 393 eclectics, 51 physio-
medicals, and 14 on the fringe of medicine such
as botanies, magnetic healers, metaphysicians,
and vitopaths.
DECLINE OF SECTARIANISM
The fifth edition of Polk’s directory published
in 1898 carries 8,231 names in Ohio of whom
the system of practice is indicated for 7,991.
for September, 1950
893
Of these 1,687, or more than twenty-one per
cent of the total of declarers, were sectarians.
The division is 914 homeopaths, 673 eclectics, 86
physio-medicals and 13 on the fringe of medicine,
such as botanies, electropaths, hydropaths,
osteopaths, and vitopaths. This directory carries
a considerable number of men who are shown
to have been graduated at sectarian medical
colleges but declared themselves regular in prac-
tice. Only a very few graduates of regular
medical colleges declared themselves sectarians.
Sectarianism was decreasing in popularity
with the laity. It declined during the final
third of the nineteenth century, first affecting
the botanies and physio-medicals. The last
physio-medical college in Ohio closed in 1885.
Rapid decline of sectarianism began about 1890
and was accelerated after 1900. The sectarian
medical colleges could not keep up with improve-
ments in medical education. A statistical study
of physicians in Ohio in the first half of the
twentieth century is desirable.
OHIO MEDICAL DEGREES CONFERRED
DURING THE NINETEENTH CENTURY
Accurate compilation of the number of degrees
granted by a medical college in each year in-
volves two difficulties, lack of available com-
plete files of catalogues and the practice of
deferred degrees.
The majority of medical colleges soon after
the close of each session published an announce-
ment containing a list of students in the session
just closed and a list of graduates at the recent
commencement. Assumption that the latter
contains the names of all graduates of that in-
stitution in that calendar year leads to errors.
A candidate for graduation might fail to
receive his degree at the regular commencement
from any one of four deficiencies, namely:
not having reached his twenty-first birthday,
not having completed the full thirty-six months
of medical study, failure at examination, and
negligence to pay his fees to the medical
college. When such deficiencies were removed,
sometimes involving a reexamination, he re-
ceived his diploma but his name would not ap-
pear in the announcement of the next year.
About 1870 many medical colleges began to
give supplementary voluntary spring sessions
in which deficiencies were removed with grad-
uation at the end of the session. Some medical
colleges, mainly sectarian, graduated two classes
in each calendar year and issued only one
announcement. At times the names of those
graduated at the second commencement did not
appear in the announcement of the following
year. Therefore annual announcements are not
reliable sources of the total number of grad-
uates in any calendar year in any medical
college.
Alumni catalogues, printed some years later,
included the deferred graduates and must be
examined to get the total number of graduates
of a medical college in any year. These show
twenty per cent of deferred graduates in some
classes.
I have examined several hundred annual an-
nouncements and alumni catalogues of medical
colleges in Ohio as sources of a table of all
graduates of each institution in each year from
1821 to 1900 inclusive, differentiating degrees in
course, honorary degrees, and ad eundem degrees.
This table, containing more than eight hun-
dred entries, is too extensive to be presented
orally or in print .and has been condensed into
a table showing the total number of degrees of
all types conferred by all medical colleges in
the state in each decade. This is followed by a
list of the total number of degrees in different
medical colleges of Ohio in the nineteenth
century.
No figures are available for several fraudulent
medical colleges in Ohio in the final quarter of
the nineteenth century. Space is lacking for
the story of these institutions. Their degrees
were legal although usually worthless, and
not recognized by licensing boards. Each
fraudulent college in Ohio had a short life.
Table III
Degrees Conferred by Medical Colleges in Ohio
in the Nineteenth Century by Decades
1821-1830,
114;
1871-1880,
4,385;
1831-1840,
514;
1881-1890,
4,494;
1841-1850,
1851-1860,
1,384;
2,478;
1891-1900,
4,145;
1861-1870,
2,638;
Total,
20,152
This total includes 350 honorary degrees, 148
ad eundem degrees, and two degrees of Doctor
of Obstetrics and Gynecology, a designation
used for women by the homeopathic medical col-
lege in Cleveland in the eighteen fifties. It
also contains 271 degrees from scattering rec-
ords of botanic and physio-medical institutions.
The figures are complete for homeopathic
institutions and contain all the graduates of
regular medical colleges except one class at the
Medical Department of the National Normal Uni-
versity at Lebanon in 1895. These classes were
small and the number in this missing class
is not more than twelve. The figures for eclectic
institutions are reasonably complete and omit
not more than fifty graduates.
The small increase for 1861-1870 over the
preceding decade was due to the Civil War.
The large increase for 1871-1880 over the pre-
ceding decade was due to the increase of medi-
cal students following every war and also was
influenced by recent legislation in several states
and by the fact that one holding a medical de-
gree could obtain a license to practice without
taking an additional examination before a
894
T be Ohio State Medical Journal
licensing board. The largest number of degrees
conferred in Ohio in any calendar year was
594 in 1881. The largest single class was
122 graduates at the Medical College of Ohio in
1880.
Available statistics for the botanic medical
colleges, which changed their designation to
physio-medical in 1850, are fragmentary but
are included in the totals in Table III as far as
statistics have been found. Worthington Medical
College is the only one for which figures are
complete. It conferred eighty-eight degrees
from 1832 to 1838. One such medical college
operated in Cincinnati from 1840 to 1885 and
a rival from 1859 to 1880. Each graduated two
classes in many calendar years, making well
over a hundred classes graduated. Scattering
figures show as few as five and as many as
thirty-seven graduates in a class. These in-
stitutions were at times prosperous and at other
times decadent. No sources have been found
to permit a close estimate of the total number
graduated by this type of school in Ohio but
it was a few hundred in addition to the 271 in-
cluded in Table III and this conjectural figure
should be added to the total in Table III to
get the total number of medical degrees con-
ferred in Ohio in the nineteenth century. A
few honorary degrees of Doctor of Medicine
conferred by colleges of arts having no relation
to a medical college are not included in Table III.
The following list gives the total number of
medical degrees of all types for each institution
named in the nineteenth century. The list is
arranged in three groups, regular, eclectic, and
homeopathic, in each in order of founding. One
small eclectic medical college existing during
a few years in the eighteen fifties is omitted
because of entire lack of statistics. The statis-
tics of the botanic and physio-medical institutions
are so fragmentary that they are not listed.
Table IV
Number of Degrees Conferred by Different
Medical Colleges in Ohio in the Nineteenth
Century
Medical College of Ohio, 4,182;
Cincinnati Medical College, 99;
Willoughby Medical College, 200;
Medical Department of Western Reserve Col-
lege and University, 2,227;
Starling Medical College, 1,873;
Cincinnati College of Medicine and Surgery,
1,383;
Miami Medical College, 1,347;
Charity Hospital Medical College, 200;
Medical Department of Wooster University,
663;
Columbus Medical College, 599;
Northwestern Ohio Medical College, 31;
Toledo Medical College, 199;
Cincinnati Woman’s Medical College, 23;
Medical Department of National Normal Uni-
versity, 61 plus;
Presbyterian Hospital Woman’s Medical Col-
lege, 23;
Ohio Medical University, 346;
Laura Memorial Medical College, 28;
Medical Department of Ohio Wesleyan Uni-
versity, 123 ;
Total regular degrees, 13,607 plus.
Eclectic Medical Institute, 3,461;
Eclectic College of Medicine and Surgery, 129;
American Eclectic Medical College, 159 plus;
Total eclectic degrees, 3,749 plus.
Cleveland Homeopathic Medical College (under
seven names), 1,668;
Woman’s Homeopathic Medical College, 17;
Pulte Medical College, 612;
Cleveland Medical College (homeopathic), 228;
Total homeopathic degrees, 2,525;
Total of three groups, 19,881.
These statistics are not claimed to be complete
but are more extensive than any that have
previously been assembled.
Dr. Samuel R. Geiser — 1850-1924
Dr. Samuel R. Geiser was born in Missouri
in 1850. After graduating from a literary Col-
lege he came to Cincinnati in 1873, and entered
Pulte Medical College from which he graduated
in 1875 and practiced medicine in Cincinnati
until almost the hour of his death. He served
as professor of Materia Medica at Pulte Col-
lege for 25 years. He gained national prominence
as an authority on diseases of children and on
Materia Medica and his services as a writer and
lecturer on these subjects were in frequent de-
mand. He took postgraduate work in London
and Vienna.
Dr. Geiser became president of the staff at
Bethesda Hospital and was honored at a testi-
monial dinner at his retirement having served
for 25 years in that capacity. At his death in
1924, the members of the staff of Bethesda in
their resolutions expressed unstinted praise and
tribute from which we quote: “Clean, upright,
honorable, unassuming and capable he held the
esteem of the members of our staff during the
long period of his presidency of twenty-five
years. We cannot conceive it possible for any
man, hedged about by our limitations, to have
left a more honorable or efficient record than
has our departed friend.
“We hope the inspiration of his noble life
may ever be a guiding star to his fellow members
of the staff who are left to carry on the great
wTork of Bethesda Hospital — a work that has
grown greatly since its modest beginning with
Dr. Geiser and his bosom friend, Dr. Christian
Golder, at the helm.”
He became identified with every Homeopathic
association and interest from local to national,
and gave of his time, money and support for he
was a staunch believer in Homeopathy. Quiet,
gentle, cheerful, with a considerate bedside man-
ner, he inspired hope and faith in his patients.
He was a family doctor in every sense of the
word. How sad that we have so few of them. —
Lucy S. Hertzog, M. D., Chardon, Ohio.
for September , 1950
895
A.M.A. Annual Session
• • •
House of Delegates at San Francisco Session Takes Actions on Many
Matters and Policies of Utmost Importance to Medical Profession
SEVERAL matters of far-reaching importance
to the medical profession were transacted
at the Annual Session of the American
Medical Association in San Francisco, June 26-30.
Because the official proceedings of the House
of Delegates had not been made available in
time, only a brief summary of these activities
was reported in the August issue of The Ohio
State Medical Journal. The following paragraphs
contain further summaries of some of the more
important actions taken by the House of Dele-
gates. The complete proceedings are contained
in The Journal of the A. M. A. beginning with
the July 15 issue.
One of the more important policy matters
decided by the House of Delegates was adoption
of a revision of the “Hess Report” or report
of the Committee on Hospitals and the Practice
of Medicine dealing with the physician-hospital
relationship. This report, because of its impor-
tance to the medical profession, is given in full
on page 899 of this issue.
JUNIOR A.M.A.
The House of Delegates approved a report of
the Council on Medical Education and Hospitals
which recommended that the A. M. A. not lend
its support to the activities of the Association of
Interns and Medical Students, for reasons out-
lined. The complete report is published begin-
ning on page 992, Journal of the A.M. A., July 15.
Prominent among reasons for disapproval of
the organization was its affiliation and associa-
tion with Communist and Communist Front or-
ganizations, and its reputation of being a left
wing organization. Among factual information
reported by the Council was that the Associa-
tion of Interns and Medical Students at its 1948
convention had endorsed the principle of com-
pulsory health insurance.
In pointing out that the organization has
enrolled not more than 5 per cent of the
total number of medical students, interns and
residents, the report further states that “prob-
ably the great majority of the members of the
association are well intentioned individuals . . . .”
The House at the same session approved estab-
lishment of a junior American Medical Associa-
tion as proposed by the Board of Trustees. In
its proposal, the Board recommended that the
organization be limited to medical students; that
county medical societies be encouraged to offer
special memberships to interns; that the basis
of the organization be local student societies
with advisory committees ; that an executive
secretary be appointed with offices at the A. M. A.
Headquarters; that the national organization
have representation (without vote) in the House
of Delegates.
MEMBERSHIP AND THE JOURNAL
A resolution proposing a single membership
classification in the A. M. A. and including The
Journal of the A.M.A. as part of the mem-
bership benefits was introduced by Dr. Carl A.
Lincke for the Ohio delegation.
The reference committee considered this res-
olution in conjunction with two other similar
resolutions and reported favorably on includ-
ing The Journal of the A. M. A. as part of mem-
bership benefits. The House approved the com-
mittee’s recommendation that beginning Janu-
ary 1, 1951, membership dues shall include the
subscription to The Journal.
In regard to a single membership classifica-
tion, the committee recommended (and the House
concurred) that the matter be referred to the
Interim Committee on Amendments to the Con-
stitution and By-Laws for prolonged study and
report at the next session of the House.
In another action, the By-Laws of the A. M. A.
were amended to include “Active Members”
among those permitted to register at sessions
of the Association.
GENERAL PRACTICE
The House approved a report of the Committee
on General Practice which enumerated a num-
ber of pertinent observations, opinions and rec-
ommendations. The Committee “recognizes a
change in the attitude toward and the emphasis
on general practice in the past three years.
. . . that medical students and interns are plan-
ning in increased numbers to engage in general
practice, that more medical schools are aware
of their responsibility for the training of ade-
quate numbers of students for general practice
and that the public is becoming increasingly
aware of the need for the family and personal
health counselor . . .”
“It is the opinion of the Committee,” the re-
port continues, “that an insufficient number of
general practitioners are being trained to fill
the basic needs for adequate care for the Ameri-
can people and that there is still an over-
emphasis on the training of specialists. It is
896
The Ohio State Medical Journal
realized by leaders responsible for medical edu-
cation and distribution of medical care that the
best interests of the American people are served,
economically and medically, when a balanced
medical community is established with a founda-
tion of 60 to 80 per cent of w^ell trained general
practitioners, with highly trained specialists
skilled in the narrower branches of medicine
readily available.”
The Committee recommended the inclusion of
general practitioners as clinical instructors in
medical schools; a series of lectures or panel
discussions on the art of medical practice dur-
ing the junior and senior years, and preceptor-
ships sponsored and controlled by state medical
societies and medical schools. It further com-
mended the Council on Medical Education and
Hospitals for its work on development of general
practice residencies and recommended that the
Council make every effort to have these facilities
expanded. In this respect, it recommended that
the Council consider use of small general hos-
pitals for training.
The Committee expressed its opinion that a
higher quality of specialist would be obtained
if the candidate for any field of specialization
were taken from the ranks of the general prac-
titioner with several years of practice.
The Committee further recommended a con-
tinuance of the integration of general practition-
ers into hospital staffs.
MEDICAL EDUCATION
The House adopted the report of the reference
committee which approved a supplementary re-
port of the Council on Medical Education and
Hospitals pertaining to a revision of certain
sections of the “Essentials of Approved Resi-
dencies and Fellowships.” The complete report
is published beginning on page 995, Journal of
the A. ML A., July 15.
The House adopted a report of the reference
committee which commended the American
Academy of General Practice for the initiative
it has shown in preparing the Manual on the
Establishment and Operation of a Department
of General Practice in Hospitals and suggested
that it be made available to hospitals which are
planning to develop general practice sections.
The House rejected a resolution which would
have instructed the Advisory Board for Medical
Specialties to authorize no more new specialty
boards without specific approval of the House
of Delegates, as being out of the jurisdiction
of the A. M. A. At the same time, however, it
suggested that the Advisory Board for Medical
Specialties and the Council on Medical Education
and Hospitals exercise the greatest discretion
before approving any additional specialty boards
to avoid an overabundance of specialty boards.
The House adopted a resolution disapproving
the practice of certain hospitals making specialty
board ratings a requirement for appointment or
promotion.
MASS SURVEYS
In regard to exfoliative cytologic diagnostic
procedure, the House adopted the following re-
solution:
“Whereas, The American Medical Association
wishes to promote the diagnosis of cancer in
its early stages; and
“Whereas, It wishes to support the applica-
cation of such diagnosis throughout the profes-
sion; and
“Whereas, It believes that the diagnosis of
cancer should be a function of the local private
practice of medicine; therefore be it
“Resolved, That the American Medical Associa-
tion endorses the use of all recognized facilities
for the initial diagnosis of malignant disease,
including the examination of tissues, exudates
and bodily excretions. In the case of mass
surveys, the American Medical Association be-
lieves that this work should be in the hands of
qualified private practitioners; and be it further
“Resolved, That these surveys be conducted
at the local level and under direction of the
county or state medical society.”
The House adopted a resolution approving
of self-testing for sugar in diabetic detection.
PUBLIC RELATIONS
The Board of Trustees reported that since
the December meeting of the House, the Wash-
ington Office had been moved into much larger
and better equipped quarters and that the per-
sonnel also had been increased. Dr. Joseph
Lawrence, director, is now assisted by two
physicians, one lawyer, one staff writer and one
administrative assistant.
At direction of the House of Delegates, the
Board appointed the Coordinating Committee
on Legislation whose duties are the facilitating
of the activities on legislative matters and the
dissemination and distribution of legislative in-
formation throughout the various states.
The Board of Trustees reported that it had
extended the contract with Whitaker & Baxter
whereby the national educational campaign will
be continued during the year 1951, but at a
“greatly decreased tempo.”
OTHER ACTIONS
The Board of Trustees reported continued
progress on the part of the Commission on
Chronic Illness for which the A. M. A. provides
office space. The Commission is composed of
approximately 35 members representing the
general public, industry, labor, agriculture, edu-
cation, religion, the social sciences, journalism,
health and welfare as well as medicine.
The House adopted a resolution directing the
Council on Medical Service to study the feasibility
of including payment for nursing service in
for September, 1950
897
Voluntary Health Insurance Plan Benefits and
to report its findings to the House at the next
session.
It was suggested that state medical examining
boards and the Federation of State Medical
Boards of the U. S. give special study to the
situation with respect to displaced physicians
with the idea of framing special regulations
to meet it.
The House adopted a request that the Council
on Scientific Assembly be requested to consider
again the establishment of a Section on Military
Medicine and Surgery and a recommendation
that the Council on Scientific Assembly provide
time on the program to be devoted to the medi-
cal and health problems of our national defense
and security.
The Interim Session of the A. M. A. will be
held in Cleveland, December 5-8, and not in
Denver as previously announced, according to
a report of the Board of Trustees.
The Board of Trustees reported that it had
considered feasibility of publishing a bulletin
for the Woman’s Auxiliary and had decided
against doing so, primarily because members
of the Auxiliary did not desire such a publica-
tion.
St. Luke’s Hospital, Cleveland,
Schedules Weekly Symposia
The fall term weekly symposia, sponsored by
the Postgraduate Committee of Saint Luke’s
Hospital, Cleveland, will be held beginning on
Wednesday, September 20.
Each symposium is planned for thorough,
practical coverage in diagnosis and treatment and
is designed to be of general interest. Those
attending may secure credit toward General
Practice Boards, Dr. Joseph E. Brown, chairman
of the Postgraduate Committee, said.
Registration fee for the full term is $10,
payable in advance upon registration.
The following subjects have been announced.
All symposia are on Wednesday afternoons:
Sept. 20 — “Ear, Nose and Throat in General
Medicine.”
Sept. 27 — “Arthritis.”
Oct. 4 — “Anesthesia in General Practice.”
Oct. 11 — “Peptic Ulcer.”
Oct. 18 — “Backache.”
Oct. 25 — “Congenital Heart Disease.”
Nov. 1 — “Sequela of Subdural Hematoma.”
Nov. 8 — “Endocrinology.”
Nov. 15— “The Kidney.”
Nov. 29 — “Allergy in Children.”
Dec. 6 — “Occupational Hazards.”
Registration may be made or additional in-
formation obtained by addressing the Postgrad-
uate Committee at the hospital, 11311 Shaker
Blvd.
Medina Hospital Program
Scheduled October 4
The Medical Staff of the Medina Community
Hospital will present its third annual Hospital
Day at the Westfield Country Club, LeRoy, on
October 4, starting with a scientific session at
2 p. m.
The afternoon program includes the following
features to be presented by members of the
Cleveland Clinic Staff:
“Diagnosis of Neurological Lesions,” Dr. W.
J. Gardner;
“Discussion and Moving Pictures of Recent Ad-
vances in the Treatment of Hypertension,” Dr_
A. C. Corcoran;
“Peptic Ulcer,” Dr H. R. Rossmiller;
“Recent Advances in Diagnosis and Treat-
ment of Thyroid Gland Disease,” Dr. G. W. Crile,
Jr.
A social hour will be held beginning at 5
p. m. with dinner following at the Westfield Inn
at 6:30 p. m.
“Life Under the Sea,” colored moving pictures
taken by Dr. and Mrs. Crile on their deep sea
diving expedition to the West Indies will be
shown.
During the afternoon session, wives may play
golf or have a session of bridge. An “antiquing”
trip also will be conducted for those interested.
All doctors and their wives are invited.
Sixth District Postgraduate Day
Scheduled October 4
The Sixth Councilor District Postgraduate
Day will be held on Wednesday, October 4, in
Canton, it was announced following a meeting"
of the District officers on August 13.
Registration will be held from 9 to 9:30 a. m.
at the St. Francis Hotel. First Session will be
from 9:30 a. m. to 12 noon and the Second
Session from 1:30 p.m. to 4:30 p. m. The
Banquet will begin at 6:30 p.m. in the Hotel
Onesta, followed by an evening speaker at
7:30 p.m.
A panel of outstanding medical speakers has
been secured for the session. The following
speakers will each present two medical topics:
Dr. Robert Durham, internist, Ford Hospital,
Detroit, Mich.; Dr. A. L. Hoyne, pediatrician,
Chicago, 111.; Dr. Phil Thorek, surgeon, Chicago;
and Dr. H. A. Power, obstetrician and gyne-
cologist, Pittsburgh, Pa.
A registration fee of $6 will include the
banquet. Advance registrations can be made
by contacting Mr. E. M. Sprunger, executive
secretary of the Stark County Medical Society,
400 Fourth St., N. W., Canton 2.
898
The Ohio State Medical Journal
• • •
The Hess Report
Physician - Hospital Relationship Interpreted as A. M.A. Delegates
Approve Findings of Committee on Hospitals and Practice of Medicine
FOLLOWING is the revised and amended
draft of the so-called “Hess Report” as it
was adopted by the House of Delegates of
the American Medical Association at the San
Francisco Annual Session in June. The report
derives its name from Dr. Elmer Hess, of Erie,
Pa., chairman of the Committee on Hospitals
and the Practice of Medicine which formulated
it and later revised it.
The report is a declaration of principles in
regard to the relationship between physicians
and hospitals or other corporate organizations.
Its history is outlined in the first few para-
graphs.
The text following is the final draft of the
report containing amendments and revisions made
on the floor of the House, as it appeared in the
official proceedings, pages 1090-1092, Journal of
the A. M. A., July 22.
^ ^ ^
AMENDED REPORT OF THE COMMITTEE ON
HOSPITALS AND THE PRACTICE OF MEDICINE
In June 1949, the House of Delegates approved
a report, as revised by the Reference Committee,
submitted by the Committee on Hospitals and
the Practice of Medicine. Subsequent to this
meeting and after receiving a legal opinion from
the Association’s general counsel, the Board of
Trustees referred the entire- report back to the
House with specific recommendations concern-
ing certain portions of the report.
PRIOR ACTION
In December 1949, the House of Delegates
approved the following resolution in regard to
this report:
“. . . . that in the interests of maintaining
high professional standards and protecting the
public health, the House of Delegates reaffirms
the philosophy underlying and the principles
enunciated in the Hess Committee report, and
that in view of the possible legal technicalities,
the activation of the Hess Committee report be
deferred until after the next meeting of the
House of Delegates and that between this and
the next meeting of the House of Delegates the
original report be re-referred to the original
committee or reasonable facsimile thereof and
that the committee be instructed to consider ways
and means of activating the original report in
accordance with the principles expressed therein
and in accordance with legal considerations which
must be present.”
In view of this resolution of the House of
Delegates, the Correlating Committee on Exten-
sion of Hospitals and Other Facilities of the
Council on Medical Service consisting of the
original members of the Committee on Hospitals
and the Practice of Medicine plus two additional
members appointed by the Council has under-
taken to restudy the problem and rewrite the
report in such manner as to meet the directives
of the House of Delegates.
In addition to studying the original report,
the Committee requested expressions of opinion
on the part of the various specialty groups and
of the various hospital associations and also
granted them permission to have representatives
appear before the Committee if they so desired.
CORPORATE PRACTICE
The Committee wishes to report again that
so far as it can determine, on the basis of a
study made by the Bureau of Legal Medicine
and Legislation of the American Medical Asso-
ciation, as a matter of law the corporate prac-
tice of medicine is illegal in most states. In
almost all instances the classic example given
by the courts of the type of corporate practice
of a profession that is illegal is the instance in
which a corporation hires a professional man
and then sells his services to the public on a
fee basis for the profit of the corporation. Such
exceptions as there are refer to statutory legis-
lation in several states permitting certain modi-
fications of this general law. It must also be
remembered that fee splitting with a corpora-
tion is just as unethical as fee splitting with
another physician.
In addition to being guided by the laws of the
various states, physicians in their relationships
with hospitals must be guided by the Principles
of Medical Ethics of the American Medical
Association. Those sections of the Principles
which have a distinct bearing on these relation-
ships are as follows:
Chapter I. Sec. 3. “Groups and Clinics — The
ethical principles actuating and governing a
group or clinic are exactly the same as those
applicable to the individual. As a group or
clinic is composed of individual physicians, each
of whom, whether employer, employee or part-
ner, is subject to the principles of ethics herein
elaborated, the uniting into a business or profes-
sional organization does not relieve them either
individually or as a group from the obligation
they assume when entering the profession.”
Chapter III. Article VI. Sec. 2. “Conditions
of Medical Practice — A physician should not dis-
pose of his services under conditions that make
it impossible to render adequate service to his
patients, except under circumstances in which the
for September, 1950
899
patients concerned might be deprived of im-
mediately necessary care.”
Chapter III. Article VI. Sec. 3. “Contract
Practice — Contract practice as applied to medi-
cine means the practice of medicine under an
agreement between a physician or a group of
physicians, as principals or agents, and a cor-
poration, organization, political subdivision or in-
dividual, whereby partial or full medical services
are provided for a group or class of individuals
on the basis of a fee schedule, or for a salary or
for a fixed rate per capita.
“Contract practice per se is not unethical.
Contract practice is unethical if it permits of
features or conditions that are declared unethical
in these Principles of Medical Ethics or if the
contract or any of its provisions causes deteriora-
tion of the quality of the medical services
rendered.”
Chapter III. Article VI. Sec. 6. “Purveyal
of Medical Service — A physician should not dis-
pose of his professional attainments or services
to any hospital, lay body, organization, group
or individual, by whatever name called, or how-
ever organized, under terms or conditions which
permit exploitation of the services of the phy-
sician for the financial profit of the agency
concerned. Such a procedure is beneath the
dignity of professional practice and is harmful
alike to the profession of medicine and the
welfare of the people.”
In conclusion, the Principles of Medical Ethics
states: “These principles of medical ethics have
been and are set down primarily for the good
of the public and should be observed in such
a manner as shall merit and receive the en-
dorsement of the community . . .”
On page 31 of the Constitution and By-Laws
as printed in the Handbook under the Duties
of the Judicial Council, is found the following:
“The Council shall have jurisdiction on all
questions of medical ethics and the interpreta-
tion of the laws of the Association.
“The Council at its discretion may investigate
general professional conditions and all matters
pertaining to the relations of physicians to one
another and to the public, and may make such
recommendations to the House of Delegates or
the constituent associations as it deems necessary.
“The Council shall have authority to request
the President to appoint investigating juries to
which it may refer complaints or evidence of
unethical conduct which in its judgment are of
greater than local concern. Such investigating
juries, if probable cause for action be shown,
shall submit formal charges to the President,
who shall appoint a prosecutor to prosecute
such charges against the accused before the
Judicial Council in the name and on behalf
of the American Medical Association. The
Council may acquit, admonish, suspend or expel
the accused.”
REMOVAL FROM LIST
If and when a physician is found to be unethical
by the proper authorities as established through
channels specified in the Constitution and By-
Laws, and he is still retained on the staff of
any hospital approved for resident or intern
training by the Council on Medical Education
and Hospitals, it shall be the duty of the Judicial
Council to request the Council on Medical Edu-
cation and Hospitals to show cause as to why that
Council should not remove such hospital from
the approved list under the assumption that the
hospital is just as unfit for the training of young
physicians for unethical reasons as it is unfit
because it may not or does not have proper filing
systems for its laboratory or clinical records.
Another matter which the Committee believes
pertinent as regards the problem of physician-
hospital relationships is the set of principles
prepared by the Council on Professional Prac-
tice of the American Hospital Association (Robin
C. Buerki, M. D., Chairman) and approved in
1946 by the Board of Trustees of the American
Hospital Association, the American College of
Surgeons, representatives of the various specialty
groups (anesthesiology, radiology, and path-
ology), and the Council on Medical Education
and Hospitals of the American Medical Associa-
tion.
These Principles of Relationship Between Hos-
pitals, Radiologists, Anesthetists and Pathologists
emphasize that the primary obligation of both
physicians and hospitals is to serve the best
interest of the patients. This the Committee
believes leads to a fundamental principle that
the decision as to the ethical or unethical na-
ture of practice must be based on the ultimate
effect for good or ill on the public as a whole.
These principles also recognized the basic fact
that all of the various questions involved in the
relationship between physicians and hospitals,
both legal and ethical, must be considered in
the first instance at the local level because of
the various differences which of necessity exist
in the many sections of the country. Again, the
Committee believes that this gives us another
fundamental principle, that, consonant with estab-
lished principles of medical ethics, local condi-
tions must decide the various arrangements
and conditions of practice in reference to both
hospital facilities and medical personnel and
their relationships.
‘HOSPITAL SERVICES’ ONLY
One of the factors that have aggravated phy-
sician-hospital relationships is the inclusion of
medical services in the contracts of voluntary
hospital service plans. The medical profession
is fostering voluntary health insurance, and we
believe that nothing should be done to disturb
this very important and essential program.
However, the American Medical Association has
reaffirmed many times through its then Bureau
of Medical Economics, its Judicial Council, and
the House of Delegates the principle that hos-
pital service plans should exclude all medical
services, and the contract provisions of such
plans should be limited exclusively to hospital
services. At the same time, so that there would
be no misunderstanding as to which services
should or should not be included, the House of
Delegates has stated that “. . . if hospital serv-
900
The Ohio State Medical Journal
Ice is limited to include only hospital room ac-
commodations, such as bed, board, operating
room, medicines, surgical dressings and general
nursing care, the distinction between hospital
service and medical service will be clear.” (Pro-
ceedings of the San Francisco Session of the
House of Delegates, 1938, p. 31.) Furthermore,
past actions of the House of Delegates give the
Committee every reason to reiterate that radi-
ology, anesthesiology, pathology and physiatry
constitute the practice of medicine.
In order to initiate a method for remedying
this situation, it is recommended that Blue
Shield and Blue Cross be requested to cooperate
to the extent of writing all new contracts in
such a manner that Blue Shield WTill cover in-
surable medical services and Blue Cross will
cover insurable hospital services. Your Com-
mittee believes that the professional and hospital
authorities and the voluntary prepayment plans
will cooperate in furthering these recommenda-
tions.
DOCTORS’ INTERESTS ALL INCLUSIVE
The Committee believes that since the physician
and hospital are interdependent, it is incumbent
on both to be interested in all phases of their sci-
entific and financial relationships. This means
that the professional staff of the hospital has very
definite responsibilities toward not only other
members of the professional staff, whether
active or courtesy, but also toward hospital
management. The recommendations of the staff
concerning medical matters are usually accepted
by the management of the hospital through its
board of managers or trustees. It must also be
remembered that to be approved for residencies
in specialties by the American Medical Associa-
tion and the American College of Surgeons,
certain requirements are mandatory to the in-
stitution, among them adequate pathologic and
radiologic coverage. As a rule, the staff of a
hospital elects an executive committee or works
under an appointed executive committee to
advise the lay officers of the institution on purely
professional matters, and recommends who may
or may not use the institution for professional
work. Unfortunately, in many instances, the
financial problems of the lay hospital manage-
ment have been no affair of the staff or of its
professional executive committee. This is wrong
and probably the cause of most of the differences
of opinion between physicians and hospital man-
agement. The financial problems of an institu-
tion in which a physician does his professional
work are definitely of importance to him and
to the professional staff, and the proper con-
sideration must be given to these problems if
the hospital is to work efficiently and remain
the workshop of the physician, and without
proper facilities the services rendered to the pub-
lic are in jeopardy and these public services
are the all-important function of both hospital
and staff.
Every professional man on the appointed
staff should have a voice in the professional man-
agement of the institution. The pathologist,
roentgenologist, anesthesiologist and physiatrist,
as well as the other professional staff members,
should have equal standing as active members
of the staff with all the rights and privileges
pertaining to other members of the staff of equal
standing. The chiefs of these departments
should be nominated and appointed in the same
manner as are the chiefs of other major depart-
ments in the same hospital.
The revised Principles of Medical Ethics has
been written with all of these various factors
in mind and is broad enough to cover all pos-
sible ethical physician-hospital relationships.
The Constitution and By-Laws of the American
Medical Association distinctly covers methods of
procedure for all persons who have a complaint
so that they may approach the Judicial Council.
The functions of that Council are specifically
delineated.
FIRST ON LOCAL LEVEL
For the purpose of activating this report, the
Committee has the following suggestions:
In the event of a controversy between phy-
sician and physician, or physician and hospital
management, on these problems, it is recom-
mended that, since local conditions must be
taken into consideration, these problems be
resolved insofar as possible at the local level.
The Committee believes that there can be no
exploitation of the doctor or of the hospital if
everyone concerned in management and on the
professional staff will work together to supply
the greatest possible good quality medical and
hospital services to the public. In any given
controversy, every effort should first be made to
settle the matter at the staff-management level.
In case of failure to settle the controversy at
this level, assistance of the county medical so-
ciety should be requested. If, then, it cannot
be resolved it should be submitted to a committee
of the state medical association for advice and
recommendation. If problems cannot be solved
at the staff-management level, through the
county medical society, or through the state
medical association, the Constitution and By-
Laws of the American Medical Association pro-
vides that “. . . the (Judicial) Council may, at
its discretion, investigate general professional
conditions and all matters pertaining to the
relations of physicians to one another and to
the public, and make such recommendations to
the House of Delegates or the constituent asso-
ciation as it deems necessary.”
COUNTY AND STATE COMMITTEES
To implement the settlement of such con-
troversies, it is recommended that each compon-
ent medical society and each constituent state
and territorial medical association appoint a
Committee on Hospital and Professional Rela-
tions. This committee should be available to
receive complaints from any physician, hospital,
medical organization, or any other interested
for September, 1950
901
person or group with reference to professional
or economic relations existing between doctors
of medicine and hospitals. On receipt of such
complaint by such a committee the matter should
be investigated and acted on in such manner as
will best effect adjustment of the complaint.
Your Committee has already communicated
with every state in the Union requesting that
a Committee on Hospital and Professional Rela-
tions be created at the state level to assist similar
committees at the county society level in solving
these disagreements wherever they arise. Many
states have already established these com-
mittees, and they are functioning.
Another approach that should not be neglected
in activating this report is that of the local and
state hospital associations. Most of the states
and many communities have hospital associations
providing direct representation for the hospitals
within their areas. It seems reasonable to as-
sume that state medical associations and com-
ponent county medical societies could well effect
liaison with these organizations in the settle-
ment of problems involving physician relation-
ships.
The following principles are additional guides
to individual physicians, county medical societies
and state medical associations:
1. A physician should not dispose of his pro-
fessional attainments or services to any hospital,
corporation or lay body by whatever name called
or however organized under terms or conditions
which permit the sale of the services of that
physician by such agency for a fee.
2. Where a hospital is not selling the serv-
ices of a physician, the financial arrangement if
any between the hospital and the physician
properly may be placed on any mutually satis-
factory basis. This refers to the remuneration
of a physician for teaching or research or chari-
table services or the like. Corporations or other
lay bodies properly may provide such services
and employ or otherwise engage doctors for
those purposes.
3. The practice of anesthesiology, pathology,
physical medicine and radiology are an integral
part of the practice of medicine in the same
category as the practice of surgery, internal
medicine or any other designated field of medicine.
Finally, in order that progress regarding the
activation of the report may be followed, the
Committee suggests that the House of Delegates
authorize this Committee to keep in touch with
the Committees on Hospital and Professional
Relations appointed by the county medical so-
cieties and the state medical associations and
report on such progress at the next annual
meeting.
ADDENDUM: SUPPLEMENTARY REPORT OF THE
COMMITTEE ON HOSPITALS AND THE PRACTICE
OF MEDICINE
The Committee believes that if the following
pattern were followed the possibility of solving
any controversy between physician and hospital
would be greatly improved:
When a physician believes he has a legitimate
complaint against hospital management, he should
first attempt to solve the difficulty at the staff
level. And it is incumbent on the medical staff
to assist in arriving at a fair and proper
solution.
If no solution is reached at this level, the
physician should appeal to the appropriate com-
mittee of his county medical society for advice
and assistance. The county medical society com-
mittee should develop methods for contacting
hospitals, management and boards, as well as
local associations representing- hospitals, in order
that all sides of the controversy may be under-
stood and personality difficulties minimized.
When a solution seems impossible through
the good offices of the county medical society,
mechanisms should be available for presentation
of the matter to the state medical association
of which the physician is a member. Here again,
for the purpose of receiving all available facts
and opinion, the state medical association should
develop liaison with the state hospital associa-
tion.
To facilitate the consideration and mediation
of physician-hospital controversies, specific au-
thorization to handle such matters should be
given to some committee of both county and
state medical societies. In the larger county
societies and the state associations this function
could be best carried out through a special com-
mittee created for just this purpose. It should
be the function of such committees to mediate
differences in the light of the existing state
laws, the Principles of Medical Ethics, and the
best interests of the patients.
The services of the Correlating Committee on
Extension of Hospitals and Other Facilities of
the Council on Medical Service, working with
a similar committee of the American Hospital
Association, should be available to study and
assist in solving physician-hospital problems
which seem unsolvable at the local and state
levels. For formal opinion or adjudication, how-
ever, the portfolio should be presented to the
Judicial Council.
(The recommendation of the reference com-
mittee that the supplementary report be referred
to the Judicial Council was approved by the
House of Delegates.)
The first of the A. M. A. documentary programs
is scheduled to be broadcast over the National
Broadcasting Company network on Labor Day.
The program is built around the A. M. A. Coun-
cil on Industrial Health, and will portray the
progress which has been made in industrial
health. It recognizes the broad modern concept
of industrial health which takes into account
the economic, social and emotional welfare of
workers as well as their physical well-being.
902
The Ohio State Medical Journal
Unusually satisfactory results
have been obtained with Dramamine*
for the Prevention
or Treatment of
Motion Sickness
(brand of dimenhydrinate) as a pro-
phylactic or active therapeutic agent
for the relief of nausea, vomiting or
dizziness, which many individuals
experience in travelling by ship, air-
plane, train and other vehicles.
1. Council on Pharmacy & Chemistry: New and Non-
official Remedies, 1950, Philadelphia, J. B. Lippincott
Co., 1950, p. 460.
*Trademark of G. D. Searle & Co., Chicago 80, HI.
SERVICE OF MEDICINE
for September, 1950
903
Washington Roundup . . .
Some Notes on Medical and Health Proposals and Developments in the
Capital with Observations on Other Matters of Vital Interest to Doctors
A GOVERNMENT survey, made public late
in July, is evidence that only about one-
third of the money spent for health pur-
poses goes to physicians in payment for their
services. The report, covering 1949, says that
about 1.2 per cent of all money spent by
American families for consumer goods and
services goes to doctors of medicine. On the
other hand, 2.06 per cent of the total goes for
other health expenses.
During the 12 months, physicians received
$2,267,000,000. During the same period Ameri-
cans were spending $1,391,000,000 on drugs,
$105,000,000 on private nurses, $416,000,000 on
ophthalmic products and orthopedic appliances
and $1,631,000,000 on private hospitals. If non-
private hospitals were included — Federal, state
and local — the hospital cost figure would be sev-
eral times as high, with subsequently greater dif-
ference between payments to physicians and pay-
ments for other health services.
❖ ❖ ❖
Informal weekly conferences are bringing to-
gether the Federal government’s top medical of-
ficials in the closest approach yet to military-
civilization coordination. The meetings are be-
ing held in the office of Dr. Richard Meiling, Co-
lumbus physician now serving as the Defense
Department’s medical director. The meetings are
attended by the surgeons general of the Army,
Navy and Air Force and by special invitation
of Dr. Meiling include the surgeons general of
the Public Health Service and the Veterans
Administration. This brings together at least
once a week the six physician-officials respon-
sible for the entire Federal government medical
program.
❖ ❖ ❖
The Civil Aeronautics Administration’s list
of 350 ambulance planes, giving capacity and
facilities (oxygen, etc.) and day and night phone
numbers of owners, is now available to county
medical societies.
❖ ❖
In the first 15 years of the Social Security
Act, 24 billion dollars has been paid to individuals
— over two-and-a-half billion for care of de-
pendent children; nearly 10 billion to needy aged;
close to eight billion in unemployment insurance;
287 million to the blind; nearly three-and-one-
half billion in old age benefits.
Sfc H5
The bill which would have given Federal aid
to medical education (H. R. 8886) was considered
at an executive session of the House Interstate
and Foreign Commerce Committee. A vote was
taken on motion to table the bill which carried
nine to eight. Staff members of the committee
interpret this to mean that the legislation will
not be considered for the rest of this session.
The committee on two prior occasions refused
to report this legislation by a one vote margin.
5fC
The Armed Forces’ Medical Advisory Committee,
known as the Cooper Committee, has recom-
mended that military medical departments con-
centrate on support of combatant forces as their
primary mission. Since the last war, officials
have had this subject under study. Last fall
Secretary of Defense Johnson ordered the three
medical services to put primary emphasis on
care of military personnel. However, he later
explained that military dependents would con-
tinue to receive attention.
5jc Sjc
The energetic Chronic Disease Division of
Public Health Service is readying itself for
emergencies. The division’s top officials are
looking toward a fast change of emphasis, under
which they would break off long-range surveys
and programs and concentrate on problems di-
rectly related to the emergency. This shift still
is in the talking stage, but the people involved
believe it is pretty likely to take place, and soon.
It was this division which perfected a multi-
phasic screening program for rapid mass-testing
for such major diseases as tuberculosis, dia-
betes, venereal diseases, etc. Such a process
undoubtedly would be an important time-saver
in some phases of military inductions, as well
as large industrial plants. Chronic disease of-
ficials also are working out plans for greater
cooperation with other agencies, government
and private, to meet the new problems.
¥
On September 1, a comprehensive system >©f
prepaid insurance for doctor bills starts in Mary-
land. Eligible are subscribers to the Maryland
Hospital Service (Blue Cross) who constitute
40 per cent of the state’s population. The
comprehensive plan (Blue Shield) will supplement
the Blue Cross’s hospital plan by paying stand-
ard fees to physicians. If the family income is
under $3,600 per year, the doctor may collect
only the standard fees. If the family’s income
is higher, the doctor may charge in excess of
the standard rates and collect the difference from
the subscriber.
904
The Ohio State Medical Journal
The Seal of Acceptance de-
notes that the nutritional state-
ments made in this advertise-
ment are acceptable to the
Council on Foods and Nutri-
tion of the American Medical
Association.
That a nutritious breakfast providing generous amounts of high quality
protein prevents late morning hypoglycemia has been amply demon-
strated. As shown by Thorn and co-workers,1 and later confirmed by
Orent-Keiles,2 ”... breakfast high in protein and low in fat and carbo-
hydrate was followed by an improved sense of well-being and no symp-
toms of hypoglycemia.”
Meat for breakfast — ham, sausage, bacon, breakfast steaks — is an
appetizing means of increasing the protein content of the morning meal.
Its biologically complete protein contains all essential amino acids,
and serves well in complementing less complete proteins from other
sources. Furthermore, muscle meat is an outstanding source of B
complex vitamins and of iron.
(1) Thorn, G.W.; Quinby, J.T., and Marshall, C., Jr., Ann. Int. Med. 18:913 (June) 1943.
(2) Orent-Keiles, E., and Hallman, L. F., Circular No. 827, United States Department of
Agriculture, Bureau of Human Nutrition and Home Economics, Agricultural Research
Administration, Dec., 1949.
American Meat Institute
Main Office, Chicago... Members Throughout the United States
for September, 1950
905
Poor Relief Problem . . .
Situation Regarding Financing of General Relief and Old Age Pensions
Is Acute; What Is Cause? What Are Facts? What Is Remedy?
SITUATIONS which have been developing in
many communities of the state with re-
spect to the furnishing of poor relief and
pensions for the aged indicate that a real crisis
looms.
Many areas do not have adequate funds
available to meet general relief needs, includ-
ing medical and hospital care. The same situa-
tion prevails so far as state assistance is
concerned.
Allowances to recipients of aid to the aged have
been insufficient in many instances, welfare
officials and recipients have charged.
SOME PERTINENT QUESTIONS
How much is being spent in Ohio on these
services? What has caused the existing prob-
lems? What are the solutions, if any? How far
can the state go in supplying public funds for
such purposes? Are local communities meeting
their responsibilities ?
These are some of the questions which are
being asked.
The answers to some of them, in addition to
some pertinent statistics and other data on the
matter, generally, will be found in the following
article and tables, published in a recent issue of
Public Welfare in Ohio Today, official magazine
of the Ohio State Department of Public Welfare:
“Numerous inquiries have been made to the
State Department of Public Welfare as to the
ability of the State to increase its allocations
for General Relief and Old Age Assistance.
“Whether the State will be able to liberalize
its present policy will depend upon future legis-
lative enactment.
“The total expenditure for public assistance
in Ohio during 1949 (at both the state and local
levels) amounted to approximately $112.8 million.
During 1948, this amount was $96.5 million; and
in 1947, $82.2 million.
INCREASES SHOWN
“In 1949, the unduplicated average monthly
‘case load’ was 169,331, involving 271,002 per-
sons; as compared with 156,998 cases, involving
228,546 persons in 1948; and 151,108 cases, in-
volving 208,843 persons in 1947.
“It should be noted that the expenditures for
public assistance in Ohio in 1949 were over $30
million more than in 1947.
“The foregoing figures cover all forms of
public assistance, and include administrative
costs. As this discussion will be limited to
General Relief and Aid for the Aged, no further
reference will be made to the Aid to Dependent
Children and Aid to the Blind programs in Ohio.
NO U. S. HELP
“Under our laws, the Federal Government does
not participate in any way in Ohio’s General
Relief Program which is administered by local
TABLE NO. 1
EXPENDITURES FOR GENERAL RELIEF, BY SOURCE OF FUNDS
Total State Local State Local
Expenditures Funds Funds Pet centage Percentage
1949 . $24,957,000 $22,597,000 $2,360,000 90.5 9.5
1948 , 17,847,000 17,531,000 316,000 98.2 1.8
1947 12,118,000 12,116,000 2,000 99.95+ .05-
In the above table, public utility excise taxes collected by the State and distributed to local
relief areas on a formula basis, together with the legislative appropriation from the State’s General
Revenue Fund are designated as “State” funds. The amounts from these sources distributed in
each of the years 1947, 1948, and 1949 is shown below. In 1948 and 1949, when State’s funds used
exceeded the distributions within the respective years, the difference was provided from balances of
utility excise taxes remaining unexpended from previous years in local treasuries.
STATE FUNDS DISTRIBUTED FOR GENERAL RELIEF, BY SOURCE
Total Legislative Ap-
propriation from
State’s General Public Utility
Revenue Fund Excise Taxes
1949 $20,062,000 $10,971,000 $9,091,000
1948 16,303,000 8,878,000 7,425,000
1947 12,786,000 6,013,000 6,773,000
906
The Ohio State Medical Journal
Baker Laboratories
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all the utensils necessary in formula
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doctor said and more. More people comment on
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3. Two added sugars — lactose
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5. Not less than 800 units of
Vitamin D per quart.
6. Added iron.
7. Zero curd tension.
Very truly yours,
Mrs. Dimitro Bourandas,
Mt. Pleasant, Mich.
for September, 1950
907
TABLE NO. 2
AID FOR THE AGED
Total Ex-
penditures
State
Funds
Federal
Funds
r ;
State
ter cent
Federal
Fer cent
No. of Re-
cipients at
End of Year
Average
Grant for
December
1942
$43,145,000
$21,693,000
$21,452,000
50.3
49.7
138,402
$26.97
1947
60,336,000
28,075,000
32,261,000
46.5
53.5
123,001
40.31
1948
66,997,000
31,628,000
35,349,000
47.2
52.8
124,223
46.45
1949
74,477,000
33,075,000
41,402,000
44.4
55.6
127,095
46.77
relief areas, under standards prescribed by the
State.
“Ohio laws contemplate that expenses for
General Relief shall be shared by both the state
and local governmental units. Funds to meet the
expenditures of this program come from appro-
priations made by the Legislature from the Gen-
eral Revenue Fund, from state-collected public
utility excise taxes and by appropriations made
by local governmental units. During the past
several years, however, nearly all of the funds
for this program have been provided by the
State as shown in table No. 1.
“As the State distributed over $7 million
more to local relief areas for general relief in
1949 than it did in 1947, and in view of the
present condition of the State Treasury and -the
other requirements of the State government, it
is improbable that the State will be able to
enlarge its grants for General Relief to any
great extent in the future without the imposition
of new taxes.
FIGURES ON AID FOR THE AGED
“In January, 1942, the number of recipients
on the Aid for the Aged assistance rolls reached
a peak of 139,567 persons. During 1942, the
total expenditures in the Aid for the Aged
program were $43.1 million, and at the end of
the year the average grant was $26.97.
“At the inception of the Aid for the Aged
program in Ohio in 1934, all of the funds were
provided by the State. The average grant during
the first month of operation was $12.74. In
August, 1936, the Federal government made
Federal funds available for matching and this
has continued ever since.
COSTS GO UP
“While there was a downward trend in the
number of recipients from January, 1942, until
early in 1946, the cost of maintaining this pro-
gram has continued to increase, with the excep-
tion of the years 1944 and 1945, until 1949,
when a total of $74.5 million was expended
under the Aid for the Aged law. On Decem-
ber 31, 1949, there were 127,095 persons re-
ceiving aid for the aged assistance and the
average grant was $46.77.
“The table above (table No. 2) shows the
trend in the cost of operating the Aid for the
Aged program in Ohio, and the source of revenue
to maintain the program.
“Practically all of the amendments to the Aid
for the Aged law since its original enactment
have had a tendency either to increase the
maximum grant or to broaden the scope of the
law, making a large number of persons eligible
for assistance.
STATE PAYING MORE
“The State’s share for operating the old age
assistance program is now $5 million more per
year than it was in 1947. The present standards
of assistance should not be lowered if it can be
avoided. Since the number of people over 65
years of age is rapidly increasing, and the
capacity of public support being limited, it is
very apparent that each application must be
carefully scrutinized to see that all grants are
made on the basis of actual need, that the same
rules are uniformly applied all over the State,
and that no one will be placed on the rolls
Who has adequate resources or responsible rela-
tives available for full support.
“In the face of a prospective declining economy,
it will be difficult for the State to maintain
its present standards of assistance in the future
under present tax laws, unless the average grant
and the number of recipients can be kept at its
present level.”
New V. A. Ruling On T. B.
Veterans of World War II who develop pul-
monary tuberculosis within three years of date
of discharge are granted new presumptions of
service-connection for purposes of compensation,
hospitalization and medical treatment under the
terms of Public Law 573, approved by the
President June 23. Previous law provided a
presumptive period of one year. The extension
is designed to match the period allowed veterans
following World War I.
908
The Ohio State Medical Journal
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for September, 1950
909
• • •
Impact of War on Physicians
Need for Additional Doctors in Armed Services Analyzed; Plans Under Way
To Obtain Required Number; Other Data On Aspects of Preparedness
WHAT effect will the war in Korea and expansion of the armed forces have on
the medical profession?
It is hazardous to make predictions — in fact to even present factual material
— as the situation is changing so rapidly — almost daily.
However, the following points can be
although the reader should keep in mind
them materially:
1. There will be big increases in the
size of all branches of the armed services.
This will mean comparable expansion of
the personnel of the medical corps of the
three services. Plans which are being
considered to accomplish this will be dis-
cussed in this article.
2. Creation of Civilian Defense Pro-
grams for the protection of the civilian
population in event of enemy attack or
disasters affecting the preparedness pro-
gram will require the use of medical
manpower for planning and operational
activities. (See special article on Civilian
Defense, page 926.)
3. Stepping up of the blood procure-
ment program of the American Red
Cross, which has been designed by the
Secretary of Defense to procure blood
and its derivatives needed by the armed
forces, will require the assistance and
cooperation of additional physicians.
4. Selective Service will need additional
physicians under its greatly accelerated
program.
5. County Medical Societies will be
called upon time and again to name rep-
resentatives to advise and assist various
agencies playing some part in local activ-
ities related to the national emergency
and the preparedness program.
HUNDREDS NEEDED
Barring a complete agreement with Russia,
it is no secret that Army, Navy and Air Force
will need hundreds — perhaps thousands — of ad-
ditional medical officers in the very near future.
Currently doctors of medicine in the three
set forth with some degree of certainty,
that over-night developments can change
services total 6,000, including men in training
and serving internships and residencies. Medi-
cal Reserve rolls total around 30,000 men.
The three services now have about run out
of any marginal medical manpower. Top military
medical officers are reluctant to order individual
reserves into service ahead of military-age men
who have not served. But it is their responsibility
to meet medical demands of their services — and
they have full authority to order any and all
reserves to duty.
CALL OF ARMY RESERVES
The Army has announced that it will call to
active duty 734 medical reserve officers by Octo-
ber 1. Ohio’s quota is 38 physicians. The quota
for the Second Army area, which includes Ohio,
Pennsylvania, Maryland, Virginia, West Virginia,
Delaware and Kentucky is 141.
In making selections, Army commanders have
been ordered to “make every effort” to enlist
the cooperation of established medical societies.
All officers selected will be ordered to the
nearest Army post for physical examinations. If
found physically fit, they will be given 21 days
to wind up their private affairs unless they are
willing to report sooner, Army announced.
It is anticipated that one-third of the group
will report by September 22 and another third
by September 29.
The Army announced that deferment from in-
voluntary call will be granted to reserve medi*
cal officers in the following five categories:
1. Those who have not completed a year’s
internship.
2. Those who are senior residents, prior to
completion of the current year’s training.
3. Reserve officers taking full-time postgrad-
uate courses, until completion of the current
academic year.
4. Reserve officers whose activity in teaching,
research or other activities is necessary to the
national interest.
5. Those doctors whose call would unduly
910
The Ohio State Medical Journal
Minds
Digitalis
< Davies, Rosa)
0.1 Gram
(8PK. t$| grains)
CAUTION: To ba
expensed only I or
«»Wfi a„ 1^
t®*’’ . • * • IVV'tS ' . : V - - .wv
• JSi * * ;"nf: C » ' # •
’if! is equivalent to one nJ.S.P. Dig|^
Clinical samples sMit to physicians on reques1
Boston 18, Massachusetts
for September, 1950
911
jeopardize the health of communities in which
they live.
The Army further announced that it will con-
tinue to accept voluntary applications for active
duty from medical officers. Officers so obtained
will be credited against the State’s quota. Of-
ficers who volunteer will receive an extra $100
per month.
Application forms for voluntary service may
be obtained through the Chief of the Ohio Mili-
tary District, Fort Hayes, Columbus.
INTERNS STAYING IN
Over 75 per cent of the medical graduates
vTho interned in Army hospitals under the Military
Intern Training Program have remained in
the Army longer than their legal requirement
for active duty, according to figures released
by Major General R. W. Bliss, the Army Surgeon
General.
Of the 311 young physicians wTho have passed
through the program, 235 have elected to remain
on active duty in the Army Medical Service,
either as Regular or M&eserve officers. Of the
other 76, several have requested return to
active duty after a comparatively brief period
of nonmilitary practice. but seven of the
76 retained their Reserve Commissions.
ABOUT V-12, A. S. T. P. DOCTORS
The question of whether compulsion will have
to be used to bring the medical corps of the
~ee services up to adequate strength will prob-
aDTj^be settled shortly. So far pressure has been
~*^-aght to bear on certain groups of physicians
to volunteer for duty. They are: (1) Former
Navy V-12 and Army A. S. T. P. medical stu-
dents who were deferred from active duty during
World War II and who had all or part of their
medical education paid for by the government;
(2) men who were deferred from active service
during the war to complete their medical edu-
cation at their own expense; (3) physicians who
were assigned to residencies and internships on
active duty status who were allowed to leave
the service upon completion of training.
Few of these classes of physicians, numbering
8000-9000, have volunteered. Even the question
of compelling them to serve at this time is a
moot one. Apparently the government has no
legal hold on most — if not all — of them. Re-
peated appeals from the three services for medi-
cal volunteers during the month of July brought
a total of 68 doctors to active duty. Totals by
services were Army 22, Navy 40 and Air Force
six.
DRAFT LEGISLATION PROPOSED
drafting of physicians falling in the above classi-
fications.
Both H. R. 9311 (Representative John Saylor,
R.-Pa.) and H. R. 9294 (Representative Anthony
Cavalcante, D.-Pa.) provide for Selective Service
registration of all persons with “needed profes-
sional, technical and specialist” skills who are
not yet 45 years of age. Inductions, however,
would not exceed twenty-one months in the
armed forces. In making calls for such persons
the President would induct in the following
order of priority: 1. Those who participated as
students in the A. S. T. P. or similar programs
administered by the Navy and persons deferred
from service during World War II for the pur-
pose of pursuing their education in the same
scientific categories covered by such programs
and who have had no active duty as commissioned
officers; 2. Those who have participated in such
programs and who have served on active duty
as commissioned officers for less than twenty-one
months; 3. Those who have less than ninety
days’ prior active honorable military duty; 4.
Those whose total active honorable military duty
is less than twenty-one months; 5. Others pre-
scribed by the President.
Mr. Saylor followed up with another bill (H. R.
9327), this one aimed specifically at A. S. T. P.
and V-12 educated physicians and dentists, and
making no reference to non-medical skills. Mr.
Saylor is confident this bill will not be ruled
out as discriminatory or class legislation, a con-
sideration responsible for inclusion of the other
skilled categories in earlier bills. Men inducted
under this bill would be assured the rank of
first lieutenant, and would be required to remain
in reserves at least six years after going off
active duty.
A. M. A. APPROVES
The Council on National Emergency Medical
Service of the American Medical Association at
a recent meeting in Washington expressed its
support of legislation, if necessary, to provide
for the military call on a priority schedule of
physicians needed for national defense.
The council’s recommendation, submitted to
the A. M. A. Board of Trustees for approval,
placed emphasis on the first call of the
non-veteran physicians who received training at
government expense during and since World
War II and of all others who were deferred in
order to complete their medical studies.
The recommendation was based on the under-
standing that an appropriate body be established
in government to effect certain measures relative
to the utilization of physicians by the medical
departments of the Armed Forces.
However, early hearings are expected in Wash- board offers recommendations
ington on two proposals presented to the Con- The Board of Trustees of the A. M. A. after
gress which are designed to provide for the considering the recommendations of the Council
912
The Ohio State Ale die al Journal
To be completely safe, a reliable contra-
ceptive must exhibit the highest spermicidal
power possible . . after dilution. In Koromex
(jelly or cream) you have the fastest
spermicidal time measurable . . when tested
. _ according to the Brown & Gamble tech-
nique representing a 1:10 dilution.
ACTIVE INGREDIENTS: BORIC ACID 2.0% OXYQUINOLIN
BENZOATE 0.02% AND PHENYLHERCURIC ACETATE
0.02% IN SUITABLE JELLY OR CREAM BASES
KOROMEX
®
A CHOICE OF PHYSICIANS
HOLLAMD-RANTOS COMPANY. INC. • 145 HUDSON ST., NEW YORK 13, N. Y.
MERLE l. YOUNGS
DENT
for September, 1950
913
on National Emergency Medical Service, voted its
definite endorsement of the principles of the
several bills pending in Congress which provide
for the registration and induction into service of
physicians.
- Dr. Louis H. Bauer, chairman of the Board,
in announcing the Board’s action, said that any
legislation enacted should provide for a call in
the following order:
1. Former students in A. S. T. P. or V-12 pro-
grams and persons deferred during World War II
in order to continue their medical education and
who have had no active duty.
2. Those deferred previously for other than
physical disability and those previously rejected
for physical disability who may be found fit on
the basis of present physical requirements.
3. Former students in A. S. T. P. or V-12 pro-
grams who served on active duty as commissioned
officers for less than 21 months, exclusive of time
in postgraduate training.
4. Those who served less than 90 days on
active honorable military or naval duty.
5. Those whose total active honorable military
or naval duty is less than 21 months.
STUDENTS MAY BE DEFERRED
Under the Selective Service Law, medical stu-
dents may not be called away from their studies
and inducted as long as their scholastic records
are satisfactory. Authority for this is Sec. II-A
of the law’s industrial deferment section. De-
cision as to whether the student’s progress is
satisfactory is left entirely to the discretion of
the local draft board, which also is guided by
the general statement that the deferment must
promise to contribute to the nation’s health.
MEDICINE RATED “ESSENTIAL”
Further tightening the military medical situa-
tion is a Department of Labor list which includes
doctors among those whose services are essen-
tial to the civilian economy. The list was issued
as a guide to military services in considering
deferment of reserve officers, and was accepted
by Department of Defense. This is purely ad-
visory, and the services remain the final judge
of what reserve officers to call up. However,
it is an official reminder that the civilian prac-
tice of medicine should be given adequate con-
sideration. The list also includes bacteriol-
ogists, biologists, botanists, chemists, dentists,
nurses, osteopaths, parasitologists, pharmacog-
nists, pharmacologists, physicists, plant path-
ologists, veterinarians and teachers in the criti-
cal occupations. Under this policy, deferments
would be for not more than six months, and
deferment could not be extended beyond an
additional six months. Requests for deferment
should not be made prior to receipt of mobiliza-
tion orders, and in every case the military service
reserves the right to cancel deferment for “over-
riding military considerations.”
NATIONAL ADVISORY COMMITTEE
Realizing that problems of health resources
are basic in mobilization for defense, Chair-
man W. Stuart Symington of the National
Security Resources Board is setting up a health
resources advisory committee. He has named
as chairman of the committee, Dr. Howard A.
Rusk, chief of physical medicine and rehabilita-
tion at New York University-Bellevue Medical
Center. Other members have not been named.
Rusk’s committee will have much to say re-
garding policies on mobilizing medical manpower,
utilization of hospital facilities and coordination
with the public health services.
REGARDING NURSES
Navy already has started issuing mandatory
orders to a few reserve nurses, but declines to
state the exact number. Army and Air Force,
however, so far have issued no mandatory orders,
and expect they may be able to meet all require-
ments through volunteers. Although Army needs
750 nurses in the next few months, it is re-
ceiving about 15 inquiries a day and says that
half of these ask for active duty assignments.
Air Force, in need of about 600 nurses, also
anticipates that volunteers will solve the prob-
lem. The Army is not doing so well in active
duty volunteers for its Women’s Medical Spe-
cialists’ Corps; it has immediate need for 70
dietitians, 40 physical therapists and 65 occupa-
tional therapists.
In its nurses. Navy has a problem not shared
by the other services. Although 5,000 nurses
are still in the Naval reserve, most of them
have not kept up contact with the service of-
fices. Navy officials are anxious to have them
report on their present status. If they are
married, and have a child or children under
18 years of age, they will be removed from the
eligible list.
WANT U. S. MEDICAL SCHOOL
While the armed services were stepping up
appeals for physicians, two Democratic Rep-
resentatives revived the proposal for a U. S.
Academy of Medicine, which would insure a
steady flow of doctors to Army, Navy and Air
Force.
Representative Anthony Cavalcante (Pa.)
proposes that a Federal medical academy be
established in or near Washington. Appoint-
ments would be made somewhat in the way ap-
pointments now are made to the military
academies at West Point and Annapolis — 150 to
be nominated by the President, 10 by the Vice-
President and the remainder by Representatives
and Senators. Enrolment would be limited to
2,304, and no more than 500 could be appointed
any one year. After finishing the Academy’s
914
The Ohio State Medical Journal
• • •
a | new [drug
for the treatment of ventricular arrhythmias
PRONESTYL Hydrochloride
Squibb Procaine Amide Hydrochloride
i Lead li. Ventricular
I quimdine therapy (8
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Oral administration of Pronestyl in doses of 3-6 grams
per day, for periods of time varying from 2 days to
3 months, produced no toxic effects as evidenced
by studies of blood count, urine, liver function,
blood pressure, and electrocardiogram. Pronestyl
may be given intravenously with relative safety.
FRONESTYL IS A TRADEMARK OF E. » SQUIBB A SONS
Pronestyl Hydrochloride Capsules, 0.25 Gm., bottles of 100 and 1000.
Pronestyl Hydrochloride Solution, 100 mg. per cc., 10 cc. vials.
For detailed information on dosage and administration, write for
literature or ask your Squibb Professional Service Representative .
Sqjjibb
MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858.
for September, 1950
915
course, men would serve internships in military
hospitals, then be obligated for six years’ service
with Army, Navy or Air Force, as reserves on
active duty. Also, these physicians might be
assigned to V. A. hospitals, or discharged from
active duty if their services were not required.
They would not have the option of resigning
from the reserves, but would be kept subject
to call until their retirement.
The bill (H. R. 9157) by Representative Louis
Heller (N. Y.) differs from Mr. Cavalcante’s
(H. R. 9156) in many respects. It would permit
assignment of academy graduates to any Federal
service, military or non-military. Proposals of
this nature received considerable attention im-
mediately after the war, but no action was taken
by Congress.
RED CROSS BLOOD PROGRAM
General George C. Marshall, president of the
American Red Cross, has accepted a request by
Secretary of Defense Louis Johnson that the
Red Cross become the official agency for the
procurement of blood for the armed forces when
such blood and its derivatives are needed.
In his letter of acceptance General Marshall
assured Secretary Johnson the Red Cross was
prepared at once “to increase the output of
its national blood program to provide the armed
services with the blood that may be required.”
Secretary Johnson recalled in his letter that
the blood procurement task performed by the
Red Cross during World War II “was most
successful.”
General Marshall designated Vice-Admiral Ross
T. Mclntire, (M. C.) USN, Retired, of the Red
Cross National Blood Program, to work with
Dr. Richard L. Meiling, (formerly of Columbus,
Ohio) director of Medical Services of the De-
partment of Defense, to coordinate and develop
the plan.
At present 34 regional blood centers and 46
mobile units are operating in the Red Cross
blood program. They are now collecting ap-
proximately 63,200 pints of blood a month for
civilian use. A total of 677 Red Cross chapters
are participating in the collection and processing
centers. The regional centers are serving more
than 1,900 hospitals in 38 states.
COLUMBUS A CENTER
One of the regional centers is at Columbus,
Ohio, which serves the Central Ohio Area, con-
sisting of 23 counties and including 27 Red Cross
Chapters. That center already has felt the
impact of General Marshall’s acceptance of
Secretary Johnson’s request.
Although no quotas for blood for military
use have as yet been received by the Columbus
Center it is planning to step up its activities
many fold to meet demands which will come
later.
The Columbus center is under the supervision
Rehabilitation Therapy
for Your Patients
Battle Creek Sanitarium fills the need
for a well-staffed, well-equipped insti-
tution to which you can confidently
send your patients requiring physical
and psychosomatic rehabilitation.
Spacious, beautiful grounds, excellent
equipment, a highly trained medical
and nursing staff, and skilled techni-
cians all contribute to successful ther-
apy. At Battle Creek, your patients are
taught to relax and are encouraged to
eat the foods they require. Integrated
physical activity, mechanotherapy,
heliotherapy and balneotherapy, and
improvement in appetite all are con-
ducive to speedy restoration of strength
and vigor. Postoperative, arthritic,
underweight, and aged patients all
benefit from this sensible and time-
proved regimen.
Battle Creek Sanitarium has been
offering its outstanding services con-
tinuously for 85 years; John ffarvey
Kellogg, M.D., served as its superintend-
ent from 1876 to 1943.
Wire or call collect for complete infor-
mation on availability of accommodations.
THE BATTLE CREEK SANITARIUM
BATTLE CREEK, MICHIGAN
916
The Ohio State Medical Journal
of Dr. Charles A. Doan, dean of the Ohio
State University College of Medicine and a
member of a five-physician medical advisory
committee to the National Red Cross Blood
Program.
COUNTIES IN AREA
Counties covered by the Columbus Center are:
Ashland, Athens, Champaign, Coshocton, Craw-
ford, Delaware, Fairfield, Fayette, Franklin,
Hardin, Hocking, Knox, Licking, Logan, Madison,
Marion, Miami, Perry, Pickaway, Richland, Ross,
Shelby and Union.
There is a possibility that the Red Cross blood
procurement program may be expanded to other
parts of Ohio to operate independently or in
cooperation with existing blood procurement and
blood bank programs. No definite plans have
been made for this as yet.
Immediate increase in the number of donors
throughout the Central Ohio area is imperative,
according to Dr. Doan.
So far, there has not been enough blood col-
lected to meet the needs of all the hospitals,
let alone having any to make a substantial
stockpile of plasma or other blood derivatives.
MEDICAL ADVISORY COMMITTEES
•
As the Red Cross Blood program operates
under the direct supervision of the medical ad-
visory committee of each chapter, more respon-
sibility than ever will be placed on the physicians
appointed to the local medical advisory com-
mittees.
At a meeting of physicians on advisory com-
mittees and public health and hospital personnel
held in Columbus July 27, plans were formulated
for organizing a regional medical advisory com-
mittee. This will be elected by the represen-
tatives of the local medical advisory committees
when they meet again in Columbus on October 26.
International Surgeons’ Assembly
Headed by Dr. Curtis
The International College of Surgeons,
United States Chapter, will hold its 15th Annual
Assembly and Convocation in Cleveland, October
31-November 3, according to Dr. George M.
Curtis, Columbus, chairman of the Assembly.
The program will include scientific sessions
on subjects in the fields of general surgery;
eye, ear, nose and throat surgery; gynecology
and obstetrics; urology; and orthopedic, thoracic,
plastic and neurological surgery. In addition,
an extensive exhibit and special entertainment
will form part of the Assembly.
All doctors of medicine interested in surgery
and its advancement are invited to attend. A
program may be obtained from Dr. Arnold S.
Jackson, secretary, Jackson Clinic, Madison 4,
Wise. For hotel reservations, contact Committee
on Hotels, International College of Surgeons,
U. S. Chapter, 511 Terminal Bldg., Cleveland 13.
• *7oiT*T>*s%
Considerable total energy may
be introduced into the deeper
tissues without excessive heat-
ing of outer surfaces. Crystal
control assures frequency sta-
bility for life of the unit.
Reprint of diathermy technics
mailed free on request. Write
"Bandmaster Booklet” on your
prescription blank or clip this
advertisement to your letter-
head and mail to:
SHORT WAVE
DIATHERM
with the
TRIPLE
INDUCTION
DRUM
The Bandmaster has
been approved or
accepted by
the following:
/
A.M.A. Council on
Physical Medicine
/
Federal Communications
Commission
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Underwriters'
Laboratory M
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Also the Canadian
Department of Transport
| and Canadian Standards
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j The Bandmaster Dia-
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ing widely recognized
f over other methods of
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THE BIRTCHER CORPORATION
5087 Huntington Drive \ Los Angeles 3 2, Calif.
To: The Birtcher Corporation. Dept. OS
5087 Huntington Drive, Los Angeles 32, Calif.
Please send me new treatment chart for LARGE AREA
TECHNIC, and new booklet "The Simple Story of
Short Wave Therapy!’
Name,
Street,
City
.State,
for September, 1950
917
Medical Care Price Indexes Below
Cost of Living for 1949
Indexes of medical care prices were not as
high as the general cost of living during 1949,
according to a study made by Frank G. Dickin-
son, Ph. D., Chicago, director of the American
Medical Association’s Bureau of Medical Eco-
nomic Research.
The Consumers’ Price Index of the United
States Bureau of Labor Statistics measures
changes since 1935-1939 in prices of fixed quan-
tities of goods and services normally purchased
by moderate income families in large cities.
“The relative importance of the medical care
items among all the items in the Consumers’
Price Index is slightly more than 3 per cent,”
Dr. Dickinson points out.
“Thus, the index of the price of medical care
may be considered a small but significant part
of the Consumers’ Price Index. With the ex-
ception of drugs, the index for physicians’
services rose least of all medical care items
between 1948 and 1949.” ’
The 1949 index for physicians’ fees was 137.9.
In 1948 it was 135.5. The 1949 index for gen-
eral practitioners’ fees was 137.7, which may
be compared with 135.2 in 1948. The 1949
index for surgeons’ and specialists’ fees was
138.4, compared with 135.8 in 1948.
“This relatively small increase in the index
for physicians’ services strongly suggests that
the demand for physicians’ services in relation
to the supply was not excessive,” Dr. Dickinson
says.
“The index for hospital room rates, again the
highest of all the medical price indexes, was 226.8
in 1949, or 17.1 points higher than the 1948
index. The hospital, a buyer of large quan-
tities of goods and services — labor, food, fuel—
which have undergone great increases in price,
is fully subject to the forces of inflation. On
the average, however, patients stay in the
hospital fewer days.
“The price indexes for other medical care
items in 1949 were considerably lower than the
Consumers’ Price Index. The index for medi-
cal care excluding drugs was 149.7 (144.4 in
1948); the index for drugs alone was 123.3.
The index for dentists’ fees was 150.6.
“To the extent that these indexes reflect na-
tionwide trends, in 1949 Americans were again
fortunate in that the prices of medical care
had not risen as rapidly as the general cost
of living since 1935-1939.”
New Arthritis Film
The Arthritis & Rheumatism Foundation has
announced the production of a new color, sound-
on-film feature reviewing the incidence and eco-
nomic and social significance of arthritis and
rheumatism.
The new film stresses the fundamental im-
portance and limitations of hormone therapy
in treating these chronic diseases, using case
histories of cortisone and ACTH treatments.
Production schedule calls for the film to be
ready about September 1. Prints are obtain-
able for showing by county medical societies
and other groups. Address the American Rheu-
matic Association, Dr. Charles Ragen, Secretary,
Presbyterian Hospital, New York 32, New York.
Only charges are to cover shipping.
Activities of The Editor
Dr. Jonathan Forman, Editor of The Journal,
has assumed editorship of a bibliographical sec-
tion of the Quarterly of Allergy and Applied
Immunology. This is a transfer to this magazine
of a service which Dr. Forman has been provid-
ing for Letters of the International Correspond-
ence Society of Allergists for the past five years.
An estimated 66,000 eye injuries — 750 of them
so serious that the child loses the sight of an
eye — occur during each school year among
American children, the National Society for the
Prevention of Blindness revealed.
THE MART E. POGUE SCHOOL
Complete facilities for training Re-
tarded and Epileptic children educa-
tionally and socially. Pupils per
teacher strictly limited. Excellent
educational, physical and occupational
therapy programs.
Recreational facilities include rid-
ing, group games, selected movies
under competent supervision of skilled
personnel.
Catalogue on Request
G. H. MARQUARDT, M. D.
Medical Director
BARCLAY J. MacGREGOR
Registrar
?9 Geneva Rd., Wheaton, Illinois (near Chicago)
918
The Ohio State Medical Journal
r#«ni(u S**
Ready-to-feed S-M-A® is patterned after human
milk. Quantitatively and qualitatively, its con-
tent of protein, fats, carbohydrates, essential
minerals and vitamins is designed to provide a
complete nutritional base for sturdy growth.
Many years of clinical experience proves S-M-A
is good for all babies.
S-M-A Powder — 1 lb. cans.
II
-
for September, 1950
919
In Our Opinion:
Comments on Current Economic and Social
Questions and Professional Problems ;
Suggestions Regarding Organized Activities
YOUR ONE VOTE MAY BE
THE DECIDING VOTE
So you don’t think it matters much whether
or not your one vote is cast on Election Day —
November 7?
History says you’re wrong.
Do you know that Jefferson and John Quincy
Adams were each elected by one vote in the
Electoral College ?
Do you know that Hayes was elected by one
vote; his election contested, and upheld by
one vote; the Congressman who cast the de-
ciding vote in favor of Hayes was elected by a
margin of one vote?
Do you know that one vote gave statehood
to California, Idaho, Oregon, Texas and Wash-
ington ?
No doubt many other examples could be cited.
Your vote may be the deciding vote.
LAST CALL FOR PAYMENT
OF A. M. A. DUES
If you have not paid your 1950 A. M. A.
dues of $25.00, the Secretary of your County
Medical Society will be seeing you in the near
future. On order of The Council, the Secre-
tary of each local society has been furnished
the names of members of the State Association
who have not paid A. M. A. dues and he has
been requested to get in touch with the unpaid
members.
Approximately 5,225 members of the O.S.M.A.
have paid A. M. A. dues. That’s good, but not
good enough. Surely, there is not a single
physician who won’t admit that the A. M. A. is
carrying on many, many excellent activities —
activities of great benefit to the profession and
the public — even if he may disagree with a
few of the policies of the A. M. A.
The A. M. A. must have adequate funds to
carry on its regular work and programs. Its
only source of revenue is from its members.
Can you think of a single organization of any
consequence to which a person belongs which
does not expect its members to make some
financial contribution? It’s time for all of us
to rationalize on this question. Let’s not fail
to see the woods for the trees.
Physicians who don’t pay A. M. A. dues by
the end of the year will be taken off the mem-
bership roster of the A. M. A. in compliance
with the By-Laws. To have his name restored
to membership at some future date, a physician
will have to pay 1950 dues, and dues for any
other year in which he is delinquent, in addi-
tion to the current dues. A. M. A. dues for phy-
sicians becoming members of their local medical
society and the State Association after July 1
are on a pro-rata basis of $12.50.
If you are interested in knowing how your
County Medical Society stacks up, following is a
tabulation of State Association members by
counties and the number of such members who
had paid A. M. A. dues at the time this issue of
The Journal went to press:
COMPARISON OF O. S. M. A. MEMBERSHIP AND
A. M. A. DUES PAID
■2!
< a.
• CL
m u
61
<
FIRST DISTRICT:
Adams 8 6
Brown 8 4
Butler 123 73
Clermont 26 17
Clinton 18 9
Hamilton 959 690
Highland __L 20 12
Warren 16 11
Totals
SECOND DISTRICT:
Champaign
Clark
Darke
Greene
Miami
Montgomery
Preble
Shelby —
1178
822
19
13
115
77
26
17
37
24
45
39
370
253
13
8
19
16
Totals 644
THIRD DISTRICT:
Allen 89
Auglaize 18
Crawford 32
Hancock 37
Hardin — - 26
Logan 23
Marion 46
Mercer 15
Seneca — — - 42
Van Wert 19
Wyandot — 14
447
69
11
21
24
16
18
29
13
32
16
10
Totals - 361 259
FOURTH DISTRICT:
Defiance 16 11
Fulton 19 15
Henry H 3
Lucas 445 325
Ottawa . 17 H
Paulding 9
Putnam 15 8
Sandusky 45 35
Williams — 17
Wood S3 28
Totals
FIFTH DISTRICT:
Ashtabula
Cuyahoga
Geauga
Lake
627
450
52
30
1622
1217
12
9
39
29
Totals
1725 1285
920
The Ohio State Medical Journal
INGLESIDE FARM INGLESIDE HOME
Hospitals for Nervous and Mental Disorders
THE FARM - Chardon, Ohio
Telephone Chardon 355
Medical Director, Neil T. McDermott, M.D.
THE HOME - 8821 Euclid Ave.
Cleveland, Ohio Cedar 5416
Mabel A. Woodruff, Director
Facilities for
Chronics and Convalescents
VIEW AT INGLESIDE FARM
THE NEW YORK POLYCLINIC
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(Organized 1881)
THE PIONEER POST-GRADUATE MEDICAL INSTITUTION IN AMERICA
EYE, EAR, NOSE, AND THROAT
A three months combined full time refresher course con-
sisting of attendance at clinics, witnessing operations,
lectures, demonstration of cases and cadaver demonstra-
tions; operative eye, ear, nose and throat on the cadaver;
clinical and cadaver demonstrations in bronchoscopy,
laryngeal surgery and surgery for facial palsy; refrac-
tion; radiology; pathology, bacteriology and embryology;
physiology; neuro-anatomy; anesthesia; physical medi-
cine; allergy; examination of patients pre-operatively
and follow-up post-operative in the wards and clinics.
PROCTOLOGY AND GASTROENTEROLOGY
A combined course comprising attendance at clinics and
lectures; instruction in examination, diagnosis and treat-
ment; witnessing operations; ward rounds; demonstra-
tion of cases; pathology; radiology; anatomy; operative
proctology on the cadaver.
DERMATOLOGY AND SYPHILOLOGY
A three year course, beginning in October, fulfilling all
the requirements of the American Board of Dermat-
ology and Syphilology.
RADIOLOGY
A comprehensive review of the physics and higher mathe-
matics involved, film interpretation, all standard general
roentgen diagnostic procedures, methods of application
and doses of radiation therapy, both X-ray and radium,
standard and special fluoroscopic procedures. A review
of dermatological lesions and tumors susceptible to
roentgen therapy is given, together with methods and
dosage calculation of treatments. Special attention is
given to the newer diagnostic methods associated with
the employment of contrast media such as bronchography
with Lipiodol, uterosalpingography, visualization of
cardiac chambers, pre-renal insufflation and myelography.
Discussions covering roentgen departmental management
are also included.
For Information Address
345 west 50th street MEDICAL EXECUTIVE OFFICER new YORK CITY 19
for September, 1950
921
E
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SIXTH DISTRICT:
Columbiana 66 57
Mahoning 233 170
Portage 31 23
Stark 267 202
Summit 345 254
Trumbull 97 63
Totals 1039 769
SEVENTH DISTRICT:
Belmont 51 35
Carroll 9 9
Coshocton 23 15
Harrison 10 6
Jefferson 58 38
Monroe 4 2
Tuscarawas j*„_ 51 29
Totals 206 134
EIGHTH DISTRICT:
Athens 30 20
Fairfield 45 24
Guernsey 28 18
Licking 57 38
Morgan 7 4
Muskingum 52 38
Noble 3 2
Perry 13 5
Washington 28 16
Totals 263 165
NINTH DISTRICT:
Gallia 19 11
Hocking 11 4
Jackson 14 6
Lawrence 23 14
Meigs 11 6
Pike 9 2
Scioto 69 43
Vinton 3 3
Totals 159 89
TENTH DISTRICT:
Delaware 20 14
Fayette 10 8
Franklin 657 461
Knox 31 28
Madison 13 8
Morrow 8 7
Pickaway 15 7
Ross 43 33
Union 13 7
Totals 810 573
ELEVENTH DISTRICT:
Ashland 26 16
Erie 49 28
Holmes 9 7
Huron 24 18
Lorain 120 83
Medina 29 23
Richland 95 80
Wayne 51 27
Totals 403 282
Total O. S. M. A. Membership, Aug. 9, 1950 7,415
Total A. M. A. Dues Paid, Aug. 9, 1950 5,275
ESSENTIAL ROLE OF PHYSICIANS
IN HELPING THE HANDICAPPED
Committees are being organized in many Ohio
communities to promote “Employ the Physically
Handicapped Week” which will be observed on
a national basis the week of October 1-7. Dur-
ing the week employers will be urged to re-
examine their attitudes toward the hiring of
qualified handicapped workers.
Literature, based on competent surveys, re-
veals that the work records of the handicapped
have shown that they are equal or better than
many non-handicapped workers in the following
aspects of job performance, if they are properly
placed: Their rate of absenteeism is lower; they
are not “job hoppers”; their rate of production
is high; their accident rate is low.
This program is designed especially to inform
and stimulate the interest of employers. So
far as the practicing physician is concerned
every week should be employ the physically
handicapped week.
In the first place, physicians are essential
in programs of rehabilitation which are going
on 365 days a year in many areas.
Secondly, the physician can play a major role in
aiding the handicapped to secure satisfactory
employment. In submitting reports on the degree
of handicap of an injured worker, the phy-
sician should emphasize the positive. Namely,
he should emphasize what the handicapped person
is capable of doing — not necessarily that which
he cannot do. In other words, the physician
should go out of his way to cooperate with the
patient and employers in trying to find the
proper job for the disabled person — a spot
where he can render efficient service despite his
handicap.
Physicians should give their support to the
programs planned for the week of October 1-7.
However, they should do more than that. They
should make this a year-round project so far
as their own handicapped patients are con-
cerned. When the physican gives them good
care, boosts their morale, and aids in getting
them back into productive employment, he
renders a real service to everyone — the dis-
abled, the employers and the community at large.
RURAL PRECEPTORSHIPS
PROGRAM STUDIED
Pick up a copy of the August 15 issue of
Look magazine and read the article beginning
on page 37.
Entitled “How Kansas Finds Country Doctors,”
the picture story follows one of 39 extern stu-
dents of the University of Kansas School of
Medicine through a day or two of his affiliation
with a country doctor preceptor.
Kansas calls it a “field training” program.
Already in operation in two other states, first
in Wisconsin, later in Oklahoma, the rural pre-
ceptorship program is designed to encourage
young physicians to settle in rural areas by
sending them for a time to the “front lines”
with a general practitioner during the interim
between the junior and senior years of medi-
cal school.
The Committee on Rural Health of the Ohio
922
The Ohio State Medical Journal
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jor September, 1950
923
State Medical Association has been studying a
large quantity of detailed information procured
from all three states, preparatory to deciding
whether to recommend to the Council of the
Association that such a plan be introduced in
Ohio.
More than a year ago, in connection with this
study, a questionnaire survey of a representative
group of Ohio general practitioners located in
towns of 2500 or less population showed that
the majority of those replying were willing
to cooperate in such a program.
This, we think, is important, for such a plan
involves an additional burden for the physician
. . . time must be taken to instruct the student
while patients are being treated. Too, the stu-
dent must be housed and fed.
These physicians are to be congratulated on
their willingness to make these sacrifices in
order to help make possible the continuation of
the heritage of the country doctor.
On the other hand, doctors in the states
where the plan is in operation report that the
preceptorship is a stimulating experience for the
physician as well as for the student.
Much work remains to be accomplished when
and if the plan is adopted here . . . medical
schools must be approached, their cooperation
secured, and a definite schedule of operations
and responsibilities established.
The Committee will be glad to receive any
comments or suggestions from members of the
Ohio State Medical Association which would be
of assistance in its deliberations.
IT WILL TAKE MORE THAN
100 TO DO THE JOB
During the early part of September, the Ohio
State Medical Association is holding 11 impor-
tant conferences in various parts of the state.
These will be attended by the officers and legis-
lative chairmen of county medical societies of
the areas, the district councilor and the district
member of the state legislative committee.
The purpose of these conferences is to re-
view data regarding candidates for public of-
fice for whom voters will cast their ballots on
November 7 and to work out practical methods
of disseminating this information to all mem-
bers of the medical profession of Ohio — and
others.
Approximately 100 physicians will take part
in these conferences. If they return to their
homes and fail to follow through, the conferences
will have been distinct failures. If they return
to their county medical societies and do the
job expected of them, the conferences will have
been exceedingly worth while.
However, it will take more than the good
work of 100 men to do the kind of job which
will be necessary this year.
The November 7 General Election will be
one of the most important — if not the most
important — in the history of Ohio and the nation
at large. Those who vote on November 7 —
goodness knows anyone in his right mind should
do so this year, of all years — will, indirectly,
be voting on many vital issues — socialized medi-
cine, socialism generally, collectivism, etc. The
public office holders of the future will decide
these issues.
Therefore, the entire medical profession must
be mobilized for action during the period leading
up to the November 7 election. Individual phy-
sicians should take the information regarding
candidates given to them by their county medi-
cal society officers and legislative committeemen
and put it to use among their relatives, friends,
neighbors and patients. If the information is
not sent to them in one way or another, they
should get in touch with these officials and
demand it.
A committee of 100, or 200 or even 500,
can’t do the job. It can only be the sparkplug.
The work has to be done by all of the phy-
sicians of Ohio.
This Fall offers the medical profession of
Ohio a rare opportunity to make its influence on
public affairs felt in a tangible way. If it
falls down on the job and fails to work with
other substantial groups to elect qualified men
for various public offices, it will have no one but
itself to blame for whatever unhappy results
may accrue.
HAVE-NOTS VERSUS
THE HAVES
Writing in the Kansas City Medical Bulletin
on the theme, “Have-Nots Versus the Haves,”
Dr. Vincent F. Williams offers the following
illustration of how smart folks get snarled up
when they play fast and loose with fundamental
principles. Dr. Williams says:
“Recently, a bunch of preachers passed a res-
olution which approved the principle of good
medical care for all Americans, to which every-
one should say, ‘Amen.’ Then they approved the
principle that taxation should be used as a
method of reducing the ‘haves’ to the ‘have-
nots’ class. What stupid simpletons!
“In spreading this dangerous doctrine, they
are unwittingly contravening precepts of the
Bible and those of ordinary common, good
horse-sense. For, together with some of the
short-sighted among labor leaders, they forget
that whenever temporary expediency dominates,
the ultimate ruler of a land having only ‘have-
nots’ is an absolute, central government and
this agency never tolerates autonomy of church
or unions.”
924
The Ohio State Medical Journal
An Observation on the Accuracy of Digitalis Doses
Withering made this penetrating observation in
his classic monograph on digitalis: "The more I
saw of the great powers of this plant, the more it
seemed necessary to bring the doses of it to the
greatest possible accuracy.”1
To achieve the greatest accuracy in dosage and at
the same time to preserve the full activity of the
leaf, the total cardioactive principles must be iso-
lated from the plant in pure crystalline form so
that doses can be based on the actual weight of the
active constituents. This is, in fact, the method by
which Digilanid® is made.
Clinical investigation has proved that Digilanid is
"an effective cardioactive preparation, which has
the advantages of purity, stability and accuracy as
to dosage and therapeutic effect.”2
Average dose for initiating treatment: 2 to 4 tab-
lets of Digilanid daily until the desired therapeutic
level is reached.
Average maintenance dose: 1 tablet daily.
Also available: Drops, Ampuls and Suppositories.
1. Withering, W.: An account of the Foxglove, London, 1785.
2. Rimmerman, A. B.: Digilanid and the Therapy of Congestive
Heart Disease, Am. J. M. Sc. 209: 33-41 (Jan.) 1945.
Literature giving further details about Digilanid and Physician’s Trial
Supply are available on request.
Digilanid contains all the initial glycosides from
Digitalis lanata in crystalline form. It thus truly
represents "the great powers of the plant” and
brings "the doses of it to the greatest possible
accuracy”.
Sandoz
Pharmaceuticals
DIVISION OF SANDOZ CHEMICAL WORKS, INC.
68 CHARLTON STREET, NEW YORK 14, NEW YORK
Have You an Article in this Issue?
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Ohio State Medical Journal until the 10th of the month and will
furnish reprints of your article at the following prices:
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STONEMAN PRESS ga&T’.TSK
for September, 1950
925
Civilian Defense Program . . .
Governor Moves To Make Organization All-Inclusive; Medicine’s Part
Important; County Societies Urged To Appoint Emergency Committees
PLANS for an extensive, all-inclusive civilian
defense program for Ohio are rapidly tak-
ing shape, with medical and health prob-
lems being given a major portion of attention.
The civilian defense set-up is designed to
handle any form of emergency within the state,
with special emphasis being placed on assist-
ance in the event of enemy action. Naturally,
the part that medical and health officials would
be called upon to play would be a major one,
and so these categories are receiving top priority
in planning from the very start.
The entire program is based upon the na-
tional program laid down by Washington as a
pattern for state and local groups. There are
five areas in the state, each with its own com-
manding colonel. They are: No. 1, Cincinnati,
Colonel Sam Richmond; No. 2, Columbus, Col-
onel Edgar A. Silbaugh; No. 3, Youngstown, Col-
onel Donald J. Lynn; No. 4, Kenton, Colonel Cecil
J. Davis; No. 5, Cleveland, Colonel Frank C.
Manik.
Executive director for the program is Dr. Wil-
liam E. Warner of Ohio State University. Dr.
Warner is a veteran of World Wars I and II
and was in charge of a similar civil defense move
in Europe.
During the last war the council was headed
by Ralph Stone, now with the Veterans Admin-
istration. Under that set-up the council had
more divisions than the present one.
ADVISORY GROUP
Adj. Gen. Leo Kreber is chairman of the
council and Governor Frank J. Lausche is vice-
chairman. In establishing a plan for the state
Governor Lausche has named an 11-man advisory
group to aid in planning all matters pertaining
to the problem. The advisors will receive no
pay for their services, but will be allowed ex-
penses incurred in their duties.
This advisory group includes: Veterans, Ralph
Stone; Mayors, Michael DiSalle; County Com-
missioners, Oliver Kuhn; Health and Medicine,
Dr. John D. Porterfield, State Director of Health;
Agriculture and Food, Joseph W. Fichter; Labor,
Phil Hannah; Manufacturing, A. S. Gentholts;
Communication, Randolph Eide; Transportation,
Raymond J. Lewis; Procurement and Salvage,
Ralph Lazarus; American Red Cross, John S.
Rolfes.
HEALTH-MEDICAL ORGANIZATION
Realizing the extent his division will be called
upon in case of enemy attack, Dr. Porterfield
has named a 15-member group to cover as many
of the phases of health and medical care as
possible. These men are representatives of the
various state associations dealing with the prob-
lems likely to be confronted. They are: Dr. C.
C. Sherburne, Columbus, chairman of the Ohio
State Medical Association’s Committee on Na-
tional Emergency Medical Service, medical; Dr.
J. 0. Watson, osteopathic; Miss Clara Brouse,
nurses board; Mrs. Elizabeth P. August, nurses
association; Nelson Carpenter, pharmaceutical;
Dr. A. E. Luckhard, dental; Erwin C. Pohlman,
hospitals; Jerry Gordon, funeral directors; and
Dr. J. H. Drayer, public health sanitation.
Dr. C. W. Greenlee, Rayland, veterinary medi-
cine; Dr. Carl A. Wilzbach, Cincinnati, public
health; John F. Rolfes, Bloomdale, general field
agent for Red Cross eastern area; Dr. S. R.
Gerber, Cleveland, secretary of the Ohio Coroners’
Association, county coroners; W. R. LaDue,
Akron, American waterworks; and A. H. Niles,
Toledo, Federal sewage works.
DIVISION HEADS
Four division heads have been named. They
are: Medical Care, Dr. Porterfield; Sanitation,
F. H. Waring; Public Health, Dr. Paul Q. Peter-
son; Professional Training, Dr. R. E. Dwork.
These four divisions will each have its own area
in which to operate.
The Medical Care group will inventory and
classify all personnel and equipment throughout
the state. The Sanitation people will make a
survey of sewage and water supply systems,
with a complete plan for alternate supplies in
case of disruption of present facilities due to
bombing or other causes. This group also will
develop a system for protection against bacteri-
ological warfare.
The Public Health division will set up for
emergency communicable disease control as well
as establishing a system to attempt to decrease
occupational hazards during wartime.
The group in charge of professional training
has three distinct fields of activity. First, it
will have the job of developing a system of co-
ordination of various aspects of civil defense.
Second, it will publish a periodical to be sent to
all local civil defense officials, and third, it
will develop and assemble material to be turned
out by the press relations office.
Just as the Federal government is establishing
a national-scale plan for state defense councils
to follow, so is the state council developing a
plan to be followed by local councils and groups
throughout Ohio. This will aid in establishing an
926
The Ohio State Medical Journal
over-all form to the defense picture, and will
facilitate the moving of disaster units into
cities or localities that have been hard hit
from others that were not attacked.
“One of our biggest jobs,” Dr. Porterfield said,
“will be in educating the people themselves.
In the event of an atomic bomb attack, huge
numbers of volunteers will be needed. But no
number of volunteer workers will be of aid
unless they have some conception of what is
needed and how to go about assisting the emer-
gency teams which move into the area.”
COUNTY SOCIETY PARTICIPATION
On July 27 Dr. E. O. Swartz, President,
Ohio State Medical Association, issued a call
requesting all county medical societies to im-
mediately establish Committees on Emergency
Medical Care. These committees will serve as
local components of the Committee on National
Emergency Medical Service of the Ohio State
Medical Association; advise and cooperate with
local defense units; help work out and administer
a proper health and medical program for the
protection of civilians in case of enemy attack,
or some other emergency; submit recommenda-
tions and suggestions on local activities to the
committee of the Ohio State Medical Associa-
tion which, in turn, can take up such matters
with the State Defense program officials.
As this issue went to press 74 county societies
had named emergency committees.
With the national, state, and local civil defense
programs moving ahead rapidly, it is imperative
that the remainder of these committees be set
up as quickly as possible.
New Members of O. S. M. A.
Following are the names of new members of
the Ohio State Medical Association, since June
13, 1950. The list shows the county in which
they are affiliated, city in which they are prac-
ticing, or temporary addresses in cases where
physicians are taking postgraduate work.
CLARK COUNTY
Clyde E. Asbury, Jr.,
Springfield
Robert A. McLemore,
Springfield
CUYAHOGA COUNTY
Leonard A. Backiel, Cleve-
land
Bernard A. Ceraldi, Cleve-
land
Robert E. Rinderknecht,
Cleveland
Homer T. Yoder, Cleve-
land
ERIE COUNTY
John F. Grant, Sandusky
FRANKLIN COUNTY
Robert H. David, Columbus
GREENE COUNTY
E. J. Schmitt, Xenia
GUERNSEY COUNTY
Elizabeth B. Smith, Cam-
bridge
Howard F. Van Noate,
Cambridge
MIAMI COUNTY
Dale A. Hudson, Piqua
MONTGOMERY COUNTY
A. J. Gabriele, Dayton
MORGAN COUNTY
Frank Lande, McConnels-
ville
VINTON COUNTY
Dean F. Hammond,
McArthur
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MILLERSTOWN, PENNSYLVANIA
Established 1938 Printers for the Medical Profession
for September, 1950
927
Rural Medical Scholarship . . .
Second of the State Association’s Awards To Stimulate Interest in
Country Practice Presented by Committee to Lawrence County Youth
A LAWRENCE County youth, 27-year-old
Robert G. Smith, of Proctorville, has been
selected as the winner of the second annual
Ohio State Medical Association Rural Medical
Scholarship.
The award was made by the Association’s
Committee on Rural Health under the chairman-
ship of Dr. J. Martin
Byers, of Greenfield. In
a public announcement
to the press, Dr. Byers
explained that the schol-
arship was created with
the idea of encouraging
rural young men and
women to take up the
study of medicine in the
hope that they will be-
come country doctors
and help supply the
needs of Ohio rural
areas.
Smith, who is a combat veteran of World War
II, will receive $500 each year during his four-
year medical course, provided he remains in good
standing. He completed his premedical work
at Ohio State University, graduating cum laude
in the class of 1950. He will become a student
at the Ohio State University College of Medi-
cine this fall.
Under the scholarship plan, which was in-
stituted a year ago by the State Medical Asso-
ciation, one student is selected each year. A
farm or a rural small town community back-
ground as well as a sincere desire to take up
a rural practice are of prime importance in
making the selection.
Smith has an excellent record in rural youth
work, including the Proctorville 4-H Club, the
Epworth League, and he was for three years
assistant advisor to the Baptist Rural Youth Lea-
gue. He is a 4th degree member of Windsor Sub-
ordinate Grange, a 5th degree member of Law-
rence County Pomona Grange and has received
the 6th degree of the Ohio State Grange.
During the summer vacations of his high
school years he worked on local farms and in
the orchards near his home town.
While attending the Ohio State University he
was a member of Alpha Epsilon Delta, honorary
premedical fraternity. As a graduate of Proctor-
ville High School in the class of 1941 he re-
ceived the Good Scholarship medal.
Smith served three and one-half years in the
Armed Services and held a first lieutenant’s com-
mission at the close of the war. He was a pilot
attached to the 301st Airborne Division of the
China-Burma-India theater.
Married and the father of two children, Smith
plans to return to his home town to practice
medicine. Commenting on his desire to practice
in a southern area of the State, he said: “Both
my wife and I come from Proctorville. We
know the people and we have seen their needs.
They need doctors in that area, and I want to
help in any way possible. I want also to have
my children brought up in a rural environment.
It’s a wholesome one.”
Last year’s winner, C. Craig Wright of Winter-
set, Guernsey County, Ohio, who will be a sopho-
more at the Ohio State University College of
Medicine, has received his second $500 check.
After the 1951 and 1952 awards have been made,
four students will be receiving checks every
year.
R. G. SMITH
RESTHAVEN
A strictly modern convalescent hospital, specially
designed and scientifically equipped for the spe-
cialized care of the aged, convalescent, or cancer
patient.
Accredited by American Medical Association.
Complete cooperation to the attending physician.
For descriptive folder, call or write
M. YOUNG, Business Manager
Telephone FA. 2535 or FA. 4893
813 Bryden Road Columbus, Ohio
928
The Ohio State Medical Journal
In Memoriam
• • •
Mary E. Anderson, M. D., Mansfield, Mass.;
Michigan College of Medicine and Surgery, 1896;
aged 86; died July 19. Dr. Anderson practiced
in Hudson before retiring several years ago.
Two sons survive.
Joseph Emil Blunden, M. D., Pasadena, Calif.;
Medical College of Ohio, Cincinnati, 1903; aged
76; died June 14; former member of the Ohio
State Medical Association and the American
Medical Association through 1944. A former
practicing physician in Cincinnati, Dr. Blunden
has made his home in California for the past
12 years.
Harold A. Campbell, M. D., Newark; Ohio State
University College of Medicine, 1924; aged 51;
died August 8; member of the Ohio State Medi-
cal Association and a Fellow of the American
Medical Association through 1949; secretary-
treasurer of the Licking County Medical Society,
1926-29; vice-president in 1930 and 1932, and
president in 1931; member of the American
Association of Industrial Physicians and Sur-
geons. Dr. Campbell had practiced in Newark
beginning in 1924.
Frank P. Charvat, M. D., Cleveland; Western
Reserve University School of Medicine, 1896;
aged 75; died July 28; former member of the
Ohio State Medical Association and the Ameri-
can Medical Association through 1936. After
studying abroad, Dr. Charvat took up his prac-
tice in Cleveland, but retired a number of years
ago because of ill health. Recently he was
awarded the 50- Year Pin and Certificate of the
Ohio State Medical Association through the
Cleveland Academy of Medicine. He was a
member of the Catholic Church. Surviving are
his widow, a daughter and a son, Dr. Thomas F.
Charvat, also of Cleveland.
Robert B. Cofield, M. D., Cincinnati; Medical
College of Ohio, Cincinnati, 1903; aged 72; died
July 14; member of the Ohio State Medical Asso-
ciation and a Fellow of the American Medical
Association through 1949; member of the Ameri-
can Orthopaedic Society, the Clinical Orthopaedic
Society, the American Academy of Orthopaedic
Surgery and the American College of Surgeons.
Dr. Cofield’s long practice and activities in Cin-
cinnati included a number of years as president
of the medical staff of Christ Hospital and par-
ticipation in organizing the orthopedic staff
there. He was one of the founders of the
Condon School for Crippled Children and was
consulting orthopedic surgeon at Children’s Hos-
pital. He also was a trustee of the National
Foundation for Infantile Paralysis. Surviving
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Water is the secret of Rexair’s dust-filtering action. Rexair— and only
Rexair — passes the stream of dust-filled air completely through a
churning bath of water, discharging dean, humidified air into the
room. Rexair direct factory sales and service branches are listed in
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for September, 1950
929
are his widow, three daughters and a son, Dr.
Robert H. Cofield, of Newtown.
Cassius Guy Dew, M. D., Nelsonville; Ohio
Medical University, Columbus, 1903; aged 71;
died July 9; former member of the Ohio State
Medical Association and the American Medical
Association through 1948; vice-president of the
Athens County Medical Society in 1927 and its
president in 1928. Dr. Dew had practiced medi-
cine in Nelsonville for more than 40 years prior
to his retirement because of illness about two
years ago. In addition to his practice he was
active in public and business life. At one time
he was chairman of the Athens County Demo-
cratic Executive Committee and served as mayor
of Nelsonville. A veteran of World War I, he
was a member of the American Legion. He
held memberships in several Masonic orders,
was a member of the Order of Eagles, the Elks
and the Knights of Pythias. Surviving are two
sisters and a brother.
E. Paul Greenawalt, M. D., Springfield; Johns
Hopkins University School of Medicine, 1920;
aged 55; died July 29; member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association; secretary of the Clark
County Medical Society in 1927, vice-president,
1933, and president in 1934; fellow of the Ameri-
can College of Surgeons. Dr. Greenawalt had
practiced in Springfield for approximately 25
years. In addition to his medical career, he was
active in several fraternal and civic organiza-
tions. He was a past-master of the Masonic
Lodge and held membership in several Masonic
orders, the Lutheran Church and Beta Theta
Pi. He was a veteran of World War I. Surviv-
ing are his widow and two sisters.
Yernon L. Hart, M. D., Minneapolis, Minn.;
University of Michigan Medical School, 1924;
aged 52; died early in July; former member of
the Ohio State Medical Association through
1933 and a Fellow of the American Medical
Association. Dr. Hart moved his practice from
Dayton to Minneapolis in 1933.
Henry L. Hinkley, M. D., Green Springs; The
Hahnemann Medical College & Hospital, 1887;
aged 92; died August 10; former member of the
Ohio State Medical Association and the American
Medical Association through 1925. Dr. Hinkley
formerly was health commissioner for Seneca
County. Two daughters and three sons survive.
Lewis Wade Heizer, M. D., Norwood; Univer-
sity of Cincinnati College of Medicine, 1910;
aged 66; died July 30; former member of the
Ohio State Medical Association and the Ameri-
can Medical Association through 1929. Dr.
Heizer was assistant health commissioner for
Cincinnati from 1919 to 1921.
Jonathan Kelley James, M. D., Delaware; Ohio
Medical University, Columbus, 1897; aged 82;
^Medical - Dental Management^
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Clayton L. Scroggins Raymond E. Scroggins
William H. Scroggins III
930
The Ohio State Medical Journal
died July 26; former member of the Ohio State
Medical Association and the American Medical
Association through 1946; president of the
Delaware County Medical Society in 1926 and
1935 and its president in 1940 and 1941. Dr.
James’ many years of practice in Delaware were
recognized recently when he was presented the
50-Year Pin and Certificate of the Ohio State
Medical Association through the Delaware County
Medical Society. He had retired from active
practice in 1946. He was a member and trustee
of the Methodist Church and a member of the
Masonic Lodge. His widow survives. Dr. James’
only son, Dr. Dorrance S. James, died in May
of this year.
William E. Kulka, M. D., Cleveland; University
of Vienna, Austria, 1905; aged 70; died July 19;
member of the Ohio State Medical Association
and the American Medical Association; member
of the American Society of Clinical Pathologists;
the Ohio State Society of Pathologists and the
Cleveland Society of Pathologists. A native of
Austria, Dr. Kulka served as a medical of-
ficer in the Austrian Army during World War I.
From 1919 until 1939 he maintained private
practice and also was a senior health officer of
the city of Vienna. Following the Nazi invasion
of Austria, he came to this country with his
family in 1939, and served successively as
pathologist and director of the blood bank at
Our Savior’s Hospital, Jacksonville, 111., and
head of the laboratories of the Millard Fillmore
Hospital, Buffalo, N. Y. In 1944 he joined the
coroner’s staff in Cleveland and became head of
the laboratory of pathology and forensic medi-
cine. Dr. Kulka was the author of more than
40 medical papers both in the U. S. and abroad.
He is survived by his widow and tw'o sons.
Edward B. Markey, M. D., Dayton; Cornell
University Medical College, 1906; aged 71; died
July 19; former member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association through 1947. Dr. Mar-
key retired from active practice about two years
ago after a long practice in Dayton. He formerly
practiced also in Butler and Preble counties. He
held memberships in the Episcopal Church and
the Masonic Lodge and was an honorary member
of the Mercator Club. Surviving are his widow,
a daughter, and a son, Dr. Robert C. Markey,
also of Dayton.
William D. Micklethwait, M. D., Portsmouth;
Medical College of Ohio, Cincinnati, 1901; aged
75; died August 8; member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association; vice-president of the
Hempstead Academy of Medicine in 1932 and its
president in 1937. Dr. Micklethwait began prac-
tice in Portsmouth in 1902. He retired in 1940,
but resumed practice during the war. In addi-
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shown by
proof of preference
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support and complete comfort, too. For patients bothered
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jor September, 1950
931
tion to his medical practice he was interested
in real estate development projects in Ports-
mouth. He also was medical examiner for three
insurance companies. Activities included mem-
berships in the Methodist Church and the Masonic
Lodge. Surviving are his widow, two sons, a
sister and a brother, Dr. Oscar 0. Micklethwait,
also of Portsmouth.
George B. Nessley, M. D., Columbus; Ohio
Medical University, Columbus, 1894; aged 81;
died July 26; member of the Ohio State Medical
Association and a Fellow of the American Medi-
cal Association through 1949. Dr. Nessley had
practiced medicine in the Hilltop area of Colum-
bus for approximately 54 years. He was a
member of the Methodist Church and was a di-
rector of the First Federal Savings & Loan
Association. Surviving are his widow, a daughter
and a sister.
Leo George Reuscher, M. D., Pleasant Ridge;
University of Cincinnati College of Medicine,
1911; aged 67; died July 9; member of the Ohio
State Medical Association and the American
Medical Association through 1919. In addition to
his practice, Dr. Reuscher formerly operated a
drug store in Cincinnati and at one time was
associated with the Cincinnati Board of Health.
He is survived by his widow, five sons, a brother
and a sister.
Joseph Perry Weiss, M. D., Akron; Ohio State
University College of Medicine, 1927; aged 57;
died July 4; member of the Ohio State Medical
Association and a Fellow of the American Medi-
cal Association. Dr. Weiss began practice in
Akron in 1928. He was a member of the
Methodist Church. Surviving are his widow,
two brothers and a sister.
Wilmington — Dr. Edward B. Headley has been
appointed commissioner of the Clinton County
Health District which includes the city of Wil-
mington. An Ohioan, Dr. Headley received his
degree from Johns Hopkins Medical School in
1949.
Dr. Harrison S. Collisi, manager of Crile
Veterans Administration Hospital since Septem-
ber of 1946, has been transferred to head the
V. A.’s new 200-bed general hospital at Erie,
Pennsylvania. The transfer is effective Decem-
ber 1.
Xenia — The following were elected by the staff
of the Greene County Memorial Hospital: Dr.
Harold E. Ray, chief of staff; Dr. P. B. Wing-
field, vice-president; Dr. C. G. McPherson, secre-
tary; Drs. W. T. Ungard, S. C. Ellis and L. W.
Sontag to the executive committee.
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The Ohio State Medical Journal
• • •
Do You Know?
Toledo’s Dr. Edward J. McCormick, A. M. A.
Board of Trustees member, has been appointed
a trustee of the Elks National Foundation. For
the past several years this foundation has been
granting college scholarships and doing other
work on the national and state levels.
* * *
The Royal College of Surgeons at London,
England, has announced the awarding of an hon-
orary fellowship to Dr. Derrick T. Vail, former
head of the department of ophthalmology at the
University of Cincinnati. The award was made
in recognition of Dr. Vail’s “outstanding service
to medicine.”
* * *
Dr. William A. Altemeier, of the College of
Medicine at the University of Cincinati, has
been appointed a member of the National Re-
search Council. Dr. Altemeier is the first U. C.
faculty member to be named to the Washington
Council. He is an assistant professor of surgery
and graduated from College of Medicine at U. C.
in 1933.
^ ^ ^
More than 80 present and former members of
the surgery department at Western Reserve Uni-
versity Medical School honored Dr. Carl H.
Lenhart this summer. The testimonial was
held at Lakeside Hospital and marked Dr.
Lenhart’s retirement after 18 years’ service.
^ ^ ^
Dr. D. A. Dukelow of Chicago, health education
advisor to the American Medical Association,
has been named to assist in the preparation of
health data for the Midcentury White House
Conference on Children and Youth. Dr. Dukelow’s
appointment was anounced by Melvin A. Glasser,
executive director of the conference.
^ ^ ^
Dr. Francis R. Manlove, Philadelphia, has
been appointed associate secretary of the A. M. A.
Council on Medical Education and Hospitals. He
is assistant professor of medicine at Temple
University School of Medicine and chief of
medical service B at Episcopal Hospital.
Sfc 5-C
The first national blood bank survey, made
under direction of Dr. Frank G. Dickinson, di-
rector of the A. M. A ’s Bureau of Medical Eco-
nomic Research, and reported at the A. M. A.
Session in San Francisco, showed that 1,636
blood banks and centers are in operation in the
United States. They are located in 951 cities.
Inventory showed a current supply of 76,000
pints. About 61,300 pints are in hospital blood
banks, 6,100 are in Red Cross regional centers
and 8,100 in nonhospital blood banks.
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for September, 1950
933
Buckeye News Notes . . .
Cleveland — Dr. Fiorindo A. Simeone has been
appointed head of surgery at City Hospital,
succeeding Dr. C. H. Lenhard, who recently re-
tired. Dr. Simeone comes from Harvard Medi-
cal School and Massachusetts General Hospital.
Cleveland — Dr. Jess J. Woodworth has been
named head of the Department of Obstetrics
and Gynecology at Huron Road Hospital.
Cleveland — Dr. I. M. Hinnant, representing the
Cleveland Academy of Medicine, addressed the
Churchmen’s League of Cleveland on Socialized
Medicine. Dr. Hinnant spoke before a luncheon
meeting of the group.
Cleveland — The promotion of Dr. Thomas D.
Kinney to professor of pathology at City Hospital
has been announced. The promotion was an-
nounced by Welfare Director Edward L. Worth-
ington and Western Reserve University President
John S. Mills. Dr. Kinney joined the staff in
1947, coming from an associate professorship of
pathology at Peter Bent Brigham Hospital at
Boston.
Forest — Two local physicians — Dr. J. F. Holtz-
muller and Dr. E. J. Clinger — endorsed for
doctors a visit of the Red Cross Bloodmobile
due at this city on Sept. 25.
Grover Hill — Dr. T. P. Fast was honored re-
cently as one of the foremost family doctors at
a community gathering sponsored by the Lions
Club. Dr. Fast began his practice in Grover
Hill in May of 1900. He was presented a gift
by his “first baby” and another by the Lions
Club.
Jackson — Dr. William B. Taylor has announced
that he will leave his practice in Jackson to ac-
cept an appointment at University Hospital,
Ann Arbor, Mich.
Oberlin — A meeting was held with the objective
of laying plans for a hospital to serve the
southern third of Lorain County.
Painesville — The Lake County Memorial Hos-
pital staff entertained members of the medical
societies of Ashtabula, Geauga Counties and
their wives on July 19. In charge of arrange-
ments were Dr. F. J. Dineen, Dr. G. Robert
Smith and Dr. John W. Davis.
Toledo — Dr. Byron Grant Shaffer has been
named director of surgery at St. Vincent’s Hos-
pital to succeed the late Dr. Fred M. Douglass.
Toledo — The American Proctological Society
this summer awarded Drs. Bernard Steinberg
and William Blank of Toledo a $100 prize for
their paper on methods of detecting cancer and
other work being done at the Toledo Hospital
Institute for Medical Research. The award
was made at the society’s Los Angeles meeting.
Cook County
Graduate School of Medicine
ANNOUNCES CONTINUOUS COURSES
SURGERY — Intensive Course in Surgical Technic,
two weeks, starting Sept. 25, Oct. 23, Nov. 27.
Surgical Technic, Surgical Anatomy & Clinical
Surgery, four weeks, starting Sept. 11, Oct. 9,
Nov. 6. Personal Course in General Surgery, two
weeks, starting Sept. 25. Surgery of Colon &
Rectum, one week, starting Sept. 11, Oct. 9.
Esophageal Surgery, one week, starting Oct. 16.
Breast & Thyroid Surgery, one week, starting
Oct. 2. Thoracic Surgery, one week, starting Oct.
9. Gallbladder Surgery, ten hours, starting Oct. 23.
Fractures & Traumatic Surgery, two weeks, start-
ing Oct. 9. Basic Principles in General Surgery,
two weeks, starting Sept. 11.
GYNECOLOGY — Intensive Course, two weeks, start-
ing Sept. 25, Oct. 23. Vaginal Approach to Pelvic
Surgery, one week, starting Sept. 8, Nov. 6.
OBSTETRICS — Intensive Course, two weeks, starting
Sept. 11, Nov. 6.
MEDICINE — Intensive General Course, two weeks,
starting Oct. 2. Gastro-enterology, two weeks, start-
ing Oct. 16. Gastroscopy, two weeks, starting
Sept. 11, Oct. 23. Electrocardiography & Heart
Disease, four weeks, starting Oct. 2.
DERMATOLOGY — Formal Course, two weeks, start-
ing Oct. 16. Informal Clinical Course every two
weeks.
UROLOGY — Intensive Course, two weeks, starting
Sept. 25. Cystoscopy, Ten Day Practical Course,
every two weeks.
Genera!, Intensive and Special Courses in all
Branches of Medicine, Surgery and the Specialties
TEACHING FACULTY — ATTENDING
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934
The Ohio State Medical Journal
Activities of
County Societies . . .
ADAMS
The Adams County Medical Society held a
meeting- at the Museum, Serpent Mound State
Park, on Aug. 17, at which families of doctors
w'ere guests. Dr. S. J. Ellison, West Union, gave
a report of the State Meeting. Guest speaker
was Dr. Robert M. Woolf ord, Cincinnati, who
spoke on “Antibiotics.” Dr. and Mrs. R. B.
Ellison, Peebles, were hosts at a picnic dinner.
CLINTON
The Clinton County Medical Society has ap-
pointed a seven-member committee to obtain
data on the organization of staffs, looking for-
ward to the formation of a staff for the Clinton
Memorial Hospital now under construction in
Wilmington.
GREENE
The regular monthly meeting of the Greene
County Medical Society was held on July 13.
Dr. H. B. Elliott, Springfield, spoke on the
subject, “Ovarian Tumors.”
A special meeting of the Society was held on
July 27 to organize a staff for the nearly com-
pleted Greene County Memorial Hospital. Dr.
Harold E. Ray was elected president of the
staff. The staff will hold monthly meetings on
the fourth Tuesday at 8 p. m.
The Society played host at a stag picnic
on August 9 to dentists, lawyers and pharmacists
of the county. The program and public relations
committees joined in promoting the affair. —
Ray W. Barry, M. D., Pres.
HURON
Members of the Huron County Medical So-
ciety entertained their wives at a dinner at the
Elks Country Club on June 21. After dinner
the group drove to the home of Dr. and Mrs.
Byron T. Merrick in Berlin Heights where Dr.
Merrick gave an informative talk based on his
collection of Swiss music boxes.
LAKE
Dr. Alan R. Moritz, professor of pathology at
Western Reserve University School of Medicine,
spoke at the annual dinner of the Lake County
Memorial Hospital staff held at the Madison
Golf Lakelands Club House on July 19. His
subject was “The Unexplained Death.” The
speaker advocated that communities should have
agencies to screen unexpected, accidental and ob-
scure deaths. He stressed the importance of
having deaths of that nature investigated by
competent medical examiners, trained in path-
ology. Twelve per cent of persons who seem
to have died unexpectedly of undiscovered causes
have died of violence. Pseudo-accidents and
pseudo-suicides which give all the outward ap-
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an artificial limb,” says 0. D. Stone, Hanger wearer
in Texas. Not all wearers of Hanger Limbs can jump
as Mr. Stone does above. But Hanger wearers can
and do walk comfortably, safely, and satisfactorily,
and perform everyday activities. Hanger Limbs al-
low the amputee to return to daily life as a living
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CINCINNATI Office: H. L. Franklin, Rep.,
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CLEVELAND Office: J. R. Ticknor, Rep.,
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COLUMBUS Office: R. G. Woehr, Rep.,
2800 Indianola Ave., Tel. Lawndale 6200
for September, 1950
935
pearances of being accidents and suicides, upon
investigation may prove to be homicidal crimes,
the speaker declared.
Dr. Paul Reading presided at the dinner
and the guest speaker was introduced by the
program chairman, Dr. F. J. Dineen.
Woman’s Auxiliary . . .
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
President — Mrs. George W. Cooperrider, 1828 Bryden Road,
Columbus
President - Elect — Mrs. Farrell Gallagher, 1527 W. Clifton
Blvd., Lakewood
Vice-President — Mrs. E. P. Greenawalt, 1707 St. Paris Road,
Springfield
Recording - Secretary — - Mrs. Ross Knoble, 219 - 44th St.,
Sandusky
Corresponding Secretary — Mrs. Oscar Jepsen, Canal Win-
chester
Treasurer — Mrs. A. Paul Hancuff, 3551 Maxwell Road,
Toledo 13
Past-President — Mrs. C. W. Kirkland, 4805 Guernsey Street,
Bellaire
SPECIAL NOTICE
To All County Presidents Who Have Not Sent in
Names and Addresses of Officers and Chairmen:
May we remind you of the importance of
sending in, immediately, to Mrs. Oscar Jepsen,
corresponding-secretary, and to your district di-
rector, the complete names and addresses of
all your local officers and chairmen of com-
mittees.
Mrs. George Cooperrider, state president, urges
that this be given attention at once. Where cor-
rect names are not available, there is regret-
table delay in necessary and important informa-
tion and materials reaching those for whom that
information is intended.
FALL DISTRICT MEETINGS
Here is the schedule of fall district meetings.
District 1 — Sept. 26, Hillsboro — Luncheon
District 2 — Oct. 18, Dayton — Luncheon, Bilt-
more Hotel
District 3 — Oct. 20, Marion — Luncheon, Hotel
Harding
District 4 — Oct. 26, Toledo
District 5 — Nov. 14, C 1 e v e 1 a n d — Luncheon,
Westwood Country Club
District 6 — Sept. 29, Warren — Luncheon, Hotel
Warren
District 7 — Oct. 10, Steubenville — Luncheon,
Count y Club
District 8 — Oct. 5, Newark — Luncheon, Country
Ciuo
District 9 — Oct. 12, Portsmouth — tea, Chez
Paree
District 10 — Oct. 23, C o 1 u m b u s — Luncheon,
Seneca Hotel
District 11 — Sept. 14, Elyria — Luncheon, Coun-
try Club
It is with deep regret that we call attention
to the great loss suffered recently by our vice-
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936
The Ohio State Medical Journal
president, Mrs. E. Paul Greenawalt. Dr. Green-
awalt died suddenly on July 29. The Woman’s
Auxiliary extends its deepest sympathy.
Because of the usual cessation of activities
for the most part during the summer months,
there are no county auxiliary news items to
record other than the luncheon, held in July,
by the Meigs County Auxiliary. Mrs. Roger
Daniels was hostess. Plans were made for an
outdoor luncheon to be held at the home of.
Mrs. William Jeric in August.
A Second Pamphlet Promotes
Truman Health Plan
Campaigners for national health insurance now
have new ammunition. The latest propaganda
effort from Democratic National Committee is
a detailed handbook for party workers, designed
to supplement a smaller, mass-appeal pamphlet
already circulating in the hundreds of thousands.
The first pamphlet, Better Medical Care That
You Can Afford, is a smartly edited, overly
simplified three-color job, which undertakes with
a few words and numerous drawings to sell 'the
general public on the advantages of compulsory
national health insurance. It is enjoying wide
circulation, mostly as a result of bulk-quantity
purchase by labor unions and other organiza-
tions and direct mailing by the National Com-
mittee.
The latest booklet is pitched to a different
population level. It dips a little deeper into
the subject, and supplies adequate material for
speeches, radio talks, group discussions, etc.
This second pamphlet is entitled Administra-
tion Health Program, a Training Kit for Lead-
ers. Although the material consists mostly of
the familiar mixtures of information and propa-
ganda, it is well arranged to simplify the job
of the party worker. The 80 pages are broken
up by sections, headings and bold face type,
and an index, resume and cross-reference sys-
tem are provided.
The section on lobbying is a 17-page attack
on American Medical Association, usually referred
to as Organized Medicine. Included are 36
questions, such as “Is It True That America
Has ‘Low Grade’ Health Care?” Answers to
each are printed in parallel columns under the
headings “Lobbyists Say” and “The Truth Is.”
A ready guide for speakers is provided in the
last chapter. This consists of liberal quota-
tions from various messages and speeches of the
President, a statement by E. S. A. Administrator
Oscar Ewing and advice on how best to appeal
to special population groups, such as housewives,
farmers, industrial workers, Negroes, business-
men. One section tells party workers what
arguments to use when they attempt to convince
doctors that national health insurance would be
to their advantage.
New Nursing School
Capital University at Columbus has announced
the establishment of the Capital University
School of Nursing. The school has been ap-
proved by the Ohio State Nurses Board. The
program comprises a 51-month curriculum and
leads to the degree of Bachelor of Science in
Nursing, the university announcement said.
RADIUM and RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician-Radioloffist)
HAROLD SWANBERG, B. S., M. D., Director
W. C. U. Bldg. Quincy, Illinois
NEIL TRAINING SCHOOL
Registered by the American Medical Association
For Retarded and Exceptional
Children
Individual attention given to educational, emotional
and speech problems. Highly-trained teachers and
supervisors.
Suburban Estate Day and Boarding Pupils
Mrs. Helen Aston Copeland,
Director
4914 W. Broad St., Columbus, Ohio. FR. 8-5394
for September , 1950
937
Health Situation in Korea Headache
For Medical Officers
To date not much information has been an-
nounced on the rate and type of casualties in
Korea. However, an Army spokesman gives
this picture: Medical supplies, equipment and
personnel are in the combat area in sufficient
quantity to meet our responsibilities. On the
scene are evacuation hospitals, mobile “clearing
companies” (division hospitals) and mobile sur-
gical hospitals, all “in adequate supply and
operating.”
Casualties whose wounds indicate they will
not be able to rejoin their units for 120 days
are sent back to the United States, others hos-
pitalized in Japan or Korea. The Far Eastern
Field Surgeon, Major Gen. Edgar Erskine Hume,
anticipates a high rate of psychoneurotic cases
because of the nature of the fighting.
Disease rates probably have gone up under
combat conditions. Under any conditions, Korea
is considered an “unhealthy” place — better than
some Far Eastern countries but worse than
others. There is virtually no control of the
water supply, and human waste is used for
fertilizer, as in most countries in that area.
Water is unsafe for drinking or bathing.
Despite these conditions, the troop disease
rate during our four years of occupation was
“not significantly higher” than elsewhere. This
was due to health discipline measures which are
of limited effect during combat. Increases are
expected in malaria, scrub typhus, diarrhea and
intestinal and other diseases. Adequate sup-
plies of proper drugs are on hand to fight this,
including chloroquine, Chloromycetin and dram-
amine.
Changes Made In Division of Aid
For Aged Fee Schedule
Several changes in the medical fee schedule of
the Division of Aid for the Aged have been an-
nounced, effective as of August 15.
The amount paid for an intravenous injec-
tion will be the fee for the home call or
office or hospital visit, plus a flat amount of
$1.50. The amount paid for an intramuscular
injection will be the fee for the call or visit,
plus a flat amount of $1.00.
Also, the division announced that penicillin
will no longer be allowable as an item charge-
able over and above the fee for the call or
visit but will be considered as ordinary medica-
tion and will be included in the cost of the call
or visit.
The American Social Hygiene Association esti-
mates that there are approximately 100,000 chil-
dren in the U. S. suffering from congenital
syphilis.
INDEX TO ADVERTISERS
Abbott Laboratories 861
American Meat Institute 905
Ames Company, Inc. 858
Ann Arbor School, The 932
Ayerst, McKenna & Harrison, Ltd._ 863
Baker Laboratories, Inc. 907
Battle Creek Sanitarium, The 916
Bell, Kathryn S., Inc. 932
Birtcher Corporation, The 917
Borden Company 868
Bowen, Charles F., M. D. 933
Camel Cigarettes 866
Camp, S. H., Company _ 862
Cincinnati Sanitarium 856
Clinical and Pathological Laboratory 933
Columbus Orthopaedic Appliance Co. 934
Cook County Graduate School of Medicine 934
Cordelia of Hollywood 909
Davies, Rose & Co., Ltd. — 911
Endo Products, Inc. 865
Fleet, C. G., Company, Inc. 857
Hanger, J. E., Inc. 935
Harding Sanitarium 854
Holland Rantos Co. 913
Ingleside Home, Inc. 921
Lederle Laboratories, Inc. 847
Lilly, Eli, and Company Insert Between
Pages 868 and 869
Luzier’s, Inc 850
McMillen Sanitarium 856
Mead Johnson & Company Back Cover
Medical-Dental Management 930
Medical Protective Company 935
Medico Press, The 927
Mercer Sanitarium, The 854
Merck & Company, Inc. 849
Miller, W. H., M. D 936
M & R Dietetic Laboratories, Inc. 864
Neil Training School 937
Nestle’s Company, Inc. 923
New York Polyclinic Medical School 921
Num Specialty Company 937
Oak Ridge Sanatorium 855
Parke, Davis & Company , 940
and inside back cover
Philip Morris & Company 860
Picker X-Ray Corp. 859
Pogue, The Mary E., School 918
Quincy X-Ray & Radium Laboratories 937
Radium Emanation Corporation 923
Resthaven 928
Rexair Division, Martin-Parry Corp. 929
Rupp & Bowman Company 939
Sandoz Pharmaceuticals, Inc. 925
Sawyer Sanatorium 845
Schering Corporation 867
Sealy Mattress Company 931
Searle, G. D., & Company 903
Squibb, E. R., & Sons 915
Stoneman Press 925
U. S. Vitamin Corporation Insert between
pages 860 and 861
Wendt-Bristol Company 936
Wickhaven Sanitarium 854
Windsor Hospital — 854
Winthrop-Stearns, Inc. 851
Wyeth, Inc 919
Zemmer Company 939
938
The Ohio State Medical Journal
GlaM>i^ied Adu&Ui&ementl
Rates: 50 cents per line. Minimum charge of $1.00 for each insertion. Price covers the cost
of remailing answers. Forms close 16th of the month preceding publication.
FOR SALE : Brown-Berger cystoscopes, urethrascope,
metal and glass instrument cabinet. Box 95, Ohio State
Medical Journal.
WANTED : By well established and older F. A. C. S., a
general practitioner for assistant ; married man ; good hos-
pital facilities. Salary first six months, then percentage.
Apartment available suburban area twin cities. Great fu-
ture. Minnesota license or national Boards. Box 612, Ohio
State Medical Journal.
OPPORTUNITIES FOR PHYSICIANS: Are you inter-
ested in a position of one of our county or district health
departments? Salary $5,600 to $7,200, with $70 a month
travel allowance. Public health scholarships available with
liberal stipends. Men and Women physicians eligible. Felix
J. Underwood, M. D., Mississippi State Board of Health,
Jackson, Miss.
WANTED : General practitioner in small town, Darke
County, Ohio ; 3 hospitals within 16 miles ; excellent farm-
ing community ; Lutheran, Christian and Catholic Churches ;
office and home combination. Joseph George, North Star,
Ohio.
WANTED : Thoroughly competent physician for In-
dustrial office. Must be graduate of Class A School with
adequate hospital training. Salary $6,000.00. 200 Republic
Bldg., Cleveland 15, Ohio.
FOR SALE : General practice office and equipment ;
in small village with large farming area, 25 miles from
Columbus ; two young doctors leaving for military service ;
available Oct. 1. Has been doctor’s office 50 years ; no
other doctor within 8 miles. Hospital facilities near ;
special equipment includes X-ray and basal metabolism ;
drug stock available ; includes living quarters, hot water
heat and oil furnace. Box 616, Ohio State Medical Journal.
FOR RENT : Office suite, opposite post office ; physician’s
office past 25 years. See H. H. Biggs, M. D., Wadsworth, O.
WANTED: General practitioner to locate in Ohio rural
community. Death of two former resident physicians
leaves the community without adequate medical service.
Residence available ; excellent school ; three Protestant
churches ; good water and sewage systems ; open staff hos-
pital 8 miles ; financial assistance if needed. Write W. W.
Windham, Rushsylvania, Ohio.
FOR SALE : Kelley-Koett X-ray tube stand with set
of cones. E. B. Mainzer, M. D., 404 Walpark Bldg., Mans-
field, Ohio.
FOR SALE : G. E. Model B. Electrocardiograph with
regular AC current and auxiliary A battery connections
with carrying case and stand. Perfect condition. $300.
W. T. Wilkins, Jr., M. D., Phone 1950, Piqua, Ohio.
FOR RENT OR SALE : Four-room office and equipment.
H. H. Sink, M. D., Columbus Grove, Ohio.
WANTED : Resident in psychiatry, or psychiatrist with
one or two years experience, for acute service for 80-bed
Receiving Hospital. Apply for particulars. Eugene E.
Elder, M. D., Supt., Youngstown Receiving Hospital, Youngs-
town, Ohio.
GENERAL PRACTICE for rent or sale, central Ohio.
Home and office combination ; equipment optional ; annual
gross income $16,000. Box 618, Ohio State Medical Journal.
FOR SALE : Established general practice of 39 years : also
drugs and equipment. Office available ; small, progressive
village on Lake Erie; physician recently deceased. Box 114,
Vermilion, Ohio.
COMING MEETINGS
A. M. A. Clinical Session, Cleveland, December
5-8
International College of Surgeons, U. S. Chap-
ter, Annual Assembly, Cleveland, October 31-
November 3.
Medina Community Hospital, Scientific Pro-
gram, Westfield Country Club, LeRoy, October 4.
St. Luke’s Hospital, Symposia, Cleveland, Sep-
tember 20.
Sixth Councilor District Postgraduate Day, St.
Francis Hotel, Canton, October 4..
Ohio Society of Allergists, Seneca Hotel, Co-
lumbus, October 7-8.
BIOLOGICALS
and
BIOCHEMICALS
Aureomycin, Bacitracin, Chloromy-
cetin, Penicillin (All Forms), Cura-
tive Sera, Vaccines, Toxoids, Labora-
tory Material.
COMPLETE STOCKS
EXPERT HANDLING
• When in urgent need of materials
of these types contact us by telephone
(Toledo LD. 167) and immediate ship-
ment will be made.
THE RUPP & BOWMAN COMPANr
315-319 Superior Street
TOLEDO 3, OHIO
A complete line of laboratory con-
trolled ethical pharmaceuticals. Chemists
to the Medical Profession since 1903.
EMMER
THE ZEMMER CO., PITTSBURGH 13, PA. |
OH— 9-50
for September, 1950
939
PARKE
& COMPA
Concise
Vitamin
Facts
From Merck & Co., Inc.
— where many of the
individual vitamins
were first synthesized.
T
hese six Merck Vitamin Reviews are yours for
the asking while the editions last. These concise
reviews contain up-to-date, authoritative facts
and can he most useful for quick reference. Please
address requests for copies to Merck & Co., Inc.,
Rahway, N. J.
Partial Index of Contents
» ^ Factors that produce avitaminosis*
» > Signs and symptoms of deficiency*
- > Daily requirements and dosages.
» > Distribution in foods.
> — > 3Iethods of administration.
* ^ Clinical use in specific conditions*
MERCK & CO., Inc.
Atanufacturing Chemists
BAHWAY, new jersey
MERCK VITAMINS are available under the labels
of leading Pharmaceutical Manufacturers in
appropriate pharmaceutical forms
for October, 1950
947
*7<4e PlufUciaa'l BaoJz4Jte,ljj
By Jonathan Forman, M.D.
The Cytologic Diagnosis of Cancer, by the
staff of Vincent Memorial Laboratory at the
Massachusetts General Hospital ($6.50. W. B.
Saunders Co., Philadelphia) , sets forth the actual
experiences of this staff of competent workers
in their attempt to diagnose cancer by the
changes they have found in cells.
Thrombosis in Arteriosclerosis of the Lower Ex-
tremities, by Edward A. Edwards, M.D. ($2.00.
Charles C. Thomas, Publisher, Springfield, III.),
is another one of those attractive small mono-
graphs in the American Lecture Series. This
method of presenting reviews and practical mate-
rial should be encouraged by all of us in
every way.
Surgery of the Mouth and Jaws, by J. Ray
Bourgoyne, D. D. S. ($12.00. Dental Items of
Interest Publishing Co., Brooklyn, N. Y.), will
be an invaluable aid to the surgeon who wishes
to acquire surgical technique and study pro-
cedures without the necessity of reading a multi-
tude of volumes on this subject. In this one
volume he will find all of the essential facts
well organized and presented in a logical and
understandable manner.
BCG Vaccination in Theory and Practice, by
K. Neville Irvine ($3.00. Blackwell Scientific
Publications, Oxford, England), is a succinct
review of the literature in an objective manner
of this controversial subject which seems to
mean more in backward countries than in coun-
tries with higher levels of living standards.
Handbook of Obstetrics and Diagnostic Gyne-
cology, by Lee Doyle, M. D. ($2.00. University
Medical Publications, P. O. Box 761, Palo Alto,
Calif.), is neither a textbook nor one of refer-
ence. It is strictly a handbook. A nice thing
for the intern or senior student on the service
to have in his pocket. A nice little gift for
him just before he goes on duty. He will be
too busy to consult larger books.
Medical Gynecology, by James C. Janney, M. D.
($6.50. Second edition. W. B. Saunders Co.,
Philadelphia), makes a strenuous attempt to in-
corporate the important physiologic and path-
ologic considerations as well as to correlate the
academic picture of disease with the complaints
in the physician’s office of a patient coming
with that particular disease.
Advances in Pediatrics, edited by S. Z. Levine,
A. M. Butler, L. E. Holt, Jr., and A. A. Weech
($6.50. Volume IV. Interscience Publishers, Inc.,
New York City), consists of seven personalized
monographs by authoritative contributors; “Diet
in Infancy” by A. Lichtenstein of Stockholm;
“Treatment of Congenital Syphilis with Penicil-
lin” by Ralph V. Platon of New Orleans; “Ery-
thema Nodosum” by Ruth T. Gross and Rustin
McIntosh of New York; “The Reticulo-
Endotheliosis of Children” by Sture Siwe of
Lund, Sweden; “Combined Immunizations” by
Joseph H. Lapin of New York; “Subdural
Hematoma in Infancy” by Franc D. Ingraham
and Donald D. Matson of Boston; “Cystmosis
in Children” by E. Freudenberg of Basle,
Switzerland. All this makes a most valuable
volume.
Hormones in Clinical Practice, by H. E. Nie-
burgs, M. D. ($5.00. Paul B. Hoeber, Inc., New
York City), is more than a refreshing survey
of the field. This book has as its objective a
fresh evaluation of the therapeutic procedures
involving the use of hormones and those directed
to a correction of endocrine disturbances.
Clinical Diagnosis by Laboratory Examinations,
by John A. Kolmer, M.D. ($12.00. Second edi-
tion. Applet omCentury -Crofts Co., Inc., New
York City), has been heavily revised and merit-
ably enlarged by inclusion of newer material.
Most physicians will want to own a copy to help
them use their laboratory facilities. Every in-
tern library must have this book.
The Meaning of Human Existence, by Leslie
Paul ($3.00. J. B. Lippincott Co., Philadelphia),
discusses the subject in terms of the mystique
of Progress upon which all Western political
doctrines were founded. The author believes
that the real crisis in the world today lies in
the failure of man’s idea of himself. You will
enjoy this book as the world is tumbling down
around you.
Hutchinson’s Food and the Principles of
Dietetics, revised by V. H. Mottram, M. D., and
George Graham, M. D. ($6.75. Tenth edition.
Williams & Wilkins Co., Baltimore, Md.), pre-
sents an almost new section on “Diet in Normal
Life.” A reference book which many of us
will consult often.
Atlas of Human Anatomy, Descriptive and
Regional, by M. W. Woerdeman, M. D. ($10.00.
Blakiston Company, Philadelphia) , is Volume I
of the series, and naturally deals with osteology,
arthrology and myology, so graphically presented
because “of the increasing scarcity in many coun-
tries of anatomical material for the dissecting
room.” The excellent figures have all been
drawn according to dissection of the adult hu-
man body.
948
The Ohio State Medical Journal
Proceedings of the First Clinical ACTH Con-
ference, John R. Mote, M. D., editor ($5.50.
Blakiston Company , Philadelphia), gives
promptly the information brought out in an in-
formal conference of those who have been given
this material for research into its nature and its
uses. Many papers now appearing in medical
journals should be brought out in this form to
relieve the great backlog of manuscripts that
most medical journals have today.
Biological Actions of Sex Hormones, by Harold
Burrows ($8.50. Second edition. Cambridge
University Press, New York City), carries out
well the intentions of the author to collect facts
and coordinate them so that the subject of sex
hormones may be regarded broadly without
obscurity derived from unconfirmed ideas.
Urologic Roentgenology, by Miley B. Wesson,
M. D. ($7.50. Third edition. Lea & Febiger,
Philadelphia), is an excellent volume for the
physician who wishes to study the films of his
patient, and “for the urologist or roentgen-
ologist preparing for Specialty Board examina-
tions.” (God save us from books for that
purpose.)
Clinical Radiation Therapy by Ernest A. Pohle,
M. D. ($15.00. Second edition. Lea & Febiger,
Philadelphia) , has 19 other contributors, and 202
illustrations and places the accent strictly on the
clinical aspects of the subject. The book is,
therefore, for the practitioner.
Gastroscopy, by Rudolf Schindler, M.D., ($20.00.
Second edition. University of Chicago Press,
Chicago, III.), has contributed much to our under-
standing of gastric disease and its diagnosis.
The author introduced the subject into America
and wrote the first edition of this book in 1937.
This then is “the bible” of endoscopic studies
of gastric pathology.
Methods in Medical Research, edited by J. H.
Comroe, Jr., ($6.50. Volume II. Year Book
Publishers, Chicago, III.), has to do witn the
present-day methods used in the investigation of
Bacterial Viruses, Pulmonary Function Tests,
and Assay of Hormone Secretions. It is the
laboratory manual of the investigation in these
fields.
Progress in Clinical Endocrinology, edited by
Samuel Soskin, M. D. ($10.00. Grune & Strat-
ton, Inc., New York City), is a book appealing
to all physicians in active practice. Its score of
contributors reads like a blue book of endocrin-
ologists.
A Pattern for Hospital Care, by Eli Ginzberg
($4.50. Columbia University Press, New York
City), is the final report of the New York State
Hospital Study. This report gives us a broad
view of what the experts in hospital administra-
tion think as well as the views of the public.
A book of advice of a statesman and public
spirited citizen.
Principles of Human Genetics, by Curt Stern
( W . H. Freeman & Co., San Francisco, Calif.),
is a college text on this rapidly expanding sub-
ject. Those of us who are losing out in fol-
lowing its progress will do well to read this text.
Community Health Organization, by Ira V>
Hiscock ($2.75. Fourth edition. The Common-
wealth Fund, New York City). The author is
well known to our readers for his survey of the
needs for the care of the sick in Metropolitan
Columbus and his study of the “Athen’s project.”
. This is the current edition of the standard text
of reference.
Helpful Hints to the Diabetic, by William S.
Collens, M. D., and Louis C. Boas, M. D. ($3.00.
Charles C. Thomas, Publisher, Springfield, III.).
This book is derived from the authors’ long and
large experiences in answering questions asked
by patients. The book does clarify the many
practical problems which confront your diabetic
patient every day.
Health Activities, by Julia C. Foster ($1.00.
J. B. Lippincott Co., Philadelphia) , is designed
to help teachers instruct boys and girls in how
to keep well. Do you know what they teach
in school nowadays?
Psychological Aspects of Medical Care, by
Morton A. Seidenfeld, ($2.00. Charles C.
Thomas, Publishers, Springfield, III.), is a timely
lecture by the director of the psychological
services of the National Foundation for Infantile
Paralysis. Every physician should read it and
every intern library should have it.
Vaughn’s Primer of Allergy, by J. Harvey
Black, M. D. ($3.50. C. V. Mosby Co., St.
Louis, Mo.), is a guidebook for those who must
find their way through the maize of this strange
and tantalizing state. I have used the original
Vaughn book extensively. Now that Dr. Black
has brought it up to date, I shall find it useful for
my patients with allergies.
A Manual of Cardiology, by Thomas J. Dry
($5.00. Second edition. W. B. Saunders Co.,
Philadelphia), is a remarkable comprehension of
condensation.
Medical Diseases of the Kidney, by J. F. A. Mc-
Manus, M. D. ($6.00. Lea & Febiger, Phila-
delphia), with 100 illustrations, is an atlas and
introduction to the subject. These almost per-
fect illustrations tell the story of acute and
chronic renal failure.
Phenol and Its Derivatives: The Relation Be-
tween Their Chemical Constitution and Their
Effect on the Organism. National Institutes of
Health Bulletin No. 190.
for October, 1950
949
FOUNDED IN 1873
Writ e for descriptive booklet
THE CINCINNATI SANITARIUM
5642 Hamilton Avenue Cincinnati 24, Ohio
Telephones: Kirby 0135, Kirby 0136
One of the oldest private hospitals
in the United States operated for
the care and treatment of nervous
and mental patients.
Modernly equipped to provide the
use of all accepted methods of treat-
ment. Constant medical supervision
with registered nurses in charge.
Ample classification facilities.
Conveniently located, twenty nine
acres of beautiful grounds assure
complete privacy.
MEMBER OF: American Hospital As-
sociation, Ohio Hospital Association,
Central Psychiatric Hospital Assoc.
APPROVED BY: American College of
Surgeons, Council of Hospitals.
LICENSED BY State of Ohio.
D. A. JOHNSTON, M.D ...Medical Director
W. N. WRIGHT, M.D. Resident Psychiatrist
HENRY GRUENER, M.D. Resident Physician
ELLIOTT OTTE Business Administrator
Rest Cottage, beautifully furnished, is
a separate department devoted to
the care of certain psycho-neuroses,
rest, and convalescent cases.
THE McMILLEN SANITARIUM
COLUMBUS, OHIO
An Active Treatment Hospital
For All Nervous and Mental Disorders including Alcoholism and Drug Addiction
50 Years Continuous Operation
SHOCK THERAPY
ROBERT A. KIDD, M. D.,
Senior Psychiatrist
NICHOLAS MICHAEL, M. D. ) . \ HERBERT L. PARISER. M U.
LAWRENCE TURTON, M.D. £ Consulting Psychiatrists j MILTON PARKER, M.D.
Telephone: Fa. 1315
950
The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association, a scientific society, non-profit corporation, with a definite
membership, for scientific and educational purposes.
Yol. 46 October, 1950 No. 10
Jonathan Forman, M.D., Editor
Charles S. Nelson,
Managing Editor — Bus. Mgr.
R. Gordon Moore,
Asst. Managing Editor
Mild Hypothyroidism: A Common Disease
HERBERT E. CHRISTMAN, M. D.
EACH week thousands of patients consult
physicians complaining“ of fatigue. A rel-
atively small number are found to have
cardiorenal disease, anemia, diabetes, tubercu-
losis, or Addison’s disease as a basis for this
complaint. In many instances it becomes evident
that life situations are a little too difficult for
some of these people to meet. Sometimes the
fatigue can be accounted for by poor habits
of living, or a schedule of activities which leaves
no leisure. Very often, however, no definite
diagnosis is made, and the patient is empirically
given iron, liver extract, vitamins by mouth and
needle, and assorted tonics without benefit; he
drifts from one doctor to another, takes vaca-
tions as often as his work and pocketbook permit,
and finally perhaps reconciles himself to feeling
tired.
It has been our impression that many of these
people who are tired, but otherwise well, show
at least several signs and symptoms of hy-
pothyroidism; laboratory data and response to
dessicated thyroid have in most instances been
confirmatory. Unfortunately Gull’s early des-
cription of a cretinoid state in middle-aged
women is still the basis of the description of
the adult hypothyroid state in some textbooks.
Partial hypothyroidism seems to be frequently
overlooked, while classical myxedema appears
to be growing more uncommon. Because mild
hypothyroidism can be so effectively, easily, and
inexpensively treated, we present an analysis of
138 cases seen in our private practice. These
were found in 1000 consecutive unselected case
histories of patients seen in the office during a
period of a little less than four years — an in-
Submitted January 5, 1950.
The Author
• Dr. Christman, Lakewood, Ohio, is a grad-
uate of Harvard Medical School, Boston, 1933;
member, Amer. Heart Assn.; fellow, Amer.
College of Physicians; asst, director of Medi-
cine, Fairview Park Hosp., Cleveland; visiting
physician, Lakewood hosp.; physician to Out-
patient dept., City Hosp., Cleveland.
cidence of 13.8 per cent in a practice limited to
internal medicine but not otherwise restricted.
DIAGNOSTIC CRITERIA
Gull described two women showing languor,
increased bulk, round face, smooth fine skin,
flattened broad face, depressed nose, soft hair,
large thick tongue, gutteral voice, broad spade-
like hands, folds of skin beneath eyes and jaws,
much subcutaneous fat, slight pretibial edema,
and a “mind generally placid and lazy, but liable
to being occasionally suddenly ruffled.” One also
showed menorrhagia and bradycardia. To this
picture Ord five years later applied the term
myxedema. Since that time dry skin and hair,
brittle nails, poor cold tolerance, dyspnea, head-
ache, muscle aches, irritability, impaired fertility,
dysmenorrhea, anemia, lowered metabolism and
serum iodine, and elevated cholesterol have
been described as associated with hypothyroidism,
with or without myxedema.
All of our patients have had at least four
(usually more) of the clinical signs or symp-
toms, a lowered basal metabolic rate, an elevated
serum cholesterol when this determination was
965
done, and all showed a definite subjective and
objective response to thyroid therapy. Serum
precipitable iodine determination, an expensive
and difficult procedure, was not done. Curtis
found serum iodine depressed after thyroidec-
tomy and roughly proportionate to the basal
metabolic rate. Winkler et al1 found serum
iodine low in untreated hypothyroidism, though
often greater than zero; with administration of
desiccated thyroid it rose faster than the basal
metabolic rate in a roughly linear fashion. Un-
fortunately no method yet devised for serum
iodine determination is simple enough to be
practicable for routine use; furthermore a fairly
large range of error is inherent in the technique.
It is extremely important to distinguish hy-
pometabolism from hypothyroidism, for the for-
mer is not benefited by desiccated thyroid.
Means points out that many perfectly normal
individuals have a low basal metabolic rate, per-
haps as a manifestation of increased efficiency;
this is also found in Addison’s disease, Sim-
mond’s disease, starvation, nephrosis, sometimes
in diabetes; it is also found at times in under-
nourished and chronically tired individuals who
also have other symptoms suggesting mild
hypothyroidism. The serum cholesterol may
help to distinguish this group when the dif-
ferential diagnosis is not obvious; a therapeutic
trial for a month will certainly differentiate,
for the response of the true hypothyroid is one
of the most gratifying responses in medicine and
usually a source of amazement to the patient,
while the non-hypothyroid patient may tolerate
larger doses of thyroid or thyroxin than the
normal gland secretes and yet show little or no
effect on symptoms, pulse rate, serum iodine,
or basal metabolic rate.2
In this group of 1000 patients 20 were found
to have a low basal metabolic rate but were not
hypothyroid. Since these patients all had symp-
toms suggesting hypothyroidism and since esti-
mation of the basal metabolic rate was not done
where symptoms did not suggest its need, it can
be assumed that the true incidence of hypo-
metabolism in this group was considerably higher.
AGE AND SEX INCIDENCE
Age ranged from 14 to 71 years, although
there were only six older than 60. (The author’s
practice does not include children before puberty.)
Peak incidence was in the fourth decade, with
a large number also in the third and fifth.
There were 112 females to 26 males, a little lower
than the ratio usually reported.
The explanation for this sex discrepancy en-
courages speculation; menstruation and child-
bearing are the obvious points of difference
between the sexes which immediately come to
mind. It has long been recognized that the
basal metabolic rate normally increases through-
out the last 6 months of pregnancy, but Sandi-
ford and Wheeler have calculated that this is
directly proportional to the increase in body
surface of mother and foetus combined. More
significant is the recent study of Heinemann
et al3 showing that serum iodine rises as early
as the third week, remains throughout preg-
nancy about 50 per cent higher than in non-
pregnant normal subjects, and falls rapidly
after delivery. In the only three subjects who
had these studies continued as long as three
months postpartum, serum iodine fell to less
than the normal level for non-pregnant subjects.
They also correlated low levels with miscarriage
or threatened abortion. Similar studies carried
out over a longer period postpartum might give
interesting information on incidence of hypo-
thyroidism developing after childbirth. Obser-
vations by the same group indicate a slightly
lower serum iodine after menstruation than
before, although the difference is not great. Ap-
parently there is no difference in serum iodine
between normal males and normal non-pregnant
females.
In our group there were 79 parous women, 33
nulliparous, and 26 males; these differences are
f-if' l
not explained by the total numbers of these three
groups seen. Reference to figure 1 indicates
that age incidence by decades is fairly well
scattered in our males, while in females, both
parous and nulliparous, the highest incidence is
in the fourth and third decades, respectively —
that is, the child-bearing years. It is also strik-
ing that not infrequently the symptoms ap-
peared after a delivery, sometimes the second or
third one. In our few cases in the second decade
— too few to be significant — no sex difference
was noted.
This indirect evidence would suggest that
child-bearing and menstruation might both be
factors contributing to the higher incidence of
hypothyroidism in females.
FATIGUE
Of the 138 hypothyroid patients every one
either complained chiefly of easy fatigability or
admitted it upon questioning. Of the 1000 pa-
tients from whom the 138 were drawn, 325 corn-
966
The Ohio State Medical Journal
plained of or admitted fatigue; hence in
41 per cent of all these tired patients, hy-
pothyroidism appeared to cause, and desiccated
thyroid relieved, this symptom.
INTEGUMENT
Eighty-five per cent of the 138 showed a dry
skin (more often a little rough and scaly than
smooth and fine, as Gull described it), dry brittle
hair, often falling excessively, or brittle or
Tidged nails; most of them showed changes in
all these structures.
Of the women during the menstrual age, 24
per cent had a vaginal discharge which micro-
scopically consisted of squamous epithelial cells
with some leukocytes. This was definitely not
a cervical discharge, and all women having
cervicitis or vaginitis apparently due to other
causes were excluded.
CALORIGENESIS
Poor tolerance for cold was rarely offered as
a primary complaint but was admitted on
questioning in 80 per cent. These patients felt
better in warm weather, liked the house or ap-
partment warmer than the average (usually 75-
80°F.), and often complained of cold hands and
feet.
CARDIOVASCULAR SYMPTOMS
Dyspnea on one flight of stairs, with no
objective evidence of cardiac or respiratory dis-
ease and no significant anemia, was present in
24 per cent, palpitation in 12 per cent. These
symptoms would tend to direct one’s attention
first to the heart, lungs, and blood, or might even
suggest hyperthyroidism.
Bradycardia has been regarded as one of the
common signs of hypothyroidism. In this group
26.8 per cent had a pulse rate below 70, 62.3
per cent between 70 and 80, and 10.9 per cent
over 80. These rates, however, were recorded
on routine office visits, not under basal conditions.
It was felt that determination of range of pulse
rates on casual visits would be of more value
than under unusual conditions of examination.
Blood pressure was considered low if the
systolic pressure was less than 100 millimeters
or if the pulse pressure was less than 40 per
cent of the diastolic, high if the systolic pres-
sure exceeded 150 or the diastolic 95. Using
these criteria, 1.4 per cent were hypertensive,
34.7 per cent normotensive, and 63.9 per cent
hypotensive. Almost all of the last group had
low pulse pressures.
Because of the hypercholesteremia of un-
controlled hypothyroidism it might be assumed
that atherosclerosis would be more common in
this group. Barr states that individuals with
untreated myxedema ultimately develop arterio-
sclerosis. Experimentally, Steiner et al have pro-
duced in the dog arteriosclerotic lesions showing
the same morphology, development, and distribu-
tion as human arteriosclerosis by feeding
cholesterol and thiouracil; the associated hyper-
cholesteremia is much greater than that produced
by cholesterol alone, and atherosclerosis in this
omnivorous animal could not be produced by
cholesterol alone. Dauber et al found that des-
iccated thyroid consistently minimized the rise
in blood cholesterol and gave some protection
against atherosclerosis in cholesterol-fed chick-
ens. Clinical correlation between elevated serum
cholesterol and increased incidence of coronary
disease has been observed. Of the 15 males in
our series past 40, two had had myocardial in-
farctions at ages 42 and 44; two others showed
peripheral and aortic arteriosclerosis in the sixth
decade, and one at 60 showed electrocardiographic
changes suggesting coronary disease. Although
coronary sclerosis is relatively uncommon in
women under 60, two of our female patients
showed clinical and electrocardiographic evidence
of this at 56, as well as two older women.
Even apart from all other considerations, this
would suggest the importance of treating hypo-
thyroidism adequately.
The term myxedema was first proposed by
Ord because he thought the peculiar edema in
this disease was due to mucin. Forty-seven
years later Boothby et al demonstrated that it
is due to protein and water storage because of
reduced endogenous protein metabolism. Some
degree of patent edema, never striking, was
found in 26.5 per cent of this series, chiefly
evident in ankles, hands, neck, and face, espe-
cially periorbital. It was usually associated with
a basal metabolic rate lower than — 20, never
higher than —15; yet many with a low basal
metabolic rate did not show it.
GASTRO-INTESTINAL SYMPTOMS
Constipation was present in 40 patients (29
per cent). Some of these had symptoms of an
irritable colon and were given appropriate diet
and antispasmodic therapy; many denied these
symptoms, and their constipation was corrected
with no therapy or advice other than thyroid.
Because of hypercholesteremia one might anti-
cipate an increased incidence of cholelithiasis.
This was demonstrated in 11 of our group (8
per cent), an incidence no greater than Bockus
estimates for the entire adult population. It
is net significant that three of the 138 had
peptic ulcer, but it is interesting that two of
these were women, despite the relatively low
incidence of ulcer in women. Of four female
ulcer patients seen in our office practice during
the four-year period covered in this study, three
were hypothyroid. Bockus states that about 10
per cent of his peptic ulcer patients show a low
basal metabolic rate and elevated cholesterol,
for October, 1950
967
roughly the same incidence as in our 1000 un-
selected cases, most of whom had no ulcer.
SYMPTOMS REFERABLE TO REPRODUCTIVE
SYSTEM
Vaginal discharge in hypothyroid women has
already been discussed. There was a history of
sterile marriages or miscarriages without other
known reason in 29 of the 76 married women in
the child-bearing period (38.2 per cent). Dysmen-
orrhea and/or menstrual irregularities (most
often hypomenorrhea and/or irregular or length-
ened intermenstrual intervals) were found in
68.6 per cent. Failing libido or impotence was
noted in 20.8 per cent.
SYMPTOMS REFERABLE TO CENTRAL
NERVOUS AND SKELETAL SYSTEMS
Nervousness, depression, or irritability was a
complaint in 81 patients (58.7 per cent). Only
occasionally was it found necessary to employ
small doses of a mild sedative in addition to
thyroid.
Headache was complained of or admitted in
58 patients (42 per cent) and almost invariably
disappeared with adequate thyroid therapy. It
was usually occipital, occurring characteristically
at the end of the day or when tired, and was
in no way different from the tension headache
which many people experience at the end of a
hard day. Its frequency in hypothyroidism may
be due entirely to the excessive effort these
people must expend to carry on their ordinary
daily tasks. However, Thompson et al found
an increase in spinal fluid protein in myxedema,
dropping to normal after thyroid administration.
Pressures were not recorded in their paper, al-
though their data indicated that the rate of
spinal fluid flow was not increased.
Osteoarthritis was found in six: three were in
the fifth decade and three in the sixth. None
of this series had rheumatoid arthritis. Eighty
others at all ages had joint or muscle pains;
some of these thought or had been told that
they had arthritis, but there was no objective
evidence of it. A common complaint was a pecu-
liar poorly localized aching and stiffness, usually
in the legs and back, most troublesome when
the patient got out of bed in the morning or
out of a chair after sitting for a long time, dis-
appearing after a little activity. This disap-
peared rather promptly after thyroid therapy;
indeed, even those with osteoarthritis of spine
and knees usually claimed amelioration of stiff-
ness and pain. Possibly this stiffness may be
due to edema in and between the muscle fibers.
GOITRE
Marine has pointed out the association of
partial hypothyroidism with simple goitre and
finds that partial hypothyroidism can be treated
by iodine alone. Winkler expressed the opinion
that true hypothyroidism is not associated with
colloid goitre, even though the basal metabolic
rate may be low. In this series we found six
(4.3 per cent of the total) with goitres and
associated hypothyroid signs and symptoms, in-
cluding hypercholesteremia in the two cases
where serum cholesterol was estimated. Thy-
roid improved the symptoms and lowered the
cholesterol but did not alter the sizes of the
goitres. Three others had had small goitres
in their teens, not clinically evident now. Four
others had had thyroidectomies, one for a toxic
goitre.
ALTERATIONS IN THE BLOOD
Hurxthal has pointed out that hyperchol-
esteremia occurs with myxedema, the blood
cholesterol usually bearing a roughly reciprocal
relationship to the basal metabolic rate. In our
series cholesterol was estimated in 34; in 33
it was elevated, the highest 340 milligrams.
There was no relation to body weight.
Several studies4 have shown that anemia,
either hypochromic or macrocytic, may occur
with myxedema. Of the 121 patients in this
series who had one or more blood counts, 25
had a hypochromic or microcytic anemia, 19
macrocytic. (Standards* used are: males red
blood count 5.4 ± 0.8 million, hemoglobin 16 ± 2
grams, hematocrit 47 ± 7; females red blood
count 4.8 ± 0.6 million, hemoglobin 14 ± 2 grams,
hematocrit 42 ± 5.) In no instance was the red
count below 3 million or hemoglobin below 10
grams; liver was never employed, iron only oc-
casionally. Without thyroid both these hemat-
inics have little or no effect.' Since achlor-
hydria and a macrocytic anemia will be found in
some hypothyroid individuals, the unwary phy-
sician may be trapped into a hasty diagnosis of
pernicious anemia; however, the anemia is not
megaloblastic, there is no associated glossitis or
cord degeneration, and liver extract or vitamin
B12 are not . indicated. We have not seen both
diseases in the same individual; the two may of
course cooexist.
Three of the 138, all young women, had a
mild non-thrombocytopenic purpura, which
showed lessened capillary permeability and
clinical improvement under thyroid therapy.
Obviously such a small number is not signifi-
cant but suggests that further observation is
desirable. Capillary fragility was tested only
when easy bruising was observed or complained
of; possibly routine testing and progress ob-
servations under therapy might show a higher
incidence. In myxedema increased capillary
permeability has been demonstrated by Lange’s
fluorescein method.
BASAL METABOLIC RATE AND DOSAGE LEVEL
Athyreosis is associated with a basal metabolic
rate of — 35 to — 45. In myxedema Means and
* Wintrobe: Hematology, p. 73. Lea & Febiger, Phila-
delphia, 1946.
968
The Ohio State Medical Journal
Lerman5 found the curve of response to thyroid
to describe a parabola: Y2 grain would raise
the rate to — 20, 1 grain — 10, IY2 grains — 5, and
3 grains ± 0. Winkler et al,8 although noting an
individual variation in ration independent of the
weight and basal metabolic rate and a basal
metabolic rate varying in the same patient with-
out changing the dose of thyroid, nevertheless
found a roughly quantitative linear relationship
between the basal metabolic rate and dosage,
which rarely exceeds 3 grains per day. They
found that the patient with true myxedema
develops no tolerance to thyroid. On the other
hand, in subjects with hypometabolism without
myxedema, tolerance to desiccated thyroid and
in lesser degree even to intravenous thyroxin
can be demonstrated, presumed to be due to
inactivation by the thyroid gland.2
In our series there was only one patient with
classical myxedema, possibly because practically
all these individuals had sought medical aid be-
fore their symptoms had been present for years.
Seventy-four had basal metabolic rates between
— 11 and — 20, thirty between — 21 and — 30, the
remainder about equally divided higher than
— 11 or lower than — 30. The propriety of includ-
ing a few with rates of — 6 to — 10 may be ques-
tioned; they are included because they all showed
signs and symptoms of hypothyroidism, all
responded within a few weeks to thyroid, and
all relapsed when thyroid was discontinued.
Two showed hypercholesteremia.
dMR -4-/0
-ft to -20
-2/ to -30
5*/oiv -30
Figure 2 indicates the spread of thyroid
dosage. In the few patients with a basal meta-
bolic rate of — 6 to — 10, about half received
maximum benefit with V2 grain thyroid, the
other half 1 grain. Of the large group whose
rates ranged from — 11 to — 20, over half seemed
to obtain full therapeutic effect from 1 grain,
one-third from 2 grains, a smaller number V2
grain, and a very few from 3 grains. Between
— 21 and — 30, most of the patients seemed to
require 1 or 2 grains, a few 3; below — 30 over
half required 5 grains.
Obviously these dosage figures do not agree
with those of Means and Winkler, which applied
to the myxedematous patient. If we assume
that the thyroid glands of the non-myxedematous
hypothyroids were present but functioning in-
adequately, and if we accept the hypothesis that
administered thyroid may be destroyed by the
thyroid gland, it would be not unreasonable to
picture a gland liberating insufficient hormone
and yet with enough functioning tissue to in-
activate part of the administered thyroid.
We prefer to start with a small dose, Y2 or 1
grain daily; although most of these patients do
not show the extreme thyroid sensitivity of true
myxedema, figure 2 indicates that these doses,
are often adequate, and we prefer to avoid
overdosage, which may influence the patient
against taking thyroid. He is then seen every
two or three weeks until symptoms are well
controlled. It is not necessary to attain a ± 0
basal metabolic rate. The slowly cumulative
effect of desiccated thyroid makes irrational
divided daily doses or frequent change of dose.
Although the optimum thyroid ration for a
given patient has usually in our experience re-
mained quite constant, occasionally it may vary
over a long period of time, and several women
whose hypothyroidism first became evident fol-
lowing childbirth have later been able to dis-
continue or reduce the drug, suggesting in these
cases temporary suppression of secretion rather
than diffuse alteration of glandular structure.
For this reason, after the optimum dosage has
been attained, we caution all patients regarding
symptoms of overdosage and check them ap-
proximatety every three months even if no ab-
normal symptoms appear.
Practically all the aforementioned evidences
of hypothyroidism show response within a few
weeks of establishment of the correct dose.
Blood pressure is a notable exception; the sys-
tolic pressure shows little rise, but the pulse
pressure increases. Occasionally iron is used as
an adjuvant for the hypochromic anemia; usually
it is not needed. Thinning hair may not be re-
stored, although patients frequently remark about
integumentary improvement. Of course sterility
will not be corrected if other causes are present,
but several of our patients became pregnant only
while taking thyroid. Osteoarthritis obviously
does not disappear, although symptoms may be
lessened.
DISCUSSION
Means and Lerman5 hold that “a person either
does or does not have myxedema. Borderline
or halfway types of hypothyroidism . . . exist
either not at all or rarely.” Myxedema is
produced only when the thyroid is totally re-
moved or atrophic. In the experience of these
authors such a state is associated with a basal
metabolic rate below — 30; between — 20 and — 30
one usually finds slight symptoms of hypothy-
for October, 1950
969
roidism; above — 20 one seldom observes them.
Although they recognize that full-blown spon-
taneous athyreosis requires years to develop,
they state that “the period of partial athyreosis
is passed in the asymptomatic zone of metabol-
ism.”
On the other hand Winkler, recognizing the
clinical entity of partial hypothyroidism, states
“there is usually a period of months and years
in which the patient suffers from an incomplete
form of hypothyroidism.” He considers
myxedema evidence of neglect. Hartsock7 as-
serts, “If one looks for the typical picture of
myxedema the diagnosis will be missed in
75 per cent of the cases.” Other authors also
recognize the state of partial hypothyroidism.
We feel that the pattern is sufficiently con-
sistent to make at least a tentative diagnosis
of mild hypothyroidism even though the basal
metabolic rate is not greatly depressed, provided
that at least several of the signs and symptoms
are present and the blood cholesterol level
elevated. Certainly the therapeutic effect is as
striking as that obtained with any replacement
therapy, and where treatment has lapsed for
several months the relapse is just as evident. It
is difficult to picture a simple pharmacodynamic
effect of dessicated thyroid, apart from its re-
placement function, overcoming such diverse
symptoms as fatigue, skin changes, headache,
dyspnea, menstrual disorders, etc., particularly
in view of the demonstrated tolerance to thyroid
of many normal individuals.
We prefer not to wait for fully developed
myxedema, believing that the level of health
of the partial hypothyroid can be improved
before athyreosis occurs.
SUMMARY AND CONCLUSIONS
1. Mild hypothyroidism is a common disorder;
in this study the incidence was 13.8 per cent
of 1000 patients seen in an office practice of
internal medicine.
2. Fatigue is the most common symptom;
it was present in every instance in this series,
and hypothyroidism represented 41 per cent of
all instances of fatigue seen.
3. Dry skin and hair, brittle nails, poor cold
tolerance, dyspnea, edema, hypotension, early
atherosclerosis, constipation, vaginal discharge,
sterility, miscarriage, dysmenorrhea, menstrual
irregularities, impotence, headache, muscle and
joint pains and stiffness, and macrocytic or
hypochromic anemia are less common findings.
We found no definite relation to pulse rate or
weight.
4. Blood cholesterol is consistently elevated.
5. In this series the incidence of postopera-
tive hypothyroidism and simple goitre was small
— less than 5 per cent of the total.
6. Incidence is much greater in females,
especially in the third and fourth decades.
7. Symptoms, signs, and laboratory abnor-
malities are corrected by desiccated thyroid,
although dose is less predictable and response
to thyroid less marked than in true myxedema.
8. Hypometabolism without hypothyroidism
must be differentiated.
BIBLIOGRAPHY
1. Winkler, A. W., Riggs, D. S., and Man, E. B. : Serum
Iodine in Hypothyroidism Before and During Thyroid
Therapy. J. Clin. Invest. 24 :732, 1945.
2. Winkler, A. W., Lavietes, P. H., Robbins, C. L., and
Man, E. B. : Tolerance to Oral Thyroid and Reaction to
Intravenous Thyroxin in Subjects Without Myxedema. J.
Clin. Invest. 22 :535, 1943.
3. Heinemann, M., Johnson, C. E., and Man, E. B.:
Serum Precipitable Iodine Concentrations During Preg-
nancy. J. Clin. Invest. 27 :91, 1948.
4. Lerman, J. and Means, J. H. : Treatment of the
Anemia af Myxedema. Endocrinology 16:533, 1932.
5. Means, J. H., and Lerman, J. : The Symptomatology
of Myxedema ; Its Relation to Metabolic Levels, Time In-
tervals, and Rations of Thyroid. Arch. Int. Med. 55:1,
1935.
6. Winkler, A. W., Criscuolo, J., and Lavieties, P. H. :
Quantitative Relationship Between Basal Metabolic Rate
and Thyroid Dosage in Patients with True Myxedema.
J. Clin. Invest. 22 :531, 1943.
7. Hartsock, C. L. : Clinical Aspects of Hypothyroidism.
Cleve. Clin. Quart. 6 :53, 1939.
The Story Behind the Word
Some Interesting Origins of Medical Terms
Keloid — A descriptive term applied because of
the irregular processes or projections occurring
at the edges of this cicatrix-like lesion, which
in appearance resembles a spreading stain. The
name is derived from the Greek word “kelis”
or stain.
Malaria — This disease has been known under
various names since ancient times. In 1753
Torte published a classical treatise upon the
various climatological fevers in which the term
malaria was used for the first time. The dis-
ease was so named from the erroneous concept
that it was caused by foul or bad air from
swamps and low-lying areas. The word is of
Italian derivation, coming from the w’ords
“male,” meaning ill or bad and “aira” or air.
Nausea — Literally means seasickness. It is
derived from the Greek word “nausia,” mean-
ing ship or seasickness and from the Greek term
“naus” a ship.
Nightmare — This term has descended to us
from the ancient Norse mythology. In this
word we remember the old Norse demi-god,
Mara, who was said to strangle people in their
sleep.
Hysteria or Hysterical — These terms literally
signify an attack or seizure provoked through
the uterus. The terms are derived via the
Latin from the Greek word “hustera,” the womb
or uterus. As the name indicates the pelvis
of hysterical women is their most common phy-
sical focus of emotional interest.
— Harry Wain, M. D., Mansfield, Ohio.
970
The Ohio State Medical Journal
Benign Nervousness
LEONARD L. LOVSHIN, M. D.
The Author
• Dr. Lovshin, Cleveland, Ohio, is a grad-
uate of the University of Wisconsin Medical
School, Madison, 1939; Associate, American
College of Physicians; on staff. Department of
Internal Medicine, Cleveland Clinic.
FUNCTIONAL illness is the most common
condition seen in general or clinic practice,
but it should not be assumed that all pa-
tients with emotional or nervous problems are
psychoneurotic. Allan and Kaufman1 have re-
cently emphasized the inadequacy of traditional
neuropsychiatric classification for that large
group of patients who have relatively minor
functional disease. They have suggested that
benign nervousness be recognized as such despite
the fact that no suitable diagnostic term is
available at present. Since the prognosis in the
benign states is so much better and the treat-
ment often so easy and satisfactory, there is
much to be gained in trying to separate these
from the more serious types of neuropsychiatric
disorders — psychoneurosis, psychosis, and psy-
chopathic personality.
The patient with benign nervousness is usually
of adequate capabilities and has made satisfac-
tory adjustment. Because of situational factors,
usually of a temporary nature, he has developed
an emotional reaction which produces one or
more symptoms. The history of the present ill-
ness is clear-cut, the story is unchanging. He
may have presented himself for examination
with a considerable degree of reluctance, often
at the suggestion of a friend or relative. After
a careful examination simple reassurance some-
times is all that is needed to bring about im-
provement. In some instances the offending
situational factors must be corrected. This is
occasionally accomplished easily; at other times
it is impossible. The patient is often benefited
by discussing his problems with a sympathetic
listener. Simple sedatives may be of help in the
readjustment period. The patient is usually
pleased and gratified to learn that no serious
illness is present. Insight may be very good;
indeed, many patients sense the cause of their
trouble even before being told.
The true psychoneurotic, on the other hand,
has an inherent defect in his personality; the
trouble is from within. There is usually a long
history of maladjustment, a train of vague
illnesses and often repeated operations or other
treatments. The medical history may be com-
plicated and inconstant; sometimes considerable
resistance is encountered. Upon being told that
no serious illness is present the reaction is often
one of disbelief or actual hostility. Simple re-
assurance is a disappointing therapeutic measure.
From the Cleveland Clinic and the Frank E. Bunts EdiL
cational Institute.
FAMILIAR PROBLEMS TO PRACTITIONER
Every practitioner is familiar with the prob-
lem presented by the overworked businessman or
the tired mother. Diagnosis is not difficult but
codification of nomenclature is a problem not yet
solved. It is not only incorrect, but grossly
unjust to be required to classify a tired mother
into one of the six types of psychoneurosis —
hysteria, psychasthenia, hypochondriasis, anxiety
state, neurasthenia, reactive depression, or mixed.
As a matter of fact, most of these mothers are
not psychoneurotic at all, they are just tired.
Nor is the overworked businessman psychoneu-
rotic; he may be tired and irritable, and be
bothered with dyspepsia but he has been stable
in the past and after his vacation will be again.
NO SUITABLE DIAGNOSTIC TERM
There is probably no one term which can be
used to describe all types of benign nervousness
just as no one designation is satisfactory for
all types of psychoneuroses or psychoses. Chronic
nervous exhaustion is a useful term which carries
with it little of the stigma commonly attached
to the use of the word psychoneurosis. Nervous
fatigue denotes a lesser degree of nervous ex-
haustion. Situational reaction used not in the
sense of reactive depression but, as was found
useful in the past war, to denote an essentially
stable individual reacting to unusual external
stress, may impart a more exact nuance of
meaning. Anxiety state or anxiety-tension state
in many instances is as applicable to the benign
conditions as it is to psychoneuroses. Diagnostic
terms which refer more specifically to the system
or area of the body most obviously involved,
like irritable colon or tension headache, are com-
monly used. There should be no great objection
to the use of these diagnoses as long as it is
clearly understood that they are but manifesta-
tions of the underlying nervous or emotional
upset.
MAJORITY AFFECTED AT SOME TIME
Benign nervousness is a condition which af-
fects almost everyone at some time or other.
No class of society is exempt. The complexity
for October, 1950
971
of modern civilization and the stress and con-
flict engendered by the frequent disparity be-
tween ambition and attainment are factors which
beset the majority. Somatic manifestations of
simple nervousness may be exceedingly mild —
irritability, or a loose bowel movement before
breakfast; nevertheless they vary only in degree
from those reactions which assume clinical im-
portance. It is not to be inferred that there
is any sharp line of distinction between the more
severe benign reactions and the true psychoneu-
roses. However, it is of considerable practical
importance to recognize those reactions which
represent no true deviation from what might
be expected of the hypothetical average man.
SITUATIONAL FACTORS FREQUENTLY
ARE CONTRIBUTING CAUSES
Despite the widespread incidence of benign
nervousness there are certain occupations and
situations which are particularly inclined to
foster an increased incidence of this disorder.
Only a few of these will be mentioned.
The tired mother syndrome is well known to
most physicians. In its most common form an
intelligent, tense, overconscientious young mother
begins to feel run-down and tired. She becomes
nervous and irritable and may develop any of a
large number of symptoms which tend to worry
and confuse her further. No psychoanalysis or
deep probing is needed to understand the situa-
tion. Her work-day is sixteen hours; she works
seven days a week. She probably has not had
a vacation in years except for the brief time
allotted for convalescence after childbirth.
There often are worries about finances or ill
health of the children. A careful physical ex-
amination, reassurance, and sympathetic advice
often is all the treatment needed. Any phy-
sician who by chance or circumstance has had
the responsibility of running his own household
for even a short period of time has probably
learned why mothers are apt to develop nervous
fatigue.
The two-job wife is in another group from
which is recruited a large number of benign
nervous reactions. The average male is ex-
pected to work eight hours a day. He is not
expected to cook meals, wash dishes, and do
housework after his day is over. Many women
handle these double responsibilities capably,
especially when there are no children. Indeed,
in many instances, when the household tasks are
light, a job in business or industry contributes
to the welfare of the otherwise idle wife.
However, many women who must work because
of financial necessity find the double burden
too great. It is not surprising that a number
of them become overtired and nervous.
Lest it be assumed that benign nervousness
belongs exclusively to the female, it would be
well to mention that the overworked business
executive is a common victim. He is often
possessed of great energy, ambition, and drive.
He is not well-acquainted with ill health. For
years he may work too hard, play too hard, and
break most rules of physiologic living. His
energy seems inexhaustible and he squanders
it lavishly. There is apt to come a time, how-
ever, when he can no longer do one and one-half
days’ work in one day and he becomes concerned
because of the ebb in vitality. Somatic symp-
toms may finally force him reluctantly to seek
medical advice. Dealing with a patient of this
group is usually a gratifying experience for
the doctor. Reassurance, simple advice, and a
vacation, work wonders. The patient soon feels
well, thanks his medical adviser, and goes back
to working too hard again.
The small businessman is also especially apt
to develop benign nervous conditions. The in-
cidence often varies with the type of business.
Restaurant and tavern owners are frequently
seen by the physician because of functional dis-
ease; more specifically, owners of small restau-
rants and taverns. In a relatively small estab-
lishment the proprietor tends to spend most of
his waking hours at his place of business. There
are laws to protect the employees, but the owner-
manager works on. Meals are irregular and
hurriedly eaten; there is a tendency to smoke
and drink too much. It is not hard to under-
stand why dyspepsia is the symptom most
commonly complained of. When the family living
quarters are directly adjacent to, or above the
place of business, the ratio of nervous disorder
increases. Owners of small grocery stores and
filling stations work under similar conditions
and are similarly afflicted.
ASSOCIATE OF ORGANIC ILLNESS
Benign nervousness is a common accompani-
ment of organic illness. Indeed, it is axiomatic
that every disease has an emotional component.
This fact is known and understood by all, but
the relative importance of each factor in the
production of symptoms is often not clearly
evaluated. The emotional symptoms occasioned
by the discovery of an early carcinoma of the
breast in an essentially happy and stable woman
will disappear with successful surgical treatment
of the breast lesion. Cholecystectomy in a tired,
unhappy woman with many family worries can
only be expected to relieve the gallbladder colic
for which the operation was performed. Too
often an unimportant organic finding is used
to explain unassociated functional symptoms.
The iatrogenic disability due to injudicious
emphasis is well demonstrated in many patients
with mild chronic valvular heart disease.
It should be recognized that organic illness
may be the precipitating cause of emotional
illness in some cases; in many, the organic ill-
ness is a contributory cause; and in a large
972
The Ohio State Medical Journal
number of patients organic findings are purely
coincidental.
It is believed that more harm than good re-
sults from applying even an innocuous organic
label to illness which is purely functional in
origin. Too often a chronic nervous exhaustion
state, as a matter of convenience, is called
anemia, hypotension or hypothyroidism. The
mere fact that nervous fatigue responds so well
to anti-anemic therapy is ample proof that many
of the benign nervous states are self-limiting
illnesses. Most patients appreciate being told
that no organic disease is present. Insight is
remarkably good in many cases.
DUTY OF GENERAL PRACTITIONER
The general practitioner is well qualified to
diagnose and treat benign nervous conditions;
in fact, he has done so since the dawn of medical
history. Not only is he well qualified, but the
nature of his practice and his thorough acquaint-
ance with the patient, his family, and the com-
munity make him better qualified than any
specialist. As a general rule psychiatrists
cannot and should not be expected to take care
of these minor emotional and nervous upsets.
It is the general practitioner’s duty, however,
to be able to separate the benign from the
more serious functional disorders, and apply for
special help when it is needed.
Treatment is usually satisfactory although
sometimes the situational factors are such that
only limited help can be given. In a large num-
ber of cases the factors responsible for the
illness are almost self-evident and no psy-
choanalytic probing is necessary. Explanation
and reassurance are the most valuable ther-
apeutic measures. The patient should be en-
couraged to correct those environmental factors
which are remedial. Simple sedatives are some-
times helpful during the transition period. There
is, however, no medication that can take the
place of forthright reassurance based on the
confidence acquired from a careful and thorough
physical examination.
CONCLUSIONS
Minor emotional and nervous disorders are
the most common conditions seen in the general
practice of medicine. Not all nervous people
are psychoneurotic. Despite the inadequacy of
traditional neuropsychiatric classification, an at-
tempt should be made to recognize the benign
nervous disorders. The general practitioner is
best qualified to diagnose and treat these condi-
tions. Treatment is usually satisfactory and
should be based on reassurance, explanation, and
sympathetic understanding. The use of diag-
nostic terms implying organic alteration is to
be avoided.
REFERENCE
1. Allan, F. N., and Kaufman, M. : Nervous Factors in
General Practice. J. A. M. A. 138:1135, Dec. 18, 1948.
APHORISMS, ADAGES AND MAXIMS
The experience and wisdom of the sages are
preserved by maxims and sayings.
Coleridge said, “The largest and worthiest
portion of our knowledge consists of aphorisms,
adages, and maxims.”
I am convinced the following gems, if made
our own, will become a part of our lives, and an
influence on our careers.
“Every thought has a physical reaction.”
“Tiredness and weariness without cause indi-
cate disease.”
“War wounds men’s minds as much as it
maims their bodies.”
“Our disposition is closely related to our diges-
tion.”
“To lengthen your life shorten the meals.”
“A disease germ is not too proud to inhabit
a youngster wearing an asafetida bag.”
“Each one of us is an omnibus loaded full
of our ancestors.”
“He who won’t be advised, can’t be helped.”
“A merry heart doeth good like a medicine;
but a broken spirit drieth the bones.”
“Nature is the ally of the patient and the
enemy of disease.”
“It is a part of the cure to wish to be cured.”
“No man is so old but thinks he may live an-
other day.”
“Folks with something on their conscience
can’t sleep.”
“We go out of life unconsciously as we come
into it.”
“Never buy a pig in a poke.”
“Castor oil makes its own way.”
“The non-vaccinated can be no real menace
to the vaccinated.”
“Better be rudely healthy than pale and in-
teresting.”
“Night air is as safe to breathe as day air.”
“No man’s opinion is entirely worthless, even
a watch that won’t run is right twice a day.”
“Neurasthenics are more often all ‘wound up’
than ‘run down.’ ”
“An ounce of prevention is worth a ton of
cure.
“Live with youth and you stay young; keep
up with youth and you die young.”
“Past pains and pains to come seem never
as bad as present pains.”
“Memory for past events becomes dominant
as one grows older.”
“A healthy liver makes a good disposition.”
“Many dogs will kill a rabbit, many defects
will kill a man.”
“The cure of tuberculosis depends more upon
what the patient has in his head than on what
he has in his chest.”
— Submitted August 15, 1950,
JohnJ. Sutter, M. D., Lima, Ohio.
for October, 1950
973
Leiomyoma of the Esophagus: Report of a Case
With Successful Resection
WALLACE C. MADDEN, M. D., and EDWIN G. OLMSTEAD, M. D.
The Authors
9 Dr. Madden, Dayton. Ohio, is a graduate
of Hahnemann Medical College of Philadelphia,
1930; member of Academy of General Practice;
on courtesy staff: Miami Valley Hosp., and
St. Elizabeth Hosp., Dayton.
• Dr. Olmstead, Milwaukee, Wis., is a grad-
uate of University of Illinois School of Medi-
cine, 1945; junior resident, internal medicine,
Milwaukee County Hospital; teaching fellow,
internal medicine, Postgraduate School of
Medicine, Marquette University College of
Medicine, Milwaukee.
BENIGN tumors of the esophagus are rare;
however, in the past fifteen years an in-
creasing number of these tumors have been
diagnosed correctly and successfully removed.
As these tumors offer a uniformly good prog-
nosis it is important to differentiate them, both
clinically and by X-ray examination, from the
more common malignant tumors of the
esophagus.
Some idea of the rarity of these tumors may
be gathered from Moersch and Harrington’s
report1 that of 11,000 patients complaining of
dysphagia only 15 had benign tumors of the
esophagus as a basis of the complaint. That all
benign tumors of the esophagus do not give
rise to symptoms may be seen in the same
report in which of 7,459 autopsied cases, 44
had benign tumors of the esophagus which had
not caused symptoms during life.
Benign neoplasms of the esophagus include
adenoma, aberrant thyroid, cysts, fibroma,
leiomyoma, lipoma, myoma, myxofibroma, papil-
loma, and polyps. Of these, the leiomyoma
is the most common. At postmortem small
leiomyomata of the esophagus are frequently
found, but they must attain considerable size
before they become large enough to produce
symptoms.
These tumors occur most frequently at the
upper or lower one-third of the esophagus with
a small number occurring in the middle one-
third. They are more common in men than in
women and are usually seen after the age of
forty although they may be encountered in any
age group.
CASE REPORT
A twenty-eight-year old white male was ad-
mitted to the Miami Valley Hospital March 25,
1949, complaining of cough of three years’
duration, pain in the chest for two years, and
shortness of breath for three weeks. He stated
that he had been in good health until three
years before admission at which time he caught
cold and developed a cough which had continued
until the present time. The cough was productive
of whitish sputum and was worse when the
patient was lying down. The sputum had
been blood-streaked on two occasions, one month
before admission. Two years before admission
the patient experienced a sharp non-radiating
substernal pain which at first was intermittent,
but later became a constant dull ache, made
worse on coughing. Three weeks prior to ad-
mission he noticed shortness of breath on walk-
ing a few blocks or climbing steps. He had
Submitted Jan. 18, 1950.
lost twenty pounds in the last two years. On
system review he admitted that he “filled up”
easily after eating even a small amount of food.
Physical examination revealed a well-developed,
well-nourished white male who did not appear
acutely or chronically ill. Examination of the
head and neck was essentially negative. The
chest was clear to percussion and auscultation.
The heart was normal in size and heart beat was
regular at eighty per minute. The blood pressure
Fig. 1 — Barium swal’ow outlining tumor of mediastinum.
Note dilatation of the esophagus above area of constriction.
Note “shelf” of barium at “a” where tumor meets un-
involved portion of esophagus.
974
The Ohio State Medical Journal
was 124/88. Examination of the abdomen and ex-
tremities was not remarkable. The red blood
count was 4,480,000 per cubic millimeter, with
94 per cent hemoglobin. The white cell count
was 11,000 per cubic millimeter with a normal dif-
ferential. Urinalysis was normal.
A teleoroentgenogram of the chest showed
enlargement of the superior mediastinum more
marked on the right than on the left. The
aortic knob could be visualized on the left and
the cardiac silhouette was normal in size, con-
tour, and position. The lung fields were normal.
A barium swallow (figure 1) showed a
roughly oval, fairly well circumscribed soft
tissue mass in the left superior mediastinum
which displaced the esophagus to the right and
sharply compressed the esophageal lumen at
the level of T6. A sharply defined lower
border or shelf of barium could be seen where
the tumor met the esophageal wall. The
esophagus was dilated about four times its
normal diameter above the area of compression
and contained particles of food debris. A lateral
film of the chest following barium swallow
showed the esophagus displaced and compressed
posteriorly and the trachea displaced anteriorly.
There was no evidence of involvement of the
esophageal mucosa.
Esophagoscopy was performed and demon-
strated a narrowing at the junction of the up-
per with the middle one-third of the esophagus
due to some external pressure in this region.
The esophagoscope was easily passed beyond the
point of narrowing and the esophageal mucosa
was reported as intact throughout.
The patient was prepared for surgery.* He
was draped with the right side up and the in-
cision was made over the fifth rib. The muscles
were transected and the fifth rib removed. The
pleura was opened and the lung was retracted
downward and forward visualizing a fairly
large tumor in the upper posterior mediastinum
in the region of the esophagus. Further ex-
ploration revealed this to be intrinsic with the
esophageal musculature. The esophageal mus-
culature was divided and the tumor was shelled
out with ease. The mediastinal pleura was
closed with continuous chromic No. 000. The
wound was thoroughly washed with aqueous
Zephiran.® Closure was made in the usual
manner. The patient made an uneventful re-
covery and left the hospital on the eleventh post-
operative day. Subsequently all symptoms dis-
appeared. The patient feels well and at present
is employed in a moderately active occupation.
DISCUSSION
The clinical features of leiomyomata of the
esophagus are similar to those seen in any
submucosal intramural benign tumor of this
region. It should be noted that these tumors
reach a large size before producing symptoms
and so are occasionally encountered on routine
chest plates at a time when the patient may
have no symptoms referable to the esophagus.
Dysphagia is probably the commonest symp-
tom reported in benign esophageal lesions. It
is often intermittent in character. Regurgitation
of food may be present and depends on the
degree the tumor has encroached upon the
esophageal lumen. There is often a sense of
* Surgery performed by Dr. A. J. Carlson and Dr. E. F.
Damstra of Dayton, Ohio.
substernal discomfort made worse when the
patient is recumbent. Dyspnea, cough, and
expectoration are present in varying degrees.
In general, the physical condition of the patient
remains remarkably good in spite of the com-
plaints, and weight loss, anemia, and other
constitutional findings occur but rarely in these
patients, a fact which is in distinct contrast to
the findings produced by malignant tumors of
the esophagus.
Although the duration of symptoms may be
longer in benign tumors as opposed to malignant
tumors of this region, the symptoms themselves
are often so similar that differentiation on
clinical grounds alone may be very difficult.
However, the combination of the above symptoms
together with a posterior mediastinal mass should
certainly raise the question of a benign tumor
of the esophagus.
Patterson2 was of the opinion that there was
no means of making a diagnosis of benign tumor
of the esophagus except by esophagoscopy or,
in the case of mucosal tumors, unless the tumor
was regurgitated through the mouth. However,
primarily through the work of Schatzki and
Hawes3 the roentgenological appearance of these
tumors has been elucidated. Submucosal in-
tramural benign tumors usually show a fairly
well circumscribed soft tissue mass lying outside
of the esophagus. This mass may move with
swallowing, respiration, or peristalsis. During
barium swallow the mucosal folds over the
tumor are usually not seen as they are stretched
over the tumor mass. The mucosal folds op-
posite the tumor appear normal. In these
benign tumors, in contrast to malignant tumors,
there is usually not much impairment to the
flow of barium as the opposite wall is normal
and dilates to allow barium passage. Probably
the outstanding roentgenological characteristic
and the one best demonstrated in the above
case is the sharp angle formed where the tumor
meets the uninvolved portion of the esophagus.
This is seen best in profile view and serves to
differentiate intramural esophageal tumors from
mediastinal tumors making pressure on the
esophageal wall in which the angle of the tumor
with the esophagus is not usually sharp but
gentle and concave.
SUMMARY
1. A case of leiomyoma of the esophagus
with successful resection is reported.
2. Some of the clinical and X-ray features of
benign intramural tumors of the esophagus are
discussed.
BIBLIOGRAPHY
1. Moersch, H. J., and Harrington, S. W. : Benign
Tumor of the Esophagus. Ann. Otorhinolaryng, 53 :800-817,
Dec., 1944.
2. Patterson, E. J. : Benign Neoplasms of the Esophagus.
Penn. M. J., 36:244-246, Jan., 1933.
3. Schatzki, R., and Hawes, L. : The Roengenological
Appearance of Extramucosal Tumors of the Esophagus.
Am. J. of Roentgenology, 48:1-15. July, 1942.
for October, 1950
975
A Plan of Annual Examination for Men
RALPH M. WATKINS, M. D.
The Author
• Dr. Watkins, Cleveland, Ohio, is a graduate
of Syracuse University College of Medicine,
1920; diplomate, American Board of Internal
Medicine; fellow, American College of Phy-
sicians; and chief of Medical Service, The
Woman’s Hospital, Cleveland.
APART of our attempts in medical educa-
tion of the laity includes the advice that
people be regularly examined in the effort
to forestall disability from disease. The years
spent in urging this are gradually bearing fruit,
in that larger numbers of persons are asking
that they be notified at regular intervals that
they are due for examination. Most of the ap-
plicants are men. Women seem less inclined
to seek periodic surveys. On the other hand,
women are more likely to call for medical at-
tention for minor disturbances.
We should like to describe a plan we have
followed for several years. It has proven satis-
factory both to the patient and to us. This is
an office annual examination routine designed
for business and professional men over 50 years
of age — busy people and assumed to be well,
or at least well enough to do their usual work.
It has been followed with some scores of men,
and has been well accepted. We feel that the
plan is simple yet elaborate enough to enable
us to detect in the early stages most of the
ailments to which this group is susceptible.
These men are anxious to learn that the ex-
aminer finds no evidence of certain diseases
especially those so widely publicized. They
most commonly want to know that there is no
sign of heart disease, arterial hypertension,
cancer or diabetes.
THE PLAN
This plan includes:
Complete physical examination
Complete blood count
Chemical and microscopic urinalysis
Blood Kline test for new patients
X-ray examination including fluoroscopy
of the chest, stomach and duodenum
plus the usual plates of the latter
Electrocardiogram
Three pre-prandial blood and urine sugar
tests
OBJECTIVES
Obviously, our object is to find pathological
conditions, especially to detect them early in
their development. The complete physical ex-
amination clears up many questions relative to
disturbances of the ears, nose, throat, vision, eye
grounds, mouth, teeth, lymphatic glands, thyroid
gland, lungs, heart, blood pressure, abdominal
contents, genitals, prostate gland, anal and
lower rectal region, superficial reflexes, skin,
Submitted Jan. 30, 1950.
bones, joints. Weight abnormalities and changes
are recorded.
The complete blood count will show the
presence or absence of anemia, infectious reac-
tions, leukemic states and others that can be
diagnosed by finding abnormalities of the cells.
The chemical and microscopic urine examination
will reveal grossly abnormal kidney function
and evidence of infection in the urinary tract.
Sugar present means that diabetes mellitus
must be ruled out. Erythrocytes seen call for
special examination.
The blood Kline test is done, as a rule, on new
patients only. If he does not already have it,
there is little likelihood of a man in this age
group contracting syphilis. If any evidence
arises in later examinations, the Kline test is
repeated.
The electrocardiogram in a number of instances
has proven its value by showing early or mild
changes, especially of the coronary system, which
had not been suspected from the history or
physical findings.
The X-ray examination includes fluoroscopy
of the chest which helps to some extent to free
the lungs and bronchial tree from suspicion. If
any indication of heart or lung disease is found
by physical examination, the electrocardiogram
or fluoroscopy, plates of the lungs or heart or
both are essential.
The primary object of the X-ray examinations
of the stomach and duodenum is to do all pos-
sible to rule out early gastric carcinoma. The
reasons are three: A. This organ is one of
the most frequent sites of cancer, especially in
men over fifty years. B. As a rule, the early
symptoms of it are so mild that by the time the
patient is suffering enough to ask medical at-
tention, the lesion is beyond the operable stage.
C. The only reasonably simple way of discover-
ing a carcinomatous lesion while it is still fairly
small, and perhaps operable, is by X-ray exami-
nation. We grant that routine gastroscopy may
97 6
The Ohio State Medical Journal
be advisable but we also know that most men
will not submit to it as a routine test.
The pre-prandial blood and urine glucose tests
are done primarily to rule out the presence of
diabetes. Not infrequently, in otherwise normal
patients, slightly elevated figures may be re-
ported, suggesting the so-called prediabetic
phase. We often discover in this way men who
did not know they might easily become diabetics,
or, in fact, had the disease in mild degree.
Glucose tolerance tests are done occasionally,
but only for special reasons.
THE ROUTINE
The complete plan can be carried out in a
few hours. The preliminary physical examina-
tibn, blood and urine examinations, are done at
an appointed time and require an hour. The
special tests are nearly all done in one morn-
ing, as follows: The patient, in a fasting state,
enters the office at 8:30 o’clock and the first
blood and urine specimens are taken; he is
then escorted to the X-ray office, near at hand,
and those examinations are started and completed
as a rule well before noon; then he returns to
our office where his electrocardiographic trac-
ings and second sugar specimens are taken; this
work is finished, as far as the man is concerned,
by noon and he. is then dismissed, told to eat a
hearty lunch and to come back to the office at
5:00 p. m. for his final sugar tests. Thus he
is free to work during the afternoon and has
used only about a half day’s time. At his last
appearance, an appointment some days later is
made, when he is to come in for a full report.
Reports are made both verbally and in writing;
many of these orderly people seem to appreciate
a written record.
OTHER EXAMINATIONS
Additional laboratory tests or examinations by
specialists are often found to be needed and are
carried out. They naturally are not included
in the basic plan we are following.
INTERVAL BETWEEN EXAMINATIONS
The word “annual” is carried in our title.
That is the interval which we follow. One
grants that yearly intervals are too great, that
many diseases can become well advanced between
examinations. Perhaps intervals of six months
or three months would be better. The fact is,
in our experience, that these men are not willing
to come for this purpose more than once a year.
We must recall that we expect to find them
well, and ordinarily do. If disease is found
they come in for attention at whatever times are
appropriate.
They are all regular patients so if any in-
tercurrent symptoms arise, they are expected to
report them, without thought of waiting for
their year to elapse.
ADVANTAGES OF THIS PLAN
1. The knowledge gained by this method is
more than reasonably adequate. We grant that
the program is not complete. Other tests and
special studies could be done, and are done if
findings warrant. But if the patient can pass
the physical examination and if the labora-
tory results are normal, we feel we can assure
him that he has none of the usual diseases —
degenerative, malignant, infectious; that his out-
look for healthful living is good.
2. A valuable help to us is the frequency of
the interview. Too many people call for medical
attention only when ill. In seeing each of the
men of this series annually we get well
acquainted with any abnormality he may have.
If later he becomes ill, we do not have a
sensation of strangeness in attending him, nor
the feeling of the need to start his study at
the very beginning.
3. The cost of the complete program is not
very great; it is not much larger than it would
be if conducted in a hospital with the need for
medical supervision and the longer period of
time required.
4. For the patient, the great advantage is
the little time needed from his work. It is
much easier for these busy people to spend
a half day with us than to set aside some days
for an adequate appraisal in a hospital. It
should be remembered that these patients con-
sider themselves well, or at least actively able
to work. They wish to be reassured that they
are likely to be able to continue their pace.
SUMMARY
1. A plan for annual examinations for men
over fifty includes complete physical examina-
tion, complete blood count, chemical and micro-
scopic urinalysis, blood Kline test (new patients),
electrocardiogram, X-ray of the stomach and
duodenum, fluoroscopy of the chest, and three-
pre-prandial blood sugar tests.
2. The program will reveal any of the common
ailments, especially those to which this group
is subject.
3. The routine is explained.
4. A year between examinations may not
be the proper interval but seems to be the most
practicable.
5. The advantages of the plan include: (a)
reasonably complete appraisal, (b) close acquaint-
ance with each patient and his peculiar prob-
lems, (c) moderate cost, (d) great saving of the
patient’s time.
The headache of hypertension is caused by
pain, fairly diffuse, or it may be focal, present
on arising each morning. It is usually throb-
bing. It may wake the patient up or he may
awake with it. It is relieved by aspirin. —
Francis M. Walsh, M. D., J. Lancet.
for October, 1950
977
Uterine Fibroids as a Cause for Postmenopausal Bleeding
CHARLES H. HENDRICKS, M. D.
The Author
• Dr. Hendricks, Columbus, is a graduate of
Univ. of Michigan Medical School, Ann Arbor,
1943; fellow, Amer. Med. Assn.; member. Cols.
Academy of Medicine; Cols. Soc. of Obstetrics
and Gynecology; instructor, dept, of Gynec. &
Obst. 0. S. U. College of Medicine, Columbus.
ALTHOUGH an estimated 20 per cent of fe-
males past the age of 35 harbor uterine
myomata,1 II, III, it is generally conceded that rel-
atively few such tumors actually cause symp-
toms. Those which produce symptoms do so,
for the most part, during the years of menstrual
activity, inasmuch as myomas arise after puberty
and complete active growth during the period of
ovarian activity. After the menopause, uterine
bleeding resulting directly from the presence of
uterine myomas is relatively rare. Davis2 states
that “women with fibroids do not cease bleed-
ing at this age (i. e., menopause) and then re-
sume bleeding from fibroids.” Te Linde3 studied
349 cases of postmenopausal bleeding, and in
only about 4 per cent were myomas felt to
be a possible explanation of the bleeding. Tay-
lor,4 reporting an even larger series, found that
even when fibroids were present in the post-
menopausal bleeding patient, another concurrent
lesion could be demonstrated as the cause of
bleeding in the vast majority of cases. Zeit5
reported recently that of 13 postmenopausal pa-
tients in his series who were operated upon
solely for myomas, the bleeding was not due to
myomas in 61.5 per cent.
A high incidence of malignancy among pa-
tients with postmenopausal bleeding is a well-
established fact. Te Linde found 53.3 per cent
malignancies in his group, while Taylor noted
a 63.3 per cent incidence of malignancy in
the series which he presented. It becomes ap-
parent, then, that it is unwarranted to assume
myoma as the primary cause of postmenopausal
bleeding because, while myomas may be present
incidentally in a large number of women, they
are not usually the site of the significant
pathology.
To demonstrate that the problem is more than
a hypothetical one, nine cases are presented.
Seven are postmenopausal, and the other two
were near menopausal age. In each, the patient
was treated by one or more of the following:
X-ray, radium, supracervical hysterectomy, total
hysterectomy, laparotomy, or injections. While
treatment was being directed specifically toward
the patients’ confirmed or imagined myomas, the
actually important diagnoses were, respectively,
carcinoma of the cervix (5 cases), carcinoma
of the corpus (3 cases), and carcinoma of the
ovary (1 case). These cases are summarized
in table 1.
CASE SUMMARIES
Case 1. The patient was a 54-year old para I,
four years postmenopausal. Soon after the onset
From the Department of Obstetrics and Gynecoloy, Ohio
State University, Columbus, Ohio.
of severe vaginal bleeding, she consulted a phy-
sician who did subtotal hysterectomy for
“fibroids.” The pathologist’s report describes
large myomata. A cervical specimen for biopsy
was not taken until 7 months postoperatively:
it showed squamous cell carcinoma of the cervix.
Case 2. The patient was a 60-year old
para VII, who was 5 years postmenopausal.
After six months of recurrent bleeding she
consulted her physician who, without doing a
pelvic examination, diagnosed “fibroids” and
treated the patient by “shots” for over a year.
A second physician whom the patient consulted
found a cervical lesion, which proved to be
squamous cell carcinoma of the cervix. No
myomata could be demonstrated.
Case 3. A 47-year old para V, five years post-
menopausal, had been treated for several years
for “uterine fibroid” by conservative therapy.
Examination at the Gynecology Tumor Clinic at
Ohio State University Hospital revealed far
advanced cervical carcinoma. No myomas could
be palpated.
Case 4. A 67-year old nullipara, 19 years
postmenopausal, had been treated for a Clinical
Stage III carcinoma of the cervix by radium
and X-ray in 1944. In 1946 she rather sud-
denly developed a pyometra, and was admitted
to another hospital with a diagnosis of “degen-
erating fibroids.” Subtotal hysterectomy was
done, and the uterine tissue revealed generalized
carcinomatous infiltration of the fundus with
squamous cell carcinoma. No myomata were
found.
Case 5. This patient was a 41-year old para
II, who had not reached menopause, but who had
progressively increasing hypermenorrhea for four
months before going to her physician who made
a diagnosis of “uterine fibroid,” and treated the
patient successively with external X-ray, supra-
cervical hysterectomy, and another exploratory
laparotomy before a speculum examination done
elsewhere revealed a cervical carcinoma from
which the patient had been bleeding. It cannot
be determined whether myomata were actually
present in the subtotally removed uterus.
Case 6. The patient was a 62-year old para
III, who was 12 years postmenopausal, and
who, after several months of vaginal hemor-
rhages was told by her physician that she had
myomas. Intracavitary radium was administered.
No biopsy or curettage was done. Bleeding
recurred a year later; the patient consulted the
Gynecology Tumor Clinic, where diagnostic
978
The Ohio State Medical Journal
Patient
Age
Yrs. Post-
menopaus.
Original
Diagnosis
Treatment
Given
Actual
Diagnosis
Fibroids
Present ?
1.
(GM)
54
4
Fibroid
Subtotal
Carcinoma
Yes
hysterectomy
cervix
2.
(AE)
60
5
Fibroid
“Shots”
Carcinoma
No
cervix
3.
(GP)
47
5
Fibroid
Conservative
Carcinoma
No
therapy
cervix
4.
(NO)
67
19
Degenerating
Subtotal
Carcinoma
No
fibroid
hysterect.
cervix
5.
(RD)
41
0
Fibroid
X-ray, Subtotal
Carcinoma
? ?
hysterectomy,
cervix
Laparotomy
6.
(CM)
62
12
F ibroid
Radium
Carcinoma
Yes
fundus
7.
(HH)
55
1
Submucous
D & C, Subtotal
Carcinoma
? ?
fibroid
hysterectomy
fundus
59
14
Fibroid
Subtotal
Carcinoma
Yes
hysterectomy
fundus
9.
(FG)
45
0
Menopause
Laparotomy
Carcinoma
Yes
& fibroids
ovary
Table 1
curettings confirmed the diagnosis of adenocar-
cinoma of the endometrium. Multiple myomata
were found at the time of the subsequent post-
radium hysterectomy.
Case 7. The patient was a 55-year old nulli-
para, one year postmenopausal. Because of in-
termittent vaginal bleeding, she had cervical
polypectomy, dilatation and curettage; the
pathology specimen showed no malignancy. She
continued to ‘‘spot,” and two years later, after
a tentative diagnosis of “probably submucous
fibroids as a basis for the bleeding,” had a
subtotal hysterectomy which had been immedi-
ately preceded by a routine dilatation and curet-
tage. The curettings and excised corpus showed
adenocarcinoma of the endometrium.
Case 8. A 59-year old para I, fourteen years
postmenopausal, had a pelvic examination be-
cause of a bloody vaginal discharge of one-year
duration. Subtotal hysterectomy was done for
“fibroid uterus”; the pathologist reported multiple
myomata and also adenocarcinoma of the en-
dometrium.
Case 9. The patient was a 45-year old para
II in the menopause who sought examination
for increased vaginal bleeding. She was told
that “menopause and fibroids” were causing
the bleeding, and was treated by laparotomy, at
which time carcinoma of the right ovary was
found as well as uterine fibroids.
DISCUSSION
None of the patients mentioned received
optimum therapy. Perhaps the outstanding
factor preventing such optimum treatment for
these patients was the misconception as to the
relative importance of myomas as causative
agents in postmenopausal bleeding. That
fibroids of the uterus fairly frequently cause
hypermenorrhea in the years just preceding and
during the menopause cannot be disputed. The
now established fact that postmenopausal bleed-
ing is very seldom per se the result of myoma
should become an equally well-known guiding
principle in management of these women.
The writer believes that loose usage of the
term menopausal bleeding has contributed
largely to misunderstandings on this subject.
In popular medical jargon, the term menopausal
bleeding may too often indicate any excessive
or intermenstrual bleeding occurring 10 years
before, during, or 10 years after the menopause.
Physiologically speaking, the menopause is a
range of time during which there is a gradual
diminution of ovarian function. During this
physiologic range of time, patients may not
only fall heir to bleeding from any reproduc-
tive tract lesion — benign or malignant — which
younger women develop, but there is also a
vastly increased incidence of so-called functional
bleeding, apparently due in whole or in part
to ovarian failure, and often associated with
endometrial hyperplasia. The combined incidence
of these causes of bleeding, together with the
rather low aggregate incidence of malignancy,
have understandably caused physician and lay-
man alike to regard menopausal bleeding more
as a source of annoyance than as a sign of
possible malignancy. The real importance of
diagnosis in menopausal bleeding, of course,
cannot be overstressed.
Bleeding in any patient who appears to have
passed fairly well through the menopause, how-
ever, should correctly be designated post-
menopausal bleeding, and treated with even
more respect than menopausal bleeding itself.
Here is a select population group in whom any
vaginal bleeding indicates malignancy in 50
to 60 per cent of cases. Early, accurate diag-
nosis, followed by vigorous treatment is in-
dicated in 100 per cent of these cases. Diagnosis
is simple in the vast majority of instances, and
consists in:
(a) Making certain that the patient is not
having withdrawal bleeding following ill-advised
estrogen medication;
(b) doing a conscientious pelvic examination,
with critical inspection of external genitalia,
vagina, and cervix;
(c) taking a biopsy specimen of any bleeding
or otherwise suspicious lesion thus visualized;
(d) a thorough dilatation and curettage of
for October, 1950
979
the uterine cavity, followed by submission of
the specimen obtained for the pathologist’s
diagnosis.
In the few patients in whom these steps fail
to establish a definite diagnosis, laparotomy may
be indicated to rule out the possibility of a
functional ovarian tumor.
At pelvic examination, any one of a number
of benign lesions causing postmenopausal bleed-
ing may be searched for visually: atrophic
vulvitis or vaginitis, ulceration due to the wear-
ing of a pessary, recently broken vaginal ad-
hesions, ulceration of a prolapsed cervix, or
cervical or endometrial polyp. Primary malig-
nant or metastatic lesions which have appeared
in the vulva, vagina, or cervix can be visualized,
as well as endometrial or endocervical carcinoma
which has grown out the external os. It should
be borne in mind that polyps, while ordinarily
benign, may be or may become malignant.
The curet is an invaluable diagnostic aid in
cases where the diagnosis is not readily ap-
parent upon speculum examination of the vagina
and cervix. Benign lesions may include en-
docervical or endometrial polyps, submucous or
pedunculated myomata or endometrial hyper-
plasia. The latter is an especially pertinent
finding, since it may indicate previous estrogen
therapy, an ovarian tumor, or be truly idiopathic
in its origin. Carcinoma of the endometrium,
sarcoma arising in myoma or uterine wall, and
metastic growths are the possible malignant
diagnoses established by curettment.
In the previously presented cases, this ap-
proach would have made diagnosis certain in
the five patients with carcinoma of the cervix,
probable in the three cases of carcinoma of
the corpus, and possible in the carcinoma of the
ovary. Instead, these cases were treated by
three general methods, all equally radical: Irradi-
ation, surgery, and neglect. Their treatment
failed because it was neither founded upon ac-
curate diagnosis nor carried out with an under-
standing of the true significance of myomata
in the postmenopausal patient.
SUMMARY
Properly speaking, the diagnosis of “post-
menopausal bleeding due to myoma” is a
diagnosis of exclusion because, while many
women harbor myomas in the postmenopausal
years, they are rarely symptomatic, and the
actual cause of the bleeding will usually be found
to lie elsewhere. This diagnosis of exclusion
should be made only after a painstaking, sys-
tematic attempt to establish a more tenable
diagnosis. It is obviously important to rule
out minor, benign causes of the bleeding so
that one will not overtreat the lesion. It is all-
important to rule out the presence of malignancy
so that one will not undertreat the patient.
Nine cases are presented in which inadequate
treatment resulted from violation of these prin-
ciples.
BIBLIOGRAPHY
1. Novak, Emil : Textbook of Gynecology. 3rd Ed. Balti-
more, Williams & Wilkins, 1948.
2. Davis, Carl Henry: Gynecology & Obstetrics, v. 2,
V. F. Prior Co., 1938.
3. Te Linde, R. W. : Wisconsin Med. J., 36 :521, 1937.
4. Taylor, Howard C., and Millen, Robert: Amer. Jour.
Obst. & Gyn., 36:22, 1938.
5. Zeit, Paul R. : Amer. Jour. Obst. & Gyn., 58:153, 1949.
Pedunculated Lipoma: Case Report
Although pedunculated lipomata are not rare
lesions, the subject case involved such a con-
fusing history and the tumor’s location was so
unusual, that a report is presented.
A 45-year old white man was examined on
December 20, 1949. The lesion about which he
complained was a soft pendulous tumor hanging
from his right axilla. The patient insisted that
a tumor the size of a guinea egg appeared in
his right axilla within one hour after being
Fig. 1. Posterior View
vaccinated for smallpox in the right deltoid
area, 19 years previously. The patient had
been exposed to smallpox while driving a school
bus. At the time of the smallpox vaccination,
the county health officer also gave a parenteral
injection along the anterior border of the right
deltoid muscle. Probably this was diphtheria
toxoid. Immediately following the immunizing
procedures, the patient developed such a severe
reaction in his right upper extremity that he
had to carry the swollen painful limb in a sling
for eight days. The tumor never became
smaller. One year later it was about two inches
long. Ten years later it was about three inches
long. Growth had been more rapid in the last
year. Aspiration of the tumor by the family
doctor in October 1949 resulted in a dry tap.
The tumor hung vertically and was somewhat
club shaped. It was 16 centimeters long and 8
centimeters in diameter in its distal third, where
it was largest. Except for the proximal 4 centi-
meters the skin which covered the lesion was
anesthetic. On December 24, 1949, the tumor
was removed under local anesthesia. It weighed
320 grams. The wound healed per primam.
Pathologic sections were taken through several
levels of the tumor and at its base. Histologically
it proved to be a benign lobulated lipoma. In
the accompanying picture the tumor was lifted
outwardly for better exposure of its pedicle. —
Carl A. Minning, M. D., Williamsburg, Ohio.
March 13, 1950.
980
The Ohio State Medical Journal
The Immediate Supportive Treatment of the
Severely Burned Patient
JAMES MITHOEFER, M. D.
WHEN one is presented with the prob-
lem of the severely burned patient the
local treatment of the injury no longer
causes much concern or is subject to major
as to what type of treatment should
Since Koch, Mason and Allen1’ 2 de-
veloped their rational plan for the treatment
of burns by cleansing and the application of
a bland ointment pressure dressing under asep-
tic conditions, this method has been used in
many centers and by the armed services during
World War II with considerable success. This
method of treatment has become so standardized
that it is familiar to almost everyone. We are
still presented, however, with the serious prob-
lem of correction of the general physiologic
abnormalites that occur in the body of the se-
verely burned person.
Uncertainty is apt to exist in the first 48 hours
following burn as to how the disturbed elec-
trolyte pattern of the patient’s blood can be
corrected, how his so-called shock should be
treated, and how his urine output may be
maintained. This paper is presented not as an
original contribution to the solution of these
problems, but as a critical review of the exist-
ing methods of treatment and as a tentative plan
which has been of some use to us in handling
persons with third degree burns. It should be
pointed out at the start that the various abnor-
malities to be discussed do not often arise in
patients with second degree burns unless they
are extensive, but a deep third degree burn,
because of its destruction of tissue, may produce
serious physiologic abnormalities even though
the area of the burn is relatively small.
It is the plan of this review to take up sep-
arately the major manifestations caused by
a severe burn and discuss each one in some
detail. Using the information thus available,
we shall present in as simple fashion as pos-
sible an outline which may be applied, with
some modification, to any individual patient.
RESTLESSNESS
The first treatment that a severely burned
patient usually receives is the administration
of some narcotic to control his severe hyper-
activity. Morphine is usually administered for
the relief of pain. One must remember that
its purpose is the control of pain and that its
analgesic effect increases with the amount of
drug up to a dose of about 10 mg. If more than
15 mg. is given the analgesic effect becomes less
From the Department of Surgery of the University of
Cincinnati College of Medicine and the Cincinnati General
Hospital.
The Author
• Dr. Mithoefer, Cincinnati, Ohio, is a grad'
uate of Harvard Medical School, Boston, Mass.,
1940. On staff: Children’s, Bethesda, Christ,
and Our Lady of Mercy Hospitals; instructor
in Surgery, University of Cincinnati College of
Medicine.
pronounced with each increment of dosage and
the undesirable side effects such as depressed
respiration and vomiting become more apparent.
If pain is not relieved by the administration of
15 mg. of morphine to a burned patient one may
properly assume that any remaining restlessness
is not due to pain. It is often due to ap-
prehension and to fear which is induced by the
obvious severity of the injury. Morphine has
very little effect upon the higher cerebral
centers in controlling this type of restlessness.
However, a dose of 0.1 to 0.2 Gm. of pheno-
barbital or another of the barbiturates is usually
effective.
Another common cause of restlessness and
one which must be recognized and treated ade-
quately is that secondary to cerebral anoxia.
This may be caused by decreased circulating
blood volume and failure to deliver a sufficient
supply of oxyhemoglobin to the brain, or it
may be due to impaired respiratory exchange.
The treatment of the former will be considered
in some detail below. Reduced respiratory ex-
change is commonly due to two causes. First,
there may be edema of the walls of the respir-
atory tract caused by the inhalation of hot gases.
Secondly, there may be respiratory depression
following an overdose of morphine. In either
event, the treatment resolves itself into the
delivery of adequate amounts of oxygen to the
lungs. The administration of oxygen by mask
or by nasal catheter should be a constant treat-
ment in all severely burned patients. Occasion-
ally one sees a person with enough laryngeal
edema to require tracheotomy. If this procedure
is indicated it should be done promptly. It is far
better to make an unnecessary tracheotomy than
to deny the patient a free airway if one is needed.
When clinical signs of pulmonary edema are
present relief may be afforded by the admin-
istration of oxygen under positive pressure.
DECREASED BLOOD VOLUME
Perhaps the most important single early mani-
festation of a severe burn is that due to decreased
decisions
beusecL
for October, 1950
981
circulating blood volume, a condition commonly
known as shock. Blood volume is diminished
both relatively and absolutely. Careful measure-
ments of the extracellular space have shown
that in a severe burn of more than 25 per cent
of the body surface there is an increase of 50
per cent in the extracellular compartment in
the first 48 hours.3 Associated with this is
less blood to fill up the intravascular space.
Blood is lost to the circulation in several ways.
There is damage to the capillaries with the escape
of whole blood. The red blood cells are hem-
olyzed by heat and perhaps by exposure to
potassium released by other destroyed cells and
to the osmotically altered serum;4 they are
trapped in the burned tissue and the adjacent
vessels.5, 6> 7 The redness of the skin of areas
of second degree burns indicates vasodilatation
with stagnation of blood and loss to the circula-
tion. The cell free fraction of the blood is poured
out of the capillaries into the vesicles and into
the interstitial spaces and manifests itself by
the presence of edema.
The correction of the diminished blood volume
is one of considerable emergency as shock may
become irreversible if it is allowed to exist long
enough, as irreparable damage to the liver and
brain and the kidneys may result. When the
patient is seen soon after the burn is incurred
signs of shock may not be manifest. However,
the astute clinician will anticipate impending
shock and institute appropriate treatment before
the signs are present. It is generally agreed
that the prevention of shock is more satisfac-
tory than its treatment. Therefore, at the
first opportunity some type of fluid must be
given intravenously in an effort to increase the
arterial pressure and deliver an adequate supply
of blood to the vital organs. If nothing else
is at hand in the emergency physiologic saline
solution may be used until plasma or whole
blood is available. The fluid of choice is whole
blood.
It must be pointed out that the diminished
blood volume is due to loss of more than pure
plasma. Studies of the changes in red cell mass
following burns have indicated that from 5 to
55 per cent of the lost blood volume is composed
of red blood cells.6 The average volume per cent
of red cells in the lost fluid is 31 per cent, which
is the equivalent of slightly anemic blood. It
has been demonstrated in experimental animals
that there is a greater incidence of recovery fol-
lowing severe burns when whole blood is given.8
These findings have been confirmed in human
subjects.9 No investigator has reported any
danger associated with the administration of
whole blood even in the presence of marked
hemoconcentration with a hematocrit level as
high as 85 per cent.6 The administration of
whole blood at this time instead of plasma
largely prevents the secondary anemia which
seems to appear several days after a burn but
which has really been present since the be-
ginning but has been masked by hemoconcentra-
tion. Furthermore, in the reported studies and
from our personal observations it appears that
patients are less inclined to vomit, take more
food and fluid by mouth, feel better generally,
and have a more benign subsequent course if
whole blood is supplied to them early in ade-
quate amounts. From the available data it
seems that blood must be furnished to a severely
burned patient in amounts equivalent to about
10 per cent of the body weight in the first 48
hours.3 It has become our practice to attempt
to supply this amount of blood. If the hemato-
crit rises above 80 per cent we have generally
switched to the administration of plasma in
similar amount, changing over to blood again if
the hematocrit falls below 80 per cent.
TRANSLOCATION OF WATER AND ELECTROLYTES
One of the most difficult problems encountered
in the early treatment of the severely burned
patient is the administration of the proper
amounts of water and of the various electrolytes
by the proper routes. It is apparent to anyone
who observes the marked edema in and about
a burn that there is serious translocation of
body water and its solutes which are lost to the
internal environment when they are extravasated
into the interstitial spaces.
For the purpose of this discussion let us
first consider the volume of water which should
be given. If one observes an untreated burned
patient he observes that little or no urine is
excreted. Anuria and oliguria may be due to
one or a combination of three factors:
1. Insufficient circulating blood volume for
glomerular filtration.
2. Renal tubular damage.
3. Insufficient intake of water.
The first factor will be controlled by the
adequate treatment of shock. If one is able to
maintain a normal arterial pressure in the
arm, the presumption is that the pressure in
the renal circulation is also adequate. In that
event, the other two causes may be differentiated
by testing the renal tubular function by the
rapid administration of water. If 500 to 1000
cc. 5 per cent glucose in water is given intra-
venously at a rapid rate — that is, in from 30
to 60 minutes, there will be immediate reflec-
tion in increased urine output if the tubules are
functioning and one may assume that the oliguria
was due to dehydration. Once renal competency
is established- the urine output is the best single
guide to the continued administration of fluid.
If urine output is kept at about 50 cc. per hour
one may be sure that adequate water is avail-
able for metabolism.
The route by which the aqueous solutions
are to be given is of great importance. It has
been demonstrated that experimentally burned
982
The Ohio State Medical journal
animals survive in greater numbers and for
longer periods of time if they are given only
blood parenterally and water and salts by
mouth;8 these findings have been confirmed by ob-
servations on burned patients.9, 10 We have, there-
fore, adopted the policy of giving nothing but
blood or plasma intravenously and giving all
water and electrolytes by mouth. If the patient
vomits or has paralytic ileus, which is not in-
frequently the case in children, one must give
tlie^aqueou^ fluids subcutaneously. Rarely it
will be found necessary to use the intravenous
or bone marrow route.
Aside from the loss of extracellular fluid
into the tissue spaces, there is considerable
translocation due to loss of electrolytes. In the
immediate period after a deep burn there is an
excess of serum potassium from the destroyed
cells. This ion must be excreted by the kidneys,
taking with it bicarbonate ion; thus the bicar-
bonate-carbonic acid ratio is disturbed, lowering
the pH so that acidosis results. Later there is
loss of chloride into the burned areas and also
In the urine. In an attempt to correct these
disturbances we have recently been administer-
ing a mixture of roughly 7/M Sodium chloride
+ 7/M Sodium bicarbonate in the ratio of two
parts of the former to one part of the latter.
The reason for using this mixture can be ap-
preciated by studying the diagrams below:
Normal 0.85% NaCl-NaHCC>3
Plasma (7/M) Mixture
NaCl
The figures represent milliequivalents per liter of solution.
It is apparent that so-called normal saline
bears no quantitative relationship to normal
plasma except in osmolarity and that it sup-
plies a great deal too much chloride in rela-
tion to the concentration of sodium ions.
The saline-bicarbonate mixture is more nearly
physiological in that respect and in addition it
Contains nearly twice the normal plasma con-
centration of bicarbonate which will help to cor-
rect the acidosis.
If it is necessary to give water and electrolytes
parenterally we have substituted 6/M Sodium
lactate for the bicarbonate and have given the
solution intravenously or we have used 7/M
Sodium chloride solution subcutaneously.
It must be emphasized that when this solu-
tion is given, one must determine the serum pH
and C02 content every 3-4 hours because within
the first 12-15 hours after the burn there may
be a rather sudden shift to alkalosis* in which
case the electrolyte content must be adjusted
accordingly.
PLAN OF TREATMENT
Treatment without a definite plan ana with-
out an understanding of the reasons for using
each therapeutic tool is at best uncertain and
often disastrous. In our experience the fol-
lowing brief outline and check list has been
helpful in the early management of serious,
burns.
ESTIMATE EXTENT OF BURN
f
Any burn of more than 10 per cent of the
body surface is potentially serious and the pa-
tient should be admitted to the hospital. An
accurate diagram of the extent of the injury
should be made and the percentage of second
degree and third degree burn estimated.
GENERAL PHYSICAL EXAMINATION
A thorough but quick general examination
should be made. Special attention should be
paid the following points:
1. Eyes: Are there burns of the lids or
corneas ?
2. Nose, mouth, pharynx: Are there signs
of burns which might indicate the inhalation
of hot gas?
3. Lungs: Are there signs of pulmonary edema
which might be caused by inhalation of noxious
fumes or hot gas?
4. Are there signs of associated trauma such
as fractures, lacerations, intra-abdominal, intra-
thoracic or intra-cranial injury?
5. Heart: The cardio-vascular system in gen-
eral must be carefully evaluated because shock
is either present or impending and as the situa-
tion becomes more complicated a knowledge of
the patient’s normal condition becomes more
valuable.
6. Estimate the patient’s weight. This will
be of utmost value later in estimating the
fluid requirements.
ASEPTIC PRECAUTION
From the time the patient is first seen it
is imperative that the strictest aseptic condi-
tions be enforced. All personnel must be
masked. The patient must be placed on and
for October, 1950
983
CHECK LIST FOR SEVERE BURNS
Hour
0
Phys. Exam.
Morphine
Dose
Hematocrit
Hemoglobin
Body Weight
Rbc_l_^_
kg.
Mouth... -
Barbiturate
Wbc
Type
Serum
Catheter
Dose
Pulse
B. P
%3°
Oxygen
Cath
Cl
CO"3
Dressing
%9.°
Mask
pH
c/c Total
BUN
Time
Temp.
Other
Creatinine
Anaesthetic
y2
i
Pulse ... ., Mental Status.
Respirations
Pulse Mental Status .
Resp BP
Temp Urine output
Oxygen.
Stridor..
Rales.
Stridor..
Rales ....
.Ain’t, blood
or plasma
Gm NaCl ...
Gm NaHCOg-
2
Pulse
Amt. Water
enteral
parenteral
..Temp Resp BP Metal Status Urine
Stridor Rales
Z
4
5
6
Phys. Exam.
"Ryes
Urine
V olume
Serum
pH
Morphine *
Barbiturate — .
Nose
Sp. gr.
Am’t. blood
Month
H’crit (or Hb)
Cl”
or plasma .
Pharynx ._ .
CO,
enteral
Lungs
—
Ain t. v\ a. ter parenteral
GmNaCl ... ....
Mental Status ....
BP
—
GmNaHCOs _
Pulse .
Temp Resp...
BP
Urine vol.
Pulse
Temp. . Resp
BP
— . - Urine vol. _
Phys. Exam.
Eyes
Nose .
Urine
Vol......
Sp. gr.
Amt. blood
plasma
. . . enteral
H’crit (or Hb)
Amt. walei parenteral
Pharynx —
Lungs
Pulse
Temp.
Serum
Ph
co.
GmNaCl _
GmNaHCOs- _
Morphine ... . .
Barbiturate .
Resp. .... —
BP
Cl"
Thereafter at least every hour check (1) Urine output' (2 Circulation (3) Respiratory distress. Adjust water intake
and blood or plasma infusion accordingly.
Every three hours check hemoglobin or hematocrit.
Every six hours check (1) Serum electrolytes (2) Urine specific gravity (3) Amount of electrolytes given (4) Do
genera] physical examination.
covered by sterile sheets until the occlusive
dressings may be applied.
BLOOD STUDIES
These are divided into two parts:
A. The determination of the cellular elements:
1. Hematocrit
2. Hemoglobin
3. Erythrocyte count
4. White blood cell count
These determinations are chiefly of value in
estimating the degree of hemoconcentration.
B. The determination of the soluble constitu-
ents:
1. Chlorides
2. Bicarbonate content
3. pH.
4. Blood urea nitrogen or nonprotein ni-
trogen
5. Blood creatinine
The first three mentioned determinations will
serve as a base line to determine the immediate
fluid therapy. The last two will serve as a
measure of renal function. The creatinine will
be of value later in deciding Whether an
elevated blood urea nitrogen or nonprotein ni-
trogen is due to impaired renal function or to
bleeding into the gastro-intestinal tract from
gastritis or a Curling’s ulcer.
OXYGENATION OF BLOOD
Oxygen should almost invariably be given,
by mask, by catheter, or by tent. If laryngeal
stridor is present, tracheotomy must be per-
formed forthwith. If pulmonary edema occurs'
the prognosis is poor, but improvement may
occur if oxygen can be given under positive
pressure.
SEDATION
Morphine 10-15 mg. is given for the relief of
984
The Ohio State Medical Journal
Chloride expressed as mg NaCl per 100 cc. x 10 x
— = “Eq Cl , L
C02 combining power expressed as vol. % x 0.423 = mEq HCOi/L
NPN expressed as mg per 100 cc. x 10 NPN/L
' 28 ” m q
pain, and one of the quick-acting barbiturates
0.1-0.£k-Gm. to- promote mental ease.
MAINTENANCE OF CIRCULATING BLOOD VOLUME
A large vein must be cannulated early and
the administration of whole blood is to be
started as soon as possible. While awaiting
cross-matching of the blood, preserved plasma
should be given. One may estimate that about
10 per cent of the body weight of blood or
plasma will be required in the first 48 hours.
The rate of infusion cannot be told accurately.
It should be given at such a rate that the blood
pressure and pulse are brought to normal values
and kept there. If the hematocrit rises above
80 per cent or if there are more than 30 grams
of hemoglobin per 100 cubic centimeters of blood
one is justified in changing the infusion to
plasma or a mixture of plasma and blood. The
value of intra-arterial transfusion in cases of
extreme hypotension must not be forgotten.
MAINTENANCE OF URINE OUTPUT
Almost all severely burned patients should
have an indwelling urethral catheter placed
soon after admission. An accurate record of
the urine flow per hour can then be kept. Water
and its solutes are given by mouth, by stomach
tube or, if necessary, parenterally at such
a rate that the urine flow is kept as close
to 50 cc. per hour as possible. Usually 1000-
3000 cc. of water will be required to re-
place the loss from the burned area in the
first 24 hours and about 2000 cc. to compen-
sate for the insensible loss. Adequate renal
function cannot be maintained unless the arterial
pressure is kept high enough to insure glomeru-
lar filtration. Renal tubular damage may also
be a factor if there has been prolonged hypo-
tension or severe hemoglobinuria. Tubular func-
tion may be tested by the rapid administration
of water as described above.
MAINTENANCE OF ELECTROLYTE BALANCE
The water intake described above will at
the outset of treatment contain the 1:3 bicar-
bonate-saline solution previously mentioned ex-
cept if it is given subcutaneously. Each liter
of this solution will contain 5.6 Gm. NaCl
and 4.0 Gm. NaHCOs, or, expressed phys-
iologically, 144 mEq Na+, 97 mEq Cl’, and
47 mEq HCOi. If at any time during the
course of treatment the bicarbonate con-
tent of the serum (as calculated from the
C02 combining power) rises above 30 mEq
per liter or if the pH rises above 7.7, the
bicarbonate content of the mixture will be
reduced proportionately.
Unfortunately the amount of chloride ion which
should be given cannot be so readily determined.
The serum chlorides are notoriously unreliable
as a guide to therapy. It is dangerous to rely
on the excretion of chloride ion in the urine
as a guide to therapy because in the first few
days following a severe burn there may not
be any significant excretion even when large
amounts are given. Empirically it seems that
the equivalent of 12-17 Gm. NaCl suffices to
supply the chloride requirements for 24 hours.
It will be noted that the values for the various
chemical determinations are all given in milli-
equivalents per liter to promote better under-
standing of the electrolyte pattern. Since many
hospital laboratories report their results in other
ways, the factors, set apart at the top of this
page, are given for their ready conversion to
the physiological units.
If these principles are kept in mind the
check list on opposite page will serve to stimulate
the memory about the many details necessary in
the treatment of a severe burn. It will also
serve as a running inventory, so to speak, of
the patient’s status at any particular time.
It will be noticed that the check list sheet
covers a six-hour period. Each additional six-hour
period may be recorded on a separate sheet. At
the end of 24 or 48 hours the period of urgent
replacement therapy is usually at an end as
demonstrated by stabilization of the patient’s
condition.
BIBLIOGRAPHY
1. Mason, M. L. : Local Treatment of the Burned Area.
Surg. Gynec. & Obst., 72:25, 1941.
2. Allen, H. S., and Koch, S. L. : The Treatment of
Patients with Severe Bums. Surg. Gynec. & Obst., 74 :914,
1942.
3. Cope, O., and Moore, F. D. : The Redistribution of
Body Water and the Fluid Therapy of the Burned Patient.
Ann. Surg., 126:1010, 1947.
4. Harkins, H. N. : The Treatment of Bums. Balti-
more, Charles C. Thomas, 194z.
5. Abbott, W. E., Meyer, F. L., Hirschfield, J. W., and
Griffin, G. E. : Metabolic Alterations Following Thermal
Bums. III. The Effect of Treatment with Whole Blood and
an Electrolyte Solution or with Plasma Following an Ex-
perimental Burn. Surgery, 17 :794, 1945.
6. Evans, E. I., and Bigger, I. A. : The Rationale of
Whole Blood Therapy in Severe Bums. Ann. Surg., 122 :693,
1945.
7. Ham, A. W. : Histopathology of Bums. Ann. Surg.,
120:689, 1944.
8. Moyer, C. A., et al : Study of Interrelationship of Salt
Solutions, Serum and Defribrinated Blood in Treatment of
Severely Scalded Anesthetized Dogs. Ann. Surg., 120:367,
1944.
9. McDonald, J. J., Cadman, S. F., and Scudder, J. :
The Importance of Whole Blood Transfusions in the Man-
agement of Severe Burns. Ann. Surg. 124 :332, 1946.
10. Abbott, W. E., et al. :Metabolic Alterations Following
Thermal Burns. V. The Use of Whole Blood and Elec-
trolyte Solutions in the Treatment of Burned Patients.
Ann. Surg. 122 :678, 1945.
for October, 1950
985
Intestinal Obstruction Caused by Spasm of Colon —
A Case Report
WILLIAM D. MONGER, M. D.
The Author
• Doctor Monger, Lancaster, Ohio, is a grad-
uate of Ohio State University College of Medi-
cine, 1942, and received his surgical training
at Nashville General Hospital in Tennessee.
Now engaged in practice at Lancaster.
IT is theoretically possible for intestinal spasm
to occur long enough to cause obstruction
because of the known ability of smooth muscle
for prolonged contraction without fatigue, and
cases have been seen and reported by Wangen-
steen, causes being given as:
1. Irritation, either from without or within
the bowel, such as foreign body, worms, ulcers,
or external trauma;
2. Poisons, lead or arsenic;
3. Psychic, neurasthenia and hysteria;
4. Idiopathic.
It would seem likely that some cases in the
idiopathic category might be due to visceral
angioneurotic edema, though if intestinal ob-
struction occurs on an angioneurotic or allergic
basis it is usually due to edema of the bowel
wall occluding the lumen. A case of an acute
abdominal emergency in an allergic patient may
deserve a therapeutic trial of epinephrin before
final decision for laparotomy is made.
CASE REPORT
History : A sixty-two-year old glassworker
not in contact with lead was first seen in March
1949 complaining of abdominal cramps of twenty-
four hours duration, with nausea and vomiting
for a few hours. He had had a previous inguinal
herniorrhaphy, two rectal operations for ab-
scesses, a suprapubic prostatectomy, and a cor-
onary occlusion, the last about one year ago.
Physical findings, positive: He was severely
ill, with vomiting simultaneous with severe
abdominal cramps. Blood vessels markedly
sclerotic. The abdomen was moderately tender,
more so in the lower half with moderate disten-
sion and the bowel pattern was visible. No
increased peristalsis and no rushes were heard.
Rectal revealed only a tight band posteriorly
at the anus.
Temperature, pulse, respiration, and blood pres-
sure normal.
He was of a nervous, apprehensive type.
Laboratory findings. Erythrocytes 4.92 mil-
lions, 96 per cent hemoglobin. Leucocytes 19,000
with 3 per cent lymphocytes and 97 per cent
neutrophils with 4 juveniles, 40 bands and 53
segmenters.
Voided urine had 45 milligrams albumin with
2 Red Blood Cells /High Power Field and 4 plus
casts. Specific gravity quantity not sufficient.
Flat plate of the abdomen showed consider-
able distension of the small bowel.
Course: He was given gastric suction and
intravenous fluids. Laparotomy, performed the
next day, showed a tight spasm in the middle
of the transverse colon with dilatation of all
bowel proximally and collapse distally. The
Submitted Feb. 3. 1950.
colon at the site of spasm was otherwise normal,
and was caused to dilate by compression proxi-
mally and remain so under observation. Mesen-
teric lymph node biopsy showed chronic lym-
phadenitis and culture of a slight collection of
free peritoneal fluid was negative.
Postoperatively he did very well and no ob-
struction occurred until six weeks later, at which
time distension, cramps, and nausea and vomit-
ing recurred. He was readmitted to the hospital
and given gastric suction for two days with
nothing bj1- mouth and intravenous fluids. He
has been well for a period of seven months.
A similar case was seen on the wards at Ohio
State University in 1939.
SUMMARY
1. Causes of intestinal obstruction due to
spasm of the bowel are listed.
2. A case of spasm of the colon causing
obstruction is detailed and another one mentioned.
Studies of Toxoplasma in Tissue Cultures
Toxoplasma were maintained in hanging drop
slide cultures of mouse tissues (i. e., spleen,
liver, heart and brain) in the plasma clot and
under perforated cellophane.
After 33 days in tissue cultures, these organ-
isms no longer caused an acute infection in mice;
however, a chronic type of infection occurred.
A detailed morphological study of the organism
was made using the light, phase, and electron
microscopes, and the effects of Toxoplasma on
various tissues grown in cultures were studied.
The practicability of tissue culture antigens
for use in skin testing is discussed.
— Theodore Suie, Jr., M. D.,
Jackson W. Riddle, Ph. D., M. D., and
Authur M. Culler, M. D.,
Columbus, Ohio.
Brief authors’ abstract of paper presented at charter
session of the Association for Research in Ophthalmology,
East-Central Section, held in Cleveland, Jan. 10, 1950.
986
The Ohio State Medical Journal
Inguinal Herniation of Stomach: Case Report
TOM F. LEWIS, M. D., and PAUL S. ROSS, M. D.
OCCASIONALLY, cases are encountered
that are of interest because of the
presence of some unusual features. In
this case, these unusual features were the
great size of the hernias, and the fact that
one of them actually contained both stomach
and small bowel. Repair was carried out suc-
cessfully. Case report follows:
Mr. T. W. G., age 69, was first seen as an out-
patient in December, 1947, complaining of two
large hernias that could be retained only five
to six hours at a time by a truss. He stated
that both had been present since the age of 20,
and that for the past 15 years he had tried
numerous appliances to restrain them without
success, chiefly because of intolerance to the
degree of pressure necessary. The hernias
had reached their maximum size about 20 years
ago, and had caused gradually increasing dis-
comfort, but had given him no great difficulty
otherwise, except that he was unable to eat
with any particular degree of comfort.
X-ray studies at this time (See Fig. 1) showed
the presence of the stomach in the right her-
nial sac, and many loops of small bowel in the
left sac.
FIGURE I
Examination revealed a frail, elderly man, age
69, weight 92 pounds, who presented huge bi-
lateral inguinal hernias, each about the size of a
football, and both easily reducible. This patient
was advised to consider surgery.
Submitted April 7, 1950.
The Authors
• Dr. Lewis, Columbus, Ohio, is a graduate
of Ohio State University College of Medicine,
1932; diplomate, Amer. Board of Surgery;
fellow, Amer. College of Surgeons; on staff, at
University, St. Francis, Mt. Carmel, and Chil-
dren’s Hospitals; asst. prof, of Surgery, Ohio
State University.
• Dr. Ross, Columbus, Ohio, is a graduate
of Yale University School of Medicine, New
Haven, Conn., 1931; diplomate, Nat’l. Board
Medical Examiners; diplomate: Amer. Board of
Internal Medicine; Amer. College of Physicians
(Assoc.) ; Amer. Heart Association; chief of
Medicine, St. Anthony’s Hospital; and on at-
tending staffs at White Cross and Mt. Carmel
Hospitals; asst. clin. prof, of Medicine, Ohio
State University.
When next seen in May, 1948, he had had
several bouts of vomiting and a further slight
weight loss. Physical examination at this time
was negative, except for the hernias and ex-
treme emaciation. He was again advised to have
surgery, and finally in October of 1948, was
hospitalized to have it carried out.
Physical examination at this time showed an
extremely thin individual, of about the stated
age, weight 95 pounds. Blood pressure 130/70.
Eye, ear, nose, and throat examination and ex-
amination of the heart and lungs were negative.
The inguinal regions revealed bilateral inguinal
direct hernias of huge proportions, each about
the size of a football. Both were easily reduc-
ible, both defects easily admitting three fingers.
Rectal examination revealed no palpable pros-
tatic enlargement. Admission urinalysis was
normal except for a few bacteria and a trace of
sugar. The Blood Urea Nitrogen was 14, total
protein 5.58, albumin 3.39, globulin 2.19, pro-
thrombin content 100 per cent. The blood count
revealed red blood count 5,000,000, white blood
count 10,200, hemoglobin 14.5 gms., and a
normal differential. The blood sugar showed a
non fasting level of 135 milligrams per cent
and a fasting of 82. Examination of the ex-
tremities revealed them to be rather cold to
touch, and there was no pulsation palpable in
the dorsalis pedis, posterior tibial, or popliteal
vessel in either lower extremity. His vital
capacity measured while at bed rest with the
hernias reduced was 3100 cubic centimeters; and
while ambulatory with the hernias in the scrotum,
it was 3000 cubic centimeters. This test was
carried out to ascertain whether or not the
return of the hernial masses to the abdominal
cavity would seriously embarrass the vital
capacity.
X-ray Reports. G. I. Tract: Fluoroscopic and
film studies of the esophagus, stomach, and
for October, 1950
987
duodenum showed barium to pass through the
esophagus without difficulty. The barium then
progresses through a markedly elongated ptotic
stomach and the angle, pylorus and duodenal
bulb are situated in a huge scrotal sac on the
right. This is well demonstrated on the films
made in the erect and recumbent positions. It
appears that multiple other loops of intestine
are also present in this tremendous hernia.
Chest: The cardiac shadow is small in size and
normal in position. The domes of the diaphragm
are flattened and low in position. There is a
Ghon tubercle in the middle third of the left
lung and slight calcification in the hilum.
There is no evidence of active tuberculosis or
malignancy. The chest appears emphysematous.
Operation on one side was undertaken on
October 16, 1948. The right inguinal canal was
opened, the contents of the scrotum having been
replaced previously without difficulty. A large
defect both direct and indirect, but mostly medial
to the deep epigastric vessels, was present. The
elongated deep epigastric vessels were divided,
the huge sac dissected free, amputated at its
neck and closed with interrupted mattress sutures
of silk. A modified McVey type of repair was
carried out, splitting Cooper’s ligament longi-
tudinally, suturing the medial flap to the pos-
terior rectus sheath, the lateral flap to the
anterior sheath, and using relaxing incisions
in this layer. The cord and testicle were re-
moved to assure a more complete and secure
closure, and the external oblique fascia was
closed. Silk was used throughout. Over this,
a piece of Tantalum gauze was applied to
further reenforce the repair.
Following this operation the patient had
rather persistent residual urine, which was
treated by insertion of a Foley catheter and
early ambulation was begun. The patient was
extremely difficult to feed, having very little
appetite, and his diet was supplemented by
vitamins and iron. He was given sulamyd®
1 gm. three times a day and duracillin® 1 cc.
twice a day to control and prevent any bladder
infection. His postoperative course was other-
wise uncomplicated.
The second operation was carried out on
November 2, 1948, for the left direct inguinal
hernia, after fully reevaluating his physical
status. The sac was approached through an
oblique incision in the inguinal region, the
inguinal canal opened and the sac dissected free.
It was found to consist of a large direct sac
and a smaller indirect one. These two were
combined into one, changing it from a pantaloon
type to a simple type of sac. This was resected
and the neck closed with silk mattress sutures.
The hernial repair was then carried out using
the posterior sheath of the rectus muscle with
the transversus abdominis aponeurosis approxi-
mated to Cooper’s ligament. No relaxing incision
was needed. The deep inguinal ring was made
smaller and the cord was dropped beneath the
external oblique fascia, and satisfactory repair
was completed by closing this layer over the
cord, creating a new subcutaneous ring.
Follow-up examination on December 6, 1948,
showed an excellent postoperative condition.
X-ray examination at this time (See Fig. 2) dis-
closes the stomach and intestines to be entirely
intra-abdominal and in near normal position.
The Tantalum gauze can be clearly seen in situ
covering the previous location of the right direct
inguinal hernia.
The scrotum was enlarged, the left testicle
slightly tender. One knot of Tantalum over
the midline was rather prominent. On Decem-
ber 29, 1948, a few infected sutures at the
lower angle of the left wound were removed,
and he was seen again on January 3, 1949,
FIGURE II
at which time his condition was excellent and he
was gaining weight steadily.
At the present time, February, 1950, his
condition is good, and the repairs are holding
well.
COMMENT
It is also felt that this case is unusual for
a number of other reasons. First, direct in-
guinal hernia rarely occurs before the age of
forty. These hernias existed since the age
of twenty. Secondly, the right direct inguinal
hernia contained part of the stomach, part of
the duodenum and loops of upper jejunum.
Herniation of the stomach, while occurring in
diaphragmatic and umbilical hernia, has rarely
been reported as occurring in an inguinal hernia.
In addition, a large portion of the ileum was
present in a similar hernia on the left side,
so that it truly may be said that much of the
patient’s main digestive tract was situated
extra-abdominally.
In spite of this extreme abdominal visceral
dislocation, this patient had existed several dec-
ades with only periodic digestive upsets. He
was able to reduce, but not restrain his hernias
and suffered severe nutritional upsets only in the
last year of his illness. Since successful sur-
gical correction of this condition, the patient
has been completely asymptomatic and his nutri-
tional status has improved.
988
The Ohio State Medical Journal
Development of Dermatology in Ohio
Part I
LEON GOLDMAN, M. D.
The Author
• Dr. Goldman, Cincinnati, is a graduate of
University of Cincinnati College of Medicine,
1929; diplomate, American Board of Derma-
tology and Syphilology; fellow. Royal Society
Tropical Medicine and Hygiene; member,
American Academy of Dermatology and
Syphilology, American Society of Tropical
Medicine, and Society for Investigative Derma-
tology; director dermatology, Cincinnati Gen-
eral and Children’s Hospitals; and prof.,
dermatology and syphilology. University of
Cincinnati College of Medicine.
IT is a gratifying feeling to return to the
study of the history of medicine even though
it be in a superficial and casual survey, such
as I must make this. Paul Bechet thinks it
always good for one’s ego in medicine to read
back into history. Please do not be misled
by this pompous title, because this report will
be merely a summary of trends rather than a
specific or cyclopedic array or even informa-
tion by gossip. The history of trends here will
illustrate both the developments of dermatology
in Ohio as it influenced American dermatology
and also the picture in Ohio as part of the back-
ground of the national scene. I shall omit much,
especially names of many who have been present
in these scenes, for this is not a detailed re-
view. I have been helped, in this report, by
my colleagues because fortunately, some der-
matologists in Ohio have also been medical
historians, for example, your own Clyde Cum-
mer, and also in Cleveland, William Thomas
Corlett and Willard L. Marmelzat and in Cin-
cinnati, Charles Tabb Pearce and Roy Kile.
Even from Corlett we have very little in-
formation available as to the interest of the
Indian medicine man in the “Ohio territory”
in dermatology. I wonder whether such peculiar
interest to diseases of the skin was exhibited
anywhere in the Americas, except perhaps in
Peru. The teaching of Medicine, as our Father
of Western Medicine, Daniel Drake, showed,
included the teaching of dermatology as part
of the general medicine. His section on the
Eruptive Fevers, Part IV of Book II of A Sys-
temic Treatise on the Principal Diseases of the
Interior Valley of North America shows the cur-
rent information on this subject, as influenced
From the Department of Dermatology and Syphilology
of the College of Medicine of the University of Cincinnati
and the Cincinnati General Hospital. Presented at Ohio
State Archeological and Historical Society Annual Meeting,
Columbus, April 14, 1950.
chiefly by Willan and others of that period.
Willan and Bateman . on cutaneous diseases and
Bell and Hunter on venereal diseases had been
recommended as textbooks at the first medical
convention of Ohio in Columbus on June 4, 1821.
EARLY TEACHINGS PERTINENT TODAY
Some of the ideas of this great teacher and
practitioner, Daniel Drake, are indeed pertinent
for today. He wrote of a group that still dis-
tresses and confuses us; he called this group,
“Roseola, lichen and strophulus.” “As they are
all more or less papulous, as in their acute
forms, the efflorescence is preceded by feverish-
ness, and tends in most of them to produce a
branny desquammation, it is easy to perceive
that the labor of studying their diagnostic rela-
tions is not small. Moreover, most of them
occur but seldom; very few of them require
medical aid, and all or nearly the whole are free
from danger. Opportunities and motives then
for studying them do not in fact exist, and the
most deligent inquiry among our physicians
(or October, 1950
989
could not bring- out much that would be worthy
of publication.” The technic of the presentation
of the detailed individual case report is a worth-
while clinical teaching- aid and his ideas in that
section revealed that he was certainly far ad-
vanced even in this field of dermatology. If
dermatology was among the things Daniel Drake
was supposed to undertake-too-much of, his so-
called discursiveness here is still appreciated
by dermatologists of today.
For some years I have been interested in
the old case books of our old hospital and have
followed the notes of the physicians of the
bygone days as they have made their ward
visits and examined the river men from the
Ohio river and the other motley crews. One
of these books from the Cincinnati Hospital and
Lunatic Asylum, was the case book of J. T.
Shotwell and J. P. Judkins of 1837. I have
mentioned before the note of John T. Shotwell
— March 10, 1837. “There is not a single record
in the medical department nor a single instru-
ment in good repair. Most of the cases of in-
struments have lost one or more important
pieces.” Those of you who have the honor to
work in general hospitals will have residents
who today re-echo the piteous wail of this
Resident Physician in 1837. There were a large
number of leg ulcers which could have been
anything. Even today, the leg ulcer problem
is still the serious economic problem for my
patients and my Service. One group in the
Surgical Ward Case Book, Clinicum Chirurgicum
of 1837, was described as “ulcers occasioned by
intemperance” and in another patient, whose
ulcers were suspected by being syphilitic, “In
relation to his infirmities, we might well ex-
claim in the language of the philanthropist
‘Alas poor human Nature!’” What dull all too
brief notes we inscribe today! We read also
where the renowned Blackman did something
that surgeons of today would never have the
nerve to do, we hope; — attempt to describe a
combination of palmar psoriasis and lichen!
Unlike this modern world, the acute venereal
diseases, or what was called that, outnumbered
the non-venereal skin diseases.
NOBLE PIONEER IN AMERICAN DERMATOLOGY
It is always customary for us in dermatology
in Ohio to point with pride to our Noah Wor-
cester. He, in spite of his active tuberculosis,
was first, Professor of Physical Diagnosis and
Pathology at the Medical College of Ohio in
Cincinnati, 1842-1843, and then Professor of
General Pathology, Physical Diagnosis and Dis-
eases of the Skin at Western Reserve, and with it
all, practiced dermatology both in Cleveland and
Cincinnati and commuted between Cincinnati and
Cleveland. Delamater with his famed monograph,
Cummer and Marmelzat have studied this noble
pioneer in American dermatology.
This is not the place to review his work in
terms of interest to the development of der-
matology, but only to mention that his book was
one of the significant beginnings of American
dermatology, since it was the first American
textbook on dermatology. To show his deep
appreciation of the problem then (and even now)
of teaching clinical dermatology, I should like
to quote from the preface of his book of 1845.
“A concise and accurate treatise, in our
language, upon Cutaneous Diseases, illustrated
by well executed plates, that can be afforded at
such a price as to be within the reach of all,
has been needed for a long time. The design
of this Synopsis, was to supply this want;
and if the Author has succeeded in giving a
correct description of the more common forms of
these affections, illustrated by well executed
plates, with the most appropriate treatment,
his object has been attained.
“Utility and not originality has been his
design; he has drawn information from every
source within his reach, and it is hoped that he
has proved in this compendium that he has
studied with some care, the works of Willan,
Bateman, Alibert, Cazenave, and Schedel, Plumbe,
Thompson, Rayer, Wilson, Gilbert, Erichsen,
Ricord, Baumes, etc. The figures have been
selected from Willan & Bateman, Thompson,
Rayer, Alibert, Wilson, Erichsen, Cazenave, and
Ricord; and it is believed they will be found
well executed. No one has taught this much
neglected branch of Medicine, that has not felt
the want of such a treatise as this is intended
to be; and it is the hope of the Author that it
may be found to supply this deficiency.
“At first it was my intention to treat of the
Eruptive Fevers in this Synopsis; I was deterred
from doing so by the consideration, that the
eruption in these affections is only a symptom
of the treatises on Theory and Practice of
Medicine, and that the principles of diagnosis
were comparatively well understood.”
As Marmelzat has pointed out, it was thirty
years before another textbook on dermatology
was published in the United States. With the
renewed interest in Noah Worcester, we trust
that he will not continue to be known as the
“Forgotten Pioneer.”
Ohio then shared in the almost universal
neglect of dermatology as a specific teaching
subject and as specific practice for some years.
Gradually, the large centers began to become
aware of the rise and development of der-
matology. It was in this period that specialism
was practically non-existent, or where it at-
tempted to develop, it was promptly put down.
As medicine progressed, however, tolerance de-
veloped even towards the so-called minor spe-
cialties. This was the period which Bechet
described when the leaders in American der-
990
The Ohio State Medical Journal
matology “lived, and worked at a time when
diagnosis and therapy depended almost entirely
on a keenly observant mind, careful and ex-
haustive physical examinations, clinical notes
and the observation of thousands of dermatologic
cases, therapy developing a clinical acumen
unusual in this day of almost complete depend-
ence on the laboratory, and diagnostic machines.”
Great changes were occurring in the Ohio
scene as regards urban development, concentra-
tion of people in cities, development of large hos-
pital centers and the consequent public and pri-
vate health problems resulting from these
changes. There was apprentice and student
teaching and the ever-present-squabbles of the
medical groups. These changes in Ohio medi-
cine have been reported in detail by the medi-
cal historians of Ohio.
EARLY NATIONAL FIGURES
Following these rough beginnings of special-
ism, a few national figures began to appear in
Ohio. Augustus Ravogli of Cincinnati spent
two years in postgraduate training in Prague,
Vienna, Paris and Berlin. In 1889 he became
Professor of Dermatology in the Ohio Medical
College and in 1894 Professor of Dermatology
at the University of Cincinnati. Before Ravogli,
Pearce mentions a Dr. Longfellow who soon left
for Toledo. In Cincinnati, at that time and
foreshadowing some activities of present day
dermatology, we note that in one hospital group
B. M. Ricketts and A. V. Phelps had been as-
signed to a special service of plastic surgery
and skin. A. G. Drury was professor of der-
matology at the Laura Memorial Medical School
in Cincinnati. Shortly afterwards was the rise
of the Cleveland School as detailed by Clyde
Cummer and Marmelzat. Marmelzat has de-
tailed the long struggles of Corlett against the
indifferences of the physicians of that time. His
period dates from 1882, his lectureship on skin
and genito-urinary diseases in the Medical De-
partment of Wooster University, and his free
skin clinic, to his professorship at Western Re-
serve. This position he held until 1914. Cum-
mer mentions the early days of the period of
1910 to 1915 when the medical students had
scanty opportunity to see any variety of clinical
dermatologic material. Then Harold Cole came
into the Department of Dermatology and began
to develop his active association with der-
matology in 1911, and his professorship was
given in 1936. The great developments of the
clinical facilities at the Lakeside and City
Hospitals were due to great energies of Dr.
Cole and later his associates. In Columbus,
Charles J. Shepard began his work at about
that time and served his community and the
Ohio State University for forty years.
(To be Concluded in November Issue)
KEEPING UP WITH MEDICINE
• Confusion still exists regarding the relation-
ship of immunity to hypersensitivity. In the
case of Brucellosis when hypersensitivity exists,
the burden of proof rests on the physician to
show that infection does not still exist.
sf:
• At least 50 per cent of the adults suffering
from asthma gave a history of its onset during
childhood.
* * *
• Big eaters not only ingest excess calories
but also tend to choose diets too high in fat,
sugar, and starch.
# %
• The intake of certain of the vitamins by
the infant fed at the breast is considerably
greater in the first few weeks than is usual
in the case of the infant fed artificially.
* * *
• All seem agreed that improperly balanced
diets, lack of adequate vitamins, metabolic dis-
orders such as hypothyroidism and other en-
docrine deficiencies, insufficient sunlight and
fresh air, climatic irregularities, local exposure
to cold, faulty habits of living, breathing and
exercising — all play a vital part in the child’s
susceptibility to both sinus infection and nasal
allergy.
%z
• One out of every five persons in this country
suffers from some chronic disease.
* * *
• No medical records of antiquity surpass the
descriptions given by Hippocrates of pulmonary
tuberculosis as it occurred in his day-to-day’s
work.
* * *
• People of Europe emerged from the Middle
Ages and came all the way down to the latter
part of the last century with little comprehen-
sion of any principles of public health other
than isolation and quarantine.
* * *
• The clinical findings in cases of gold, arsenic,
mercury, and thallium poisoning reveal lesions
and patterns of lesions characteristic of a defici-
ency of vitamin factors.
* * *
• Over 3.5 million persons in the United
States suffer from Asthma and Hay-fever.
* * *
• In the diabetic, the urine is to be collected
before the next meal and the time when the
type of insulin used is known to be exerting
its maximum action. The bladder should be
emptied 30 minutes to one hour before the
urine to be tested is passed. — J. F.
for October, 1950
991
Labor Looks at Prepaid Medical Care . . .
Frank Analysis of the Question by Harry Becker, Director of Social
Security, U.A.W. in Talk Before Conference of Medical Officials
PREPAID medical care is one of the major
public policy questions before the American
people today. Since it has become an issue
of public policy, it has become a political issue
— as it properly should. For in our democratic
society the right to make political decisions on
matters that concern all of us distinguishes our
form of government from the kinds of govern-
ment that exist today in many other parts of
the world. There are now ten different bills
dealing with health insurance before the Con-
gress. Members from both sides of the aisle
have signed these bills — some of which have
bipartisan sponsorship. At least one out of every
five senators has signed his name to one or
more of these pending health insurance meas-
ures.
It is no cause for alarm that prepaid medical
care has become a political issue.
In resolving this issue application of the
democratic process is as fundamental as the
decision that is reached. The physicians of
America as well as the general public have a
common stake in the free and honest application
of our democratic process in solving this issue
of prepaid medical care.
We are spending billions of dollars to protect
our form of government and to demonstrate its
meaning to other peoples of the world. It is
futile to appropriate enormous sums of money
for these purposes if we cannot resolve satis-
factorily at home, within the social and political
framework of our society, such questions as how
to meet the people’s need for medical care. Our
answer to Communism is Democracy — not just
the idea of democracy, but a demonstration of
how it works to meet the needs of people. In
this, organized labor and the physicians have a
common interest and a common determination.
The demand for prepaid medical care grows
out of recognition that the average family can-
not pay for costly illness unless an insurance
method for spreading the costs is developed.
The working man knows that recommended
treatment Tor himself and family often cannot
be obtained because he cannot pay for it. Pre-
payment is the basic approach to removing this
economic barrier.
COMMON INTEREST. DETERMINATION
A few decades ago the highest quality of
medical care represented a very different stand-
ard from that available today in some of our
Editor’s Note — The accompanying article
is a transcript of an address made by
Harry Becker, director, Social Security De-
partment of the United Automobile Work-
ers of America, at the 1950 Conference of
Presidents and Other Officers of State
Medical Associations in San Francisco,
June 25.
Mr. Becker presents the views of or-
ganized labor on the question of prepaid
medical care programs. Many readers of
The Journal will, no doubt, disagree with
some of the points made by Mr. Becker.
Many of his criticisms can, no doubt, be
refuted. However, in order to give its
readers views on all sides of this popular
subject, The Journal is reprinting Mr.
Becker’s talk, leaving it to them to draw
their own conclusions.
modern medical institutions — as different as the
model-T Ford is from the car of today.
Improved medical care standards are a part
of the larger movement for higher standards
of living. Higher standards are inevitable;
they are part of the fight for human progress
and a better life for all men. Higher standards
of medical care for all people result from more
knowledge and improved methods of distribution.
The medical advances of the past ten years
alone have changed patterns of practice and
changed, likewise, our concepts of satisfactory
standards of care. But these developments
mean higher costs to the consumer.
The physicians of America have agreed that
today’s higher medical costs can best be met
by some form of prepayment. The need for
prepayment is not at issue; the issue, rather,
is whether prepayment shall be accomplished
through a system of public insurance or through
a system of voluntary insurance augmented
with governmental action.
Millions of dollars have been spent in the
past several years by the American Medical
Association and groups associated with it in the
fight against national health insurance. The
effect of this widespread and intensive program
has been to promote public awareness of the
insurance idea and the advantages of prepay-
ment. The American Medical Association, there-
992
The Ohio State Medical Journal
fore, deserves not-often-expressed credit for
helping to “sell” health insurance to the Ameri-
can people and for making our Congress aware
that certain national health problems do exist
and that they exist as public issues. This aware-
ness has been further stimulated by the Blue
Cross and Blue Shield Plans and the commer-
cial insurance corhpanies in connection with their
sales programs.
Organized labor and many physicians agree
that the common objective is to bring the highest
quality of medical care within reach of all peo-
ple— that economic barriers to needed medical
care must be lifted by a system of prepayment.
From that point on, we have an area of con-
troversy which will be resolved by Congress
within the next few years.
DIFFER ON PREPAYMENT METHODS
It is to be expected that organized labor —
that International Unions such as UAW-CIO —
would have a position on this major issue.
Likewise, we should expect the physician’s
organization — the American Medical Association
— to have a point of view on the issue. When
the mechanism for financing goods and services
which the people need becomes a public issue,
we can expect that the consumers and the pro-
viders of services may have somewhat different
positions. Since workers are consumers of medi-
cal services and physicians are suppliers, it is not
surprising that organized labor and the organized
medical professions differ on the method of pro-
viding prepaid medical care.
Organized labor feels that the demand for
health insurance should be met by a compre-
hensive national health program developed with-
in the framework of our national health and
social security policy. Such a national health
program would represent a coordinated program
for the following purposes: furthering medical
research; building programs of preventive medi-
cine; strengthening facilities for training profes-
sional personnel; aiding the establishment of
hospital and clinic facilities in areas of special
need; and establishing methods of prepaying
personal medical care to assure adequate financ-
ing of the care needed by all members of our
society.
GAP REMAINS
Labor’s reasons for this position have been
stated before. The methods of making medical
care available and of paying for it have not
kept pace with our technical know-how. There
is a gap between the best that medical science
and practice has to offer and that which is gen-
erally received by the people. We have not
fully developed the vast potential for well-being
and more healthful lives that is within our
grasp. It is the desire to fill the gap between
where we are and where we could be in bring-
ing the best in medical care to the people that
motivates labor to push for and support a com-
prehensive national health program.
A problem as complex as health insurance re-
quires a synthesis of ideas from several different
fields of thought and experience if we are to
understand all of the factors involved. No
one of us has within ourselves the resources
to do this effectively and easily. Most of us
expose ourselves to those journals and other
mediums of communication peculiar to our own
professions — neglecting the vital cross-fertiliza-
tion that results from pulling together ideas from
several schools of thought.
So it requires bringing together people who
can add to our own fund of knowledge their ex-
perience and points of view. We will not always
agree with these points of view; but only in this
way can we have the opportunity to sift the
truth from the untruth, the reasonable from
the unreasonable and intelligently analyze the
problem.
A physician makes an independent analysis
before accepting the diagnosis of a colleague. To
diagnosis the problems of prepaid medical care
also requires tests and checks before independ-
ent judgment can be formed. Certainly a diag-
nosis of the economics of prepaid medical care
should be checked and rechecked before being
accepted. Too often diagnosis of this problem
has been accepted without careful and analytical
challenge.
REQUESTS UNPREJUDICED DIAGNOSIS
In view of this, we urge every physician in
America to reanalyze the problem of prepaid
medical care in the same objective and scientific
manner that he would diagnose a new patient’s
medical problem.
Let us at this point prepare our prepaid
medical care problem patient for surgery. Let
us proceed with our surgery with the same care
that we would exercise for a patient with an
obscure disease that requires exploratory ex-
amination and subsequent treatment. If we are
true medical scientists we will not be afraid
to examine our patient thoroughly nor to take
the necessary steps to accomplish the desired
course of treatment.
The American Medical Association in its diag-
nosis says that governmental prepaid medical
care is “Socialistic”; is inefficient; will lower the
quality of medical care; and is too costly. To
avoid these effects, the American Medical Asso-
ciation recommends that voluntary and non-
governmental agencies be the vehicle for provi-
sion of prepaid medical care.
The UAW-CIO and other unions currently
negotiating for partial or fully-employer-paid
hospital and medical protection for their mem-
bers and their families are having an opportunity
for October, 1950
993
to learn the extent that voluntary agencies
are unable to provide prepaid medical care.
Through collective bargaining, UAW-CIO has
won this year employer contributions toward the
cost of prepaid medical care for over half a
million families. This number will soon reach a
million in our Union; and the total number of
workers in America for whom such gains are
won in collective bargaining will soon reach five
to eight million.
CHOICES AVAILABLE
Let us examine labor’s nation-wide experience
in its efforts to provide under collective bargain-
ing agreements prepaid medical care through
existing voluntary agencies.
The choices available to labor today for pro-
grams developed under collective bargaining are:
1. To utilize the commercial insurance com-
pany plans with their cash indemnity ap-
proach.
2. To participate in Blue Shield Plans spon-
sored by the state medical societies.
3. To establish Union-operated clinics and
hospitals.
4. To promote and use such organizations as
the Health Insurance Plan of Greater New
York, the Group Health Association of
Washington, D. C.; or to make agreements
directly with physicians in group medical
practice or with hospitals with salaried
physicians.
The American Medical Association Council
on Medical Services has not taken a position in
support of the medical society-sponsored plans
as the preferred agency. The Council gives
equal weight to the commercial insurance com-
pany and the Blue Shield Plan approach. We
do not understand why non-profit prepayment
plans sponsored by the state medical societies
are not favored by the Council on Medical Serv-
ices. Neither do we understand why the Council
does not recommend the consumer-sponsored
group medical practice type of plan in preference
to the insurance company plans.
COMMERCIAL INSURANCE PLANS
The commercial insurance company prepaid
medical plans fail to meet the standards for
prepaid medical care implied by the American
Medical Association in its criticism of national
health insurance proposals. The insurance com-
panies at best provide only cash benefits with
payments depending on the surgical procedure
or other service performed. These cash benefits
bear no direct relation to the cost to the worker
of his medical care. Nor do they bear a proper
relation to the kind of care for which his phy-
sician or physicians should be reimbursed. Thus,
they meet neither the workers’ nor the physi-
cians’ needs for prepaid medical care.
Insurance companies provide an expensive
method of prepaid medical care because of high
operating expenses. For group insurance the
operating cost is measured by the amount of
premium dollar allocated for selling, profit, ad-
ministration and taxes. On the average this is
about 20 cents on each premimum dollar. Often
it is as much as 40 cents.
Benefits under commercial insurance company
plans are inadequate when measured by the
degree of protection afforded to the worker and
his family. Experience with the cash allow-
ance approach to prepaid medical care indicates
that in many instances the existence of the
insurance is interpreted by the physician as
increasing the worker’s ability to pay for care.
Therefore, his fee is larger than it might have
been had the benefit not been available — and
the worker must pay the extra amount.
Another point that should be made with
respect to this approach to prepaid medical care
is that within this framework there can be no
recognition of quality of care nor does it pro-
mise flexibility for development of comprehen-
sive services. In fact, the question might be
asked whether or not cash allowances for sur-
gical procedures do not sometimes encourage
unnecessary surgery.
We cannot recommend to our members the
commercial insurance company approach as a
satisfactory method of providing prepaid medical
care under collective bargaining contracts. Since
the insurance company plans do not satisfy the
American Medical Association’s own criticism
on many prepaid medical plans we sometimes
wonder if the support by the American Medical
Association of this approach does not indicate
that approval is being given to the insurance
company plans in exchange for their opposition
to national health insurance rather than on the
merit of their programs.
BLUE SHIELD PLANS
Organized labor, in setting up programs under
collective bargaining, has found that the Blue
Shield Plans — like the commercial insurance
company plans — fall far short of meeting re-
quirements for prepaid medical care programs
when measured by the yardstick used by the
American Medical Association in evaluating na-
tional health insurance proposals.
We must realize, when we evaluate the Blue
Shield Plans, that they are relatively new, and
have not had time to mature. At the same time
we must realize that if they are to be utilized
as a method of prepayment for medical care
under labor-management contracts they have
a job to do that has not been done. The present
Blue Shield Plans are not satisfactory to labor
groups which are making health insurance an
issue in negotiations with employers; nor are
994
The Ohio State Medical Journal
they satisfactory to many management officials
with whom labor negotiates for health insurance.
INADEQUACIES
Specifically, pur experience with Blue Shield
Plans has demonstrated the following inade-
quacies:
1. They do not provide real security to the
worker against the economic consequences of
illness. The reasons are two-fold: first, the
Blue Shield Plans are limited in scope and gen-
erally subscribers have only protection against
the cost of surgery; second, the worker has no
assurance, when he or members of his family
are ill, that the Blue Shield allowances will
meet the full cost of surgical or other types
of care; and further, the cash indemnity bene-
fits bear little relationship to the charges made
by physicians or to the amount of services ren-
dered.
Blue Shield cannot be the prepayment plan
of choice for programs set up under collective
bargaining unles the worker can be assured
that wffien he obtains Blue Shield coverage he
is given adequate health insuranc protection
against the costs of medical care. The worker
wants security against the cost of illness in the
same manner that he wants security against
the time wffien he will be too old to work and
too young to die.
The Blue Shield Plans can meet the objection
that benefits provided are not full-payment for
physicians’ services rendered by removing the
income ceilings entirely, or at least by raising
them to a level which will assure workers that
when illness strikes the full cost of care will be
met through the prepayment plan. This would
require a family income ceiling of at least
$5,000 rather than the present prevailing ceil-
ings of from $2,500 to $3,000. And this in-
come ceiling should be raised without increasing
fees and rates to a level that is prohibitive.
In most instances any increase in fees should
be minor in character to permit elective adjust-
ment of specific fees, and not across the board
increases.
EXPENSES
2. In general, Blue Shield plans are too ex-
pensive for the protection provided, because
operating costs are still too high. In 1948
the average Blue Shield Plan spent somewhat
less than 15 per cent of total income for operat-
ing expenses. Some Blue Shield Plans have an
operating expense more favorable than the
national average. Others have operating expense
records of one-fourth and more of income. This
is too high for a successful prepaid medical
care plan.
Also, Blue Shield Plans, to be successful in
competing cost-wise with other types of prepaid
medical programs, must experiment with methods
of paying physicians, including methods of pay-
ing for group medical practice and out-patient
clinic service.
QUALITY OF CARE
3. We feel that medical insurance plans
should maintain and promote incentives for im-
proving the quality of medical care. One of the
major American Medical Association criticisms
of national health insurance is that it believes
the quality of care would be lowered. But the
voluntary Blue Shield Plans have done prac-
tically nothing to improve the general level
of medical care, even though much can be done.
In fact, some Blue Shield Plans are specifically
prohibited from being concerned with any aspect
of the quality of care.
If medical review and study were given to
various aspects of the Blue Shield program,
such as studies of doctor’s bills and the pro-
cedures performed, a necessary public service
could be rendered. Group medical practice
can be encouraged by the Blue Shield Plans as
a measure for improvement of quality of care.
There are inumerable examples of how an or-
ganized prepaid medical program sponsored by
the medical profession could take positive action
within the framework of acceptable medical
ethics to raise the general level of medical care.
NON-SURGICAL AS WELL
4. Organized labor and most, if not all, man-
agement groups "want a health insurance plan
that is concerned with building a program which
removes the economic hazard of non-surgical
as well as surgical illnesses and chronic dis-
ease, and which also builds toward prepayment
for integrated preventive and treatment pro-
grams. However, with but one or two excep-
tions, the Blue Shield Plans have done nothing
about such major problems as heart disease,
cancer, rheumatic fever, diabetes, tuberculosis,
burns, osteomyelitis, severe fractures and other
types of chronic or prolonged illnesses that can
be more costly to the worker and his family
than a hospital admission for a surgical pro-
cedure. These types of chronic illnesses are
even greater economic burdens to the worker
than the type of medical care now covered by
many Blue Shield Plans.
The Blue Shield Plans have failed completely to
build toward programs of comprehensive medi-
cal and surgical coverage for the full range of
medical services, including preventive services,
for which prepaid medical care is needed.
Where integrated and coordinated community
services for adequate care of certain types of
illness are lacking the Blue Shield Plans have
not taken initiative in working with the medical
and hospital groups for the providing of pro-
grams that the Plan administrators and Boards
of Trustees know to be desirable. The Blue
for October, 1950
995
Shield Plans have not done as good a job of
health education as some of the insurance com-
panies. The Blue Shield Plans have not accepted
their responsibility to join forces with others in
the medical community in building improved
city-wide and state-wide medical care services.
Success of voluntary prepaid medical care plans
should not be measured alone by the number of
subscribers. It is impressive to show the growth
of these plans in terms of the number of sub-
scribers. It is significant that 14 million Ameri-
cans have Blue Shield coverage — but the gap
between the type of program that is provided
and what is needed is even more significant.
We must keep an eye on how rapidly and how
adequately we are meeting the real needs of
the people.
Generally speaking the Blue Shield Plans are
not giving the public much more than the in-
surance companies, and in some cases not as
much. This is a serious charge.
The medical profession has a great respon-
sibility in this matter if the voluntary plans are
going to meet the objectives of health insurance
programs set up under collective bargaining
agreements. The medical profession society
plan has been given a virtual monopoly as the
only non-profit prepaid medical care plan. The
kind of monopoly that Blue Shield enjoys re-
quires a high degree of social and community
responsiblity.
UNION AND CONSUMER-SPONSORED PREPAID PLANS
UAW-CIO, for example, feels money obtained
through collective bargaining for hospital care
should be utilized to strengthen the hospital
facilities and services for the entire community
and not just for one segment in the community.
Hospital and medical programs made possible
under collective bargaining contracts should be
developed in a manner that will strengthen the
total community prepaid hospital and medical
care program as well as facilities for care. In
those cities where most workers are assured
prepaid medical protection under collective bar-
gaining programs the money available because
of these programs will result in higher stand-
ards of hospital care and a greater number of
hospital beds. Removal, for the patient and
the physician, of the economic barriers to the
kind and amount of medical care required will
mean higher standards of care for the workers
and for all members of the community.
To the extent that existing prepaid medical
plans do not provide the kind of protection and
types of programs that are necessary for a
health insurance plan, Unions will have to make
agreements directly with hospitals and groups
of physicians. In large cities, if presently avail-
able prepaid medical care plans are not prepared
to move in the broader aspects of the voluntary
prepaid medical care job in connection with col-
lective bargaining programs the New York
Health Insurance Plan pattern may be an answer.
In smaller cites, the group medical practice
pre-payment plans built around one or two local
hospitals may be a solution for the collective
bargaining programs.
In sharing with you our criticisms of the ex-
isting voluntary prepaid medical care plans which
result from our experience with collective bar-
gaining programs, we realize that many rep-
resentatives of the medical profession will not
agree with all our objections. We believe,
however, that our experience is a valid test of
what is available today in relation to the de-
sires of our Union and many other Unions.
Even though we recognize that prepaid medical
care program set up under collective bargaining
agreements cannot substitute for a health in-
surance program covering the entire population,
some of the gaps in our collective bargaining
programs can be filled by cooperative planning
between the Unions and the plan administrators.
We should fill some of these gaps.
We cannot talk about collective bargaining
programs that require joint planning between
ourselves and representatives of the medical
profession if they are to be fully effective in
meeting their objectives without pointing out
that there are serious barriers in the way. The
practicing physician must wonder why there
exists a feeling of mistrust and misunderstand-
ing between the physicians and such consumer
groups as organized labor. It is unfortunate
that this situation exists because it impedes
progress. But it does exist and something should
be said and done about it.
UNITY LACKING
An example of the medical profession’s lack of
real support of voluntary prepaid health pro-
grams is the great difficulties experienced by
Blue Cross in establishing national standards
of hospital protection to assure full-payment for
hospitalized illness. A few months ago one
state medical society adopted a resolution in
opposition to Blue Cross efforts to establish a
standard in that state which would enable Blue
Cross to say to its subscribers that its con-
tract would pay the full amount of the hospi-
tal bill. Further, when this resolution was
passed there was no other recommendation as
to how this desirable objective should be ac-
complished by Blue Cross. How does this
medical society expect voluntary plans to provide
a comprehensive prepaid hospital plan? Another
example of the medical societies unwillingness
to provide effective prepaid medical plans is their
recent refusal in a number of states to increase
the income ceilings.
Another reason for Labor’s mistrust of the
996
The Ohio State Medical Journal
motives of the American Medical Association is
the type of publicity it has engaged in. Mil-
lions of dollars have been spent to advance the
reasons why national health insurance, in the
judgment of the American Medical Association,
is not a desired method for meeting the exist-
ing prepaid medical care problem. The Ameri-
can Medical Association in a recent folder en-
titled “The American Way is the Voluntary
Way” states that the only question is: “How
will you have your health insurance: On a
voluntary basis — with sound medical direction?
Or a compulsory basis — with politicians at the
controls ? ” Then the folder proceeds to set
forth 50 questions and answers. In many cases
the answers are factually incorrect and, for the
most part, the language which is used is intended
not to give an understanding of the problem, but
to frighten doctors and others into political ac-
tion in support of the official American Medical
Association position.
For example, the statement is made that
Lenin said: “Socialized medicine is the keystone
to the arch of the Socialist State.” The Library
of Congress has been unable to find any evi-
dence that Lenin ever made such a statement.
The leaflet follows this unsubstantiated state-
ment with the accusation that those who sup-
port national health insurance are supporting
Lenin’s concept of a Socialist State. This is,
of course, untrue, as is made obvious by Labor’s
fight against Communism.
Labor is aware that hundreds of thousands
of such folders are being distributed while at
the same time there is no evidence that organized
medicine is making any comparable efforts to
meet and solve the problems which are forcing
the people to reject the voluntary plans as a
substitute for a national health insurance
program.
DEPLORES ‘ROAD AHEAD’
Labor is also concerned because the Ameri-
can Medical Association has expended much effort
and money in the past few months to distribute
a book of half truths and scare words that is
as dangerous a threat to our form of society
as any piece of literature or activity of the
Communist Party. This reactionary, undemo-
cratic book, “The Road Ahead” by John T.
Flynn, was reviewed in the New York Times as
“The latest manifestation of an endemic hysteria
presently affecting a considerable segment of our
society.”
Even if the doctors of America were unaware
of the judgment of responsible reviewers of this
book they should be alarmed at being associated
with the kinds of groups that are asking the
American Medical Association to finance its
distribution. For example, the Committee for
Constitutional Government, which circularized
the doctors of America urging them to buy it
in quantity for their friends and patients, stands
for much that would make most physicians
cringe with embarrassment. It was reported
in the Washington Post a few days ago that a
million and a half copies of this book have been
bought and distributed by the medical profes-
sion. This statement may or may not be precisely
correct. The exact number of copies distributed
is relatively unimportant. What is striking
is that organized medicine would distribute
such a book and expect to have our confidence.
It is fair, certainly, to ask what would have
been the effect had the energy and money which
went into distribution of this book gone into
constructive effort to improve prepaid medical
care plans.
There are other reasons why organized labor
questions the social responsibility of the Ameri-
can Medical Association and why there is mis-
understanding between these two groups. One
is the American Medical Association’s opposition
to the inclusion in the Federal Social Security
program of cash income payments for persons
who are unable to work because of permanent
and total disability. Labor is concerned about
the need for retirement security for disabled
persons as much as it is for the aged.
Employers have almost without exception
recognized the need for incapacity retirement
as well as age retirement and both types of
pensions have been provided for in collective
bargaining agreements negotiated this past year.
DISABILITY IN SOCIAL SECURITY
The House of Representatives recognized this
need when it passed H. R. 6000 — the Bill amend-
ing the Federal Social Security Act — with a
provision for retirement benefits for insured
workers who are unable to work because of
permanent and total disability. Labor began
to feel that at last there was general acceptance
of the obvious need of disabled workers. But
when hearings were held in the Senate early this
year the American Medical Association and the
insurance companies led the opposition to dis-
ability benefits.
Reasons for the opposition of the insurance
companies were obvious — a public disability in-
surance program would, they feared, reduce the
volume of sales for disability insurance. Rea-
sons for the American Medical Association op-
position to this type of income maintenance
protection are not so clear.
We made a direct appeal to the American
Medical Association to support this provision
for the disabled or at least to withhold op-
position. Labor had reason to feel that or-
ganized medicine would not fight this type of
social security because in the October 11, 1947,
issue of The Journal of the American Medical
for October, 1950
997
Association it was stated editorially that “Social
security measures to maintain income such as
disability insurance, old age insurance and public
assistance are likewise of vital importance.”
This editorial comment followed earlier action
of the House of Delegates of the American
Medical Association favoring disability insurance.
But we were disappointed.
In testimony before the Senate Committee on
February 28, 1950, the official spokesman for the
American Medical Association said his organiza-
tion was opposed to the permanent and total
disability benefit because it might lead to Con-
gressional consideration at some future time of
health insurance or some form of government
medicine for this category of individuals. He
suggested that the permanently disabled should
look to local poor relief authorities for any assist-
ance they might need. Local poor relief payment
per family unit for the month in which this
statement was made was only $48.71.
Labor will not soon forget that the entire
resources of the American Medical Association
were thrown into the fight to oppose giving the
permanently and totally disabled the same kind
of protection that is now given the unemployed
and the aged.
It would seem obvious that if the voluntary
health insurance approach is so vulnerable
that an extension of cash income benefits to the
permanently and totally disabled is a serious
threat, the voluntary plans must not be as
valid an alternative to national health insurance
as many believe.
TWO MAIN PROBLEMS
When we look at prepaid medical care there
are two main problems that come to mind:
(1) How can we give all people prepaid com-
prehensive medical protection, and (2) what can
we do to make higher standards of care gen-
erally available? Neither of these tasks is
simple and neither can be accomplished quickly.
But we are going to have to solve them.
Progress toward these objectives will not be
made on a constructive basis until there is the
kind of understanding which permits the work-
ers in the shops and on the farms and the phy-
sicians of America to work together. For the
successful planning and administration of pre-
paid medical care programs requires the team-
work of the physicians who provide the care
and the people who pay the costs. This is
a reason why voluntary prepaid medical plans
should have more public representatives selected
from among the subscribers on the Boards of
trustees.
Sometime and somehow — but soon — we will
find a way to work together to lift the economic
barriers so that the highest quality of medical
care will be available to all people regardless
of their race, where they live or their economic
status.
The historian will record how well we meet
this challenging opportunity for a constructive
demonstration of democracy at work. We must
remember, in today’s war of ideas, that our
ability to work together here in America is vital
if we are going to build hope and inspiration
in the hearts of all people wherever they may
live.
Veteran Patients To Military-
Hospitals Limited
The Department of Defense and the Veterans
Administration announced that, following con-
ferences between officials of the two agencies,
the Veterans Administration will discontinue
sending Veterans Administration patients to
the majority of military hospitals in continen-
tal United States, except in emergencies. This
has been necessitated by the increasing require-
ments for medical personnel in the Korean
military operation, the flow of military casualties
from that area to the United States, and the
rapid expansion of military forces in this country.
Army hospitals will continue to care for those
veteran patients now hospitalized; it is expected,
however, that normal attrition through dis-
charge of these patients upon completion of
treatment will remove practically all of these
patients from the majority of Army hospitals
within about six weeks.
Currently, the Veterans Administration is
operating 138 hospitals with approximately
114,000 beds. During 1950, twelve more Veterans
Administration hospitals are scheduled to be
opened, adding more than 3,000 beds to the
Veterans Administration present capacity.
Exception has been made of the Tuberculosis
beds at Fitzsimons General Hospital, Where
Veterans Administration has 325 Tuberculosis
patients.
Opinion of Attorney General
The syllabus of Opinion No. 1871 of Attorney
General Herbert S. Duffy is as follows: “(1)
Paying the hospital bill of a girl or woman may
or may not be a ‘social service’ within the
purview of Section 3070-17, subsection (e), of
the General Code, depending upon the facts and
circumstances of the particular case involved.
(2) The language ‘girl or woman’ as used in
Section 3070-17, subsection (e), of the General
Code, refers to any female person regardless of
age.”
Section 3070-17 of the General Code defines
the duties and powers of a Child Welfare Board.
The subsection referred to reads: “(e) To pro-
vide social service to any girl or woman who
is pregnant with or who has been delivered of an
illegitimate child.”
998
The Ohio State Medical journal
Medical Schools Set Enrollment Record;
More Doctors Graduated
The outlook for graduation of more doctors
to safeguard the health of the American people
is better than it has ever been. This is brought
out in the annual report of the American Medi-
cal Association’s Council on Medical Education
and Hospitals, published in the September 9
issue of The Journal of the A. M. A.
All records for enrollment in approved medi-
cal schools in the United States were broken
in the past year, the report revealed.
Total enrollment in the 72 medical and seven
basic science schools for the academic year
1949 - 1950 was 25,103. This represents an in-
crease of 1,433 students, or six per cent over
the preceding year. The total is double the
enrollment in 1910 (12,530), about 18 per cent
higher than 10 years ago, and even larger
than during the years of World War II, when
extra classes were enrolled in all medical schools
on an accelerated program.
From July 1, 1949, to June 30, 1950, 5,553
physicians were graduated from approved medi-
cal schools in the U. S., an increase of 459 over
the preceding year. This is the largest number
graduating from approved medical schools in
the nation in one year except for the year 1946
and 1947 when several schools at the conclusion
of their wartime programs graduated more than
one class during a 12-months’ period.
HIGHER THIS YEAR
On the basis of their enrollments in the senior
class for 1950 - 1951, the medical schools have
estimated that they will have slightly more
than 6,000 graduates during the coming year.
The freshman class for the first time ex-
ceeded 7,000 students during 1949 - 1950. The
actual number, 7,042, represented an increase
of 354 or 5.3 per cent over the preceding year
and an increase of 1,026 or 17 per cent over
the average size of the freshman class in the
10 years preceding World War II. On the
basis of records of the past, it seems likely
that within the next few years the freshman
class will number close to 7,500 students.
The report said that the budgets of the medi-
cal schools and basic science schools for the
1950 - 1951 fiscal year total about $67,500,000,
representing an increase of about 42 per cent
in the last four years. It also said that about
$100,000,000 worth of new construction had been
reported — which is estimated as only about half
of construction completed, started, or authorized
during the last year.
Women totaled 1,806 or 7.2 per cent of medi-
cal students, compared to 2,109 or 8.9 per cent
in the preceding year. The percentage of
veterans enrolled in the medical schools and
schools of basic medical sciences was 65.9 per
cent — about the same as the preceding year.
Polls taken in 19 medical schools during the
past year reveal that the percentage of stu-
dents planning to enter general practice has
increased from 36 to 47 per cent in the last
three years. The number planning to specialize
has decreased from 36 to 31 per cent. Other
students polled in both periods still had to
make decisions.
EMERGENCY PLANS
The problem of formulating a sound program
for medical education in the event of another
world war has been under study by the Council
on Medical Education and Hospitals. The Coun-
cil and the Executive Council of the Association
of American Medical Colleges have formed a
joint committee on medical education in time
of national emergency.
This committee has been engaged since June
in drafting for submission to the appropriate
government agencies recommendations with re-
spect to the conduct of medical education, in-
cluding premedical and graduate medical edu-
cation.
Second District Meeting Scheduled
In Dayton, October 18
An afternoon and evening program will be
conducted by the Second District of the Ohio
State Medical Association at the Biltmore Hotel
in Dayton on Wednesday, October 18. Members
of Societies outside of the Second District also
are invited.
A noon luncheon will be held at the Biltmore
Hotel for members of the Auxiliary.
At 2 p. m. the subject, “The Use of Radio-
active Isotopes in Medicine,” will be discussed.
On the panel are the following members of the
Montgomery County Medical Society: Drs. Darrel
C. Caudill, William H. Fries, George A. Nicoll,
Franklin L. Shiveley, Jr., and Robert E. Zipf.
To tie in with the discussion, the Monsanto
Laboratories of Dayton have been building for
weeks an original exhibit and demonstration to
be presented for the first time at the session.
At 3:30 p. m., Dr. Allan C. Barnes, professor
and head of the Department of Obstetrics and
Gynecology, Ohio State University College of
Medicine, will discuss, “The Use of Radioactive
Cobalt in the Treatment of Cancer of the Cervix.”
A social hour for physicians and their wives
will be held from 5:30 to 6 p. m., followed by
the annual banquet at 6:30. The speaker of
the evening will be The Honorable Clarence J.
Brown, Blanchester, Representative of the
Seventh Congressional District, who will speak
on the subject, “What’s Going on in Washington.”
Reservations for the banquet are $5 each,
with the ladies as invited guests.
for October , 1950
999
t
What You Can Do . . . Should Do .
BETWEEN NOW AND NOVEMBER 7 . . .
Every Ohio physician . . . members of his family . . . must stand up and be
counted . . . must join the ranks of thousands of Ohioans who are already working
day and night to elect competent, qualified candidates to public office . . . Many phy-
sicians and their wives are taking an active part now in pre-Election activities . . .
but not enough of them.
BETWEEN NOW AND NOVEMBER 7 . . .
Ohio physicians and members of their families must work for . . . get others to
work for . . . those candidates who support sound social, economic and governmental
principles. Physicians are being subjected to vicious attacks by certain politicians
and leaders of various radical groups. The chips are down. The issues are vital.
PHYSICIANS DARE NOT BE SLACKERS IN THE CURRENT ELECTION BATTLES.
BETWEEN NOW AND NOVEMBER 7 . . .
Ohio physicians should secure from the officers and legislative chairman of
their LOCAL MEDICAL SOCIETY information and advice regarding all candidates
on the ballot at the General Election . . . should submit additional information to
them regarding candidates . . . should pass on to patients, neighbors and acquaint-
ances, information regarding candidates . . . should urge the support of candidates
worthy of public confidence.
BETWEEN NOW AND NOVEMBER 7 . . .
Ohio physicians should contact candidates they intend to support . . . should
offer active support . . . should carry on an active personal letter-writing campaign
for such candidates . . . should make use of the telephone and personal appeals
to get others to support such candidates. SUPPORT AND VOTES OF JUST
PHYSICIANS WILL NOT BE SUFFICIENT . . . The support and votes of many
others will be necessary to elect the qualified candidates.
BETWEEN NOW AND NOVEMBER 7 . . .
The wives and daughters of physicians . . . members of the Woman’s Auxiliary
. . . can and should play an important part in winning active support for qualified
candidates among physicians . . . members of their families . . . and citizens gen-
erally. After securing accurate information about candidates from the officials of
the local medical society they can carry on an active telephone, letter- writing and
door-to-door campaign to win votes for such candidates.
BETWEEN NOW AND NOVEMBER 7 . . .
Physicians who change their places of residence should see their county board
of elections about transferring to the poll list of their new precinct . . . Physicians
1000
The Ohio State Medical Journal
. Between Now and November 7
who know that they are going to be away from home on Election Day should see
their county board of elections about voting by absentee voter’s ballot . . . Physicians
who have patients who, because of illness, probably will be unable to go to the polls
on Election Day should assist such patients in securing from the board of elections
ballots for voting by mail . . . Physicians who have relatives or friends in
the armed services should assist them in voting by mail by getting information and
papers for them from the board of elections . . . Accurate information on these pro-
cedures can be obtained from each county board of elections.
BETWEEN NOW AND NOVEMBER 7 . . .
Physicians and members of their families can become active affiliates of clubs, com-
mittees and organizations which have been formed by or on behalf of many of the
qualified candidates to carry on an organized pre-election campaign. These groups
have planned programs . . . they need volunteers for their door-to-door, block-by-
block activities and letter-writing, telephone-calling programs.
BETWEEN NOW AND NOVEMBER 7 . . .
Each County Medical Society in Ohio should devote a meeting during October
to a discussion of candidates . . . how to get data on candidates into the hands of
members . . . what physicians as individuals can do for deserving candidates . . . how
physicians can help to get the sick and disabled to vote by mail or can help in
securing transportation for them on Election Day. No other subject for a county
society meeting is of greater importance at this time.
ON NOVEMBER 7 . . .
Every Ohio physician and voting members of his family should go to polls . . .
Physicians should see that their employes vote . . . are given sufficient time-off
to go to the polls . . . Wives of physicians should phone neighbors and friends for
the purpose of seeing that they have voted or are planning to go to the polls . . .
Physicians and members of their families should provide transportation for relatives,
friends, neighbors and patients who find it difficult to get to the polls or make
their automobiles available to organized transportation committees . . . Physicians
and members of their families should offer their services to committees set up to
canvass the polling places during Election Day ... to get in touch with those who
fail to show up.
ON NOVEMBER 7 . . .
The fight for good government will be won or lost. Votes will decide the issue.
Your vote could well be the deciding vote. Now is the time to get in the fight
. . . to see that the people of your community understand the issues . . . are informed
about the candidates . . . are determined to cast their votes as their conscience
and judgment dictate.
for October, 1950
1001
• • •
Licenses Granted
State Medical Board Authorizes 262 Graduates of Medical Schools
To Practice in This State Following June Examinations in Columbus
CERTIFICATES to practice medicine and
surgery in Ohio were authorized for 262
graduates of schools of medicine by the
State Medical Board at its meeting on August 8,
Dr. H. M. Platter, secretary, announced. The
licenses are being granted as the result of ex-
aminations given by the board in Columbus, June
14-17.
Highest grade in the examinations was made
by Robert C. Sheahan, of Columbus, a graduate
of the Ohio State University College of Medi-
cine. His grade was 90.6 per cent.
A close second of 90.5 per cent was made by
Charles H. McMullen, of Cincinnati, also a
graduate of Ohio State.
The third highest grade of 89.5 per cent went
to Robert J. Bosley, Cleveland, a graduate of
Western Reserve University School of Medicine.
Ten graduates of Osteopathic schools were
authorized to practice osteopathic medicine and
surgery, and one applicant who appeared for
additional examinations will receive a certificate
to practice osteopathic medicine and surgery.
In the limited branches, certificates will be
awarded to 31 chiropodists, 14 mechanotherapists,
10 chiropractors, 17 masseurs and six cosmetic
therapists.
Graduates of medical schools who will re-
ceive certificates to practice medicine and surgery
are the following:
OHIO STATE UNIVERSITY COLLEGE OF
MEDICINE: John L. Babb, Jr., Meriden, Minn.;
William L. Berson, Newark; Michael C. Bianco,
Akron; William R. Blesch, Columbus; John D.
Bloom, Miami, Fla.; Charles E. Bope, Columbus;
Roscoe C. Brand, Jr., Fort Sam Houston, Texas;
William E. Brown, Marysville.
William H. Campbell, Toronto, Ohio; Doris N.
Carson, Carrollton; Bennie W. Chiles, New York;
George G. Cornish, Cleveland; Charles V. Cox,
Chagrin Falls; David J. Crosby, Cleveland; John
R. Daniels, Columbus;
Thomas M. Faehnle, Columbus; George H.
Freetage, Columbus; Bernard Glass, Youngstown;
Thomas W. Graham, Berea; Oren B. Gum, Den-
ver, Colo.; John W. Heffelfinger, Columbus;
Lester E. Imboden, Logan; Dean H. Johnson,
Lancaster; Richard E. Jones, Columbus;
William A. Kelemen, Youngstown; Marvin I.
Xohn, Cleveland Heights; Robert Levine, Colum-
bus; Charles W. Loughry, Columbus; John D.
Lovett, Columbus; Lloyd K. Mark, Columbus;
James E. Matson, Maynard; James H. McClure,
Columbus; Charles H. McMullen, Cincinnati;
Saul L. Meyers, Columbus; Gordon L. Miles, In-
dianapolis, Ind.; George F. Millay, Columbus;
Marvin L. Mitchell, Toledo; Paul N. Montalto,
Columbus ;
John H. Nickel, Warren; Gordon F. Ogram,
Detroit, Mich.; David W. Parke, Columbus;
Frank G. Plymire, Wilmington; John R. Polsley,
Columbus; Thomas M. Prescott, Columbus;
Jack M. Randall, Dayton; Richard W. Reiman,
Dayton; Lucille Richardson, Columbus; James
R. Romaker, Lima; Alfred G. Runner, Huron;
Marvin J. Sakol, Denver, Colo.; Richard E.
Sand, Columbus; Morton Sass, Cleveland;
Richard A. Schroeder, Cleveland; William R.
Shaw, Pemberville; Robert C. Sheahan, Colum-
bus; William G. Simonis, Tiffin; Arthur I.
Stecker, Cleveland; Byron Stinson, New Hol-
land;
Miller F. Toombs, Columbus; Jewell E. Van
DeWater, Columbus; George Van Harlingen,
Dayton; Carol Dewey Varner, Columbus;
James M. Walters, Dayton; Anna Stahly Whet-
stone, Columbus; John K. Williams, Toledo; Ed-
win C. Winzeler, Toledo; John Worthman, Day-
ton; William V. Zartman, Columbus:
UNIVERSITY OF CINCINNATI COLLEGE
OF MEDICINE: Ferdinand J. Ach, Cincinnati;
Mary Allott Agna, Cincinnati; Arnold C. Ander-
son, Rhame, North Dakota;
Rolland D. Bateman, Jr., Cincinnati; John C.
Bauer, Defiance; Frank L. Baynes, West La-
fayette, Ind.; Carl P. Bernet, Jr., Cincinnati;
Robert T. Blair, Goshen; Thomas L. Bogardus,
Jr., Cincinnati; Otis E. Bridgeford, Cincinnati;
Leonard A. Burgin, Cincinnati; Robert L. Burket,
Sandusky;
Vincent J. Cannamela, Perth Amboy, N. J.;
Joseph M. Casper, Denver, Colo.; Leon G. Claas-
sen, Denver, Colo.; Mary M. Clift, Cincinnati;
Robert P. Cook, Ionia, Mich.; John S. Cunnick,
Norwood;
Melvin N. Davis, Toledo; George R. DeMuth,
Sherwood; Mark S. Dine, Cincinnati; Donald L.
Domer, Cincinnati; Roy L. Donnerberg, Sharon-
ville; John R. Donohoo, Georgetown; William
C. Duffey, Cincinnati;
Howard H. Feigelson, Cincinnati; Richard S.
Flatt, Cincinnati; William M. Follis, Lansing,
Mich.; Carl H. Hall, Dayton; Frank R. Hanzel,
Barberton; Andrew H. Henderson, Jr., Cincinnati;
James C. Hetherington, Cincinnati; Walter R.
Herron, Lawrenceburg, Ind.; James C. Hertel,
1002
The Ohio State Medical Journal
Lockland; David J. Hickson, Cleveland; Paul R.
Hummell, Brice;
John R. Keys, Cincinnati; Ralph H. Klingen-
berg, Cincinnati; William J. Kopp, Cincinnati;
Robert E. Krone, Cincinnati^ Francis X. Loth-
schuetz, Springfield;
James R. Mathews, Cincinnati; Leo C. Mc-
Campbell, Whiting, Ind.; Robert H. McMaster,
Gallipolis; John N. Meagher, Springfield; Myron
R. Melamed, Cleveland Heights; James R. Mer-
kel, Cincinnati; Frank X. Mohaupt, Cincinnati;
Gwendolyn L. Morris, Akron;
David I. Olch, Dayton; James W. Passino,
Battle Creek, Mich.; James M. Pierce, Jr., Cin-
cinnati; Charles L. Preston, Paintsville, Ky.;
William R. Puttmann, Cincinnati; Henry E.
Rasmussen-Taxdal, St. Petersburg, Fla.; Mary
Clore Readle, Cincinnati; Betty L. Wilmas Robin-
son, Cincinnati;
Jasper E. Sadler, Jr., Cincinnati; Richard B.
Salzer, Cincinnati; Frank J. Schrader, Warren;
Bernard Sisman, Youngstown; Joseph G. Sprin-
ger, Dayton; William J. Stiles, St. Bernard;
Charles E. Stilgenbauer, Lima; James B. Street,
Cincinnati; Laymond A. Swinehart, Warren;
Ingeborg P. Thuss, Cincinnati; Robert L. Tour,
Cincinnati; Eugene R. Turner, Middletown; James
W. Vaughn, Cincinnati; Marvin L. Whitman,
Warren;
Glenn L. Winkle, St. Bernard; Frederick A.
Wolf, Cincinnati; Emily E. Wright, Washington,
D. C.; Yutaka K. Yoshida, Honolulu.
WESTERN RESERVE UNIVERSITY SCHOOL
OF MEDICINE: William H. Allen, Jr., Parma;
Walter D. Anderson, Des Moines, Iowa; James
P. Andrews, Akron; Morton L. Angell, Shaker
Heights;
Jackson N. Bales, Euclid; Gilbert H. Barnes,
Cleveland; Frank M. Barnwell, Cuyahoga Falls;
Mary N. Barrington Michael, Cleveland; Harry
Bauer, Cleveland; Soil Berl, Brooklyn, N. Y.;
William F. Birskovich, E. Cleveland; Robert J.
Bosley, Cleveland; Malcolm A. Brahms, Shaker
Heights; Benjamin B. Brussel, New Haven, Conn.;
Frederic E. Caldwell, Cleveland; Lois Jones
Carter, Cleveland; Hilda B. Case, New York;
Charles E. Casto, Akron; Harry T. Cerha, San
Antonio, Texas; Kennard T. Chandler, Cleveland
Hts.; Jean E. Cram Cline, Cleveland; Theodore
N. Cline, Cleveland; Miguel A. Colon-Morales,
Arecibo, Puerto Rico;
William H. Dillon, Cleveland; Marion E. Er-
landson, Shaker Heights; Henry A. Essex, Cleve-
land; George F. Feil, Cleveland; Julius Fishman,
LTniversity Heights;
Charles N. Giering, Poland, Ohio; Eli Gold,
Cleveland; Belden D. Goldman, Cleveland; Fair-
field Goodale, Jr., Cambridge, Mass.; Edward E.
Grable, Canton; Arthur E. Grant, Denver, Colo.;
Donald R. Hales, Cleveland; Earl E. Heller-
stein, Cleveland; James E. Henderson, Denver,
Colo.; Martin Hurvitz, Mineola, Long Island,
N. Y.; Albert N. Kleinman, Cleveland Heights;
Mortimer V. Kleinmann, Jr., Cleveland;
Grant A. Leiby, Jr., Parma; Edward T. Lis,
York, Pa.; James W. Loney, Cleveland; James
A. MacKay, Toledo; Richard A. Mahrer, Cleve-
land; Walter S. McCleery, Jr., San Francisco,
Calif.; Jean G. Nau McClelland, Cleveland
Heights; John Gibson McClelland, Cleveland
Heights; James A. McEachen, Jr., Cleveland;
Felix A. McParland, Jr., Shadyside;
Clarence N. Melampy, Mason; Frank B. Mee-
ting, Wadsworth; Richard R. Neitz, Wellsville;
Evelyn J. Nelson, Cuyahoga Falls; Robert C.
Nelson, Berkeley, Calif.; William B. Newberry,
Jr., Cleveland Heights; John H. Neyer, Cleveland;
Virginia L. Owen, Valley Stream, N. Y.; Sam
Packer, Cleveland; John D. Petcher, Cleveland;
Evelyn Richardson Peters, Cleveland; Lawrence
Peters, Cleveland; Fred M. Rankin, Jr., Akron;
Robert E. L. Rochelle, Cleveland Heights; Herb-
ert B. Rosenbaum, Cleveland;
Russell L. Shafer, Weston, Mass.; John S.
Schlecht, Cleveland; John L. Schmidt, Cleveland;
Albert G. Schraff, Cleveland; Herman Schreiber,
Jr., Newport, R. I.;
Samuel R. Schuster, Baltimore, Md.; Franklin
R. Shaft, Cleveland; Henry L. Shorr, Youngs-
town; John A. Spargo, Cleveland; Anthony F.
Spech, Cleveland; Gerald H. Strate, Cleveland;
Donald L. Toker, Cleveland; Robert J. Traut-
man, Baltimore, Md.; Irvin Ungar, Cleveland
Heights; John W. Unger, Alliance; Eugene W.
Veverka, Cleveland; Walter W. Vogt, Akron;
Gertrude E. Warner, Schenectady, N. Y.; Mary
A. Weidle, Hartford, Conn.; Robert J. E. West-
hart, Chicago, 111.; Wallace G. Wheeler, Norwood,
Pa.; John V. Wilber, Cuyahoga Falls; David
Wladis, Cleveland; Martha Bieler Wysor, Cleve-
land.
GRADUATES OF OTHER SCHOOLS: Bow-
man Gray School — Gordon W. Hayslip, Columbus.
Chicago Medical School — Herbert S. Lipschultz,
Columbus.
Cornell University — David H. Williams, Cleve-
land.
George Washington University — James L. God-
dard, Kalida.
Harvard Medical School — Robert E. Eckel,
Cleveland.
Jefferson — John R. Titus, Columbus.
Johns Hopkins — Edward B. Headley, Cincinnati.
McGill — Kalman C. Kunin, Cleveland.
Marquette University — Betty L. Voelker, Cleve-
land.
Northwestern University — James L. Finley,
Petersburg, and Richard J. Yoder, Akron.
Temple University — Thomas H. Eaton, Cleve-
jor October, 1950
1003
land, and William T. Ellis, Canton.
University of Chicago — James M. Smith,
Mason.
University of Colorado — William M. Stuckey,
Mansfield.
University of Rochester — Robert P. Shanewise,
Cuyahoga Falls.
University of Tennessee — Perry M. Berg,
Cleveland, and Sol D. Braver, Cleveland Heights.
University of Toronto — Harold Broder, Cleve-
land; Sidney W. Helperin, Cleveland, and Isaac
J. Mercovitch, Baltimore, Md.
University of Wisconsin — William S. Dietrich-
son, Mansfield.
Woman’s Medical College — Mary E. Frank,
Canton.
University of Rochester — Robert B. Rardin,
Shaker Heights.
University of Vytautas, Lithuania — Alfonsas
Kisielius, Elizabeth, N. J.
University of Cracow, Poland — Borys A. Fili-
pczak, Toledo.
University of Vienna — Alexander Korosi, Wil-
lobee, Ohio.
University of Kaunas, Lithuania — Danielius
Degesys, Cleveland.
University of Tubingen, Germany — Maria V.
Ryan, Columbus.
University of Sao Paulo, Rio de Janeiro —
Nicolau S. Assali, Cincinnati.
New Allocation of Federal Health
Funds in Ohio Legally Approved
The Ohio Department of Health, under its
announced new system of distributing Federal
funds to local health departments, is within its
legal right to abolish positions of employees
formerly assigned to local districts, an opinion
of the Attorney General confirms.
The new procedure as outlined by Dr. John
D. Porterfield, director of health, was reported
in the August issue of The Journal. The fol-
lowing explanation of the change in the de-
partment’s policy and inquiry directed by Dr.
Porterfield to the Attorney General give a gist
of the new procedure.
“The Ohio Department of Health receives
from various Federal agencies grant-in-aid
funds for the purpose of providing assistance
to local health departments in this state.
“During the present Federal fiscal year we
will receive approximately $1,250,000 of which
$250,000 will be used for the employment of
personnel in the central office. Approximately
$1,000,000 will be used for the employment of
public health sanitarians, public health nurses,
and clerks, who are assigned to local health
departments.
“For obvious reasons the employment of per-
sonnel by this Department, for assignment to
local health departments, is too costly and im-
practical. Therefore, beginning July 1, 1950,
the Ohio Department of Health is planning to
distribute Federal grant-in-aid funds to the lo-
cal health departments that qualify to receive
such funds on the basis of a formula, to be
adopted by the Director of Health.
“In order for a local health department to
become eligible to participate in Federal grant-
in-aid funds, it will be necessary for the local
board of health to employ, from local funds, a
full-time health commissioner, public health
nurse, public health sanitarian and clerk. It is
conservatively estimated that approximately 70
of the 203 statutory health districts in this
state will qualify under these standards and
will, therefore, be eligible to receive Federal
grant-in-aid funds.
“During the past year we have employed 330
public health sanitarians, public health nurses,
clerks, part-time physicians and clinicians, pur-
suant to the provisions of the Ohio Civil Service
Law, who have been assigned to local health
departments. It is planned to abolish these posi-
tions as of June 30, 1950, with the hope that
local boards of health will reemploy these people
using Federal grant-in-aid funds provided
through this Department. . . .
“Can the positions referred to ... be abolished
as a result of a change in departmental policy
with respect to the allocation of Federal funds
to local areas — such change being predicated on
the fact that present procedures are too costly
and unsatisfactory?”
Attorney General Herbert S. Duffy, in Opinion
1846, while agreeing that such employees come
within the classified civil service of the State
of Ohio, quoted from a court decision as fol-
lows: “. . . Provisions, however, do not restrict
public authorities in their bona fide efforts to
effect necessary and desirable economies, or to
prevent the laying off of an unessential employee
for reasons of economy.”
After quoting excerpts from Federal and
State laws and opinions, the Attorney General
concluded: “In view of the foregoing, it is my
opinion that the Department of Health may, in
accordance with the plans presented by it and
approved by the Surgeon General of the Public
Health Service, abolish such positions as public
health sanitarians, public health nurses, clerks,
part-time physicians and clinicians.”
Course in Diseases of Chest
A postgraduate Course in Diseases of the
Chest, sponsored by the Council on Postgraduate
Medical Education and the New York State Chap-
ter of the American College of Chest Physicians,
will be held at the New Yorker Hotel, New
York, November 13-18. Further information may
be obtained from Dr. Frank R. Ferlaino, secre-
tary of the Council on Postgraduate Medical
Education, 580 Park Ave., New York 21, N. Y.
1004
The Ohio State Medical Journal
Doctors and the War . . .
State Association Acts To Coordinate Military Requirements With
Civilian Needs; Doctor-Draft Explained; Reserve Status Discussed
DEVELOPMENTS in the war and national military preparedness program which
affect members of the medical profession have been rapid within the past
few weeks. The situation is fluid with new developments coming almost daily.
Here are the high lights up to the time this issue of The Journal went to press,
all of which will be covered in detail in this article:
1. The Council of the Ohio State Medical Association meeting on September 16
and 17 set up machinery to bring about a coordination between the requirements
of the armed forces for medical officers and the needs of communities, including
medical schools, hospitals, insitutions, and other agencies, for adequate medical
and health services.
President E. O. Swartz, Cincinnati, was authorized by The Council to appoint
a committee of 12 physicians to serve as a Military Advisory Committee.
Each County Medical Society will be asked by The Council to appoint a similar
committee to advise the state committee on local matters.
Selection of a physician to serve as chairman of the Military Advisory Committee
and on a full-time basis as administrator of the work of the committee was authorized.
2. The so-called doctor-draft law was enacted by the Congress and signed by
President Truman, giving the latter authority to call into military service physicians
under 50 years of age if they are needed by the armed services.
3. Immediately following passage of the doctor-draft law, the Department of
Defense announced certain revisions in the procedures for calling up medical reserve
officers, which may reduce the number of reserve officers to be called to active service
at this time.
O.S.M.A. PROGRAM
President Swartz has announced that a
physician from each of the State Associa-
tion’s 11 Councilor Districts will be named
by him to the Military Advisory Com-
mittee. Announcement of the committee
personnel will be made just as soon as
letters of appointment can be sent out
and acceptances received.
Dr. Robert Conard, Wilmington, has been
appointed by Dr. Swartz as chairman of the
Military Advisory Committee. Dr. Conard served
in a similar capacity during World War II and
■was generally recognized as having done an
outstanding job in efforts to bring about a co-
ordination of military and civilian needs during
the war years.
Dr. Conard also was named by The Council
to serve on a full-time basis, with compensation,
as administrator of the activities of the Military
Advisory Committee. He will discontinue his
private practice in Wilmington on October 1 in
order to carry on this assignment. Office space
for Dr. Conard, together with personnel and
facilities, have been provided in the Columbus
Office of the Ohio State Medical Association.
MILITARY ADVISORY COMMITTEE
The Military Advisory Committee will func-
tion as a part of the Association’s Committee on
Emergency Medical Service. The military phases
of the work and responsibilities of the Com-
mittee on Emergency Medical Service will be
handled by the Military Advisory Committee
under the chairmanship of Dr. Conard.
Civilian defense activities and responsibilities
will be carried on by a Committee on Civilian
Defense under the chairmanship of Dr. C. C.
Sherburne, Columbus. The personnel of the
second committee will be the same as the Com-
mittee on Emergency Medical Service which has
been in existence for the past year or so.
Dr. Conard and Dr. Sherburne wall sei;ve as
co-chairmen of the over-all committee — Com-
mittee on Emergency Medical Service. This
dual set-up will bring about close coordination
and cooperation between the Military Advisory
for October, 1950
1005
Committee and the group directly concerned with
civilian defense matters.
Members of the Military Advisory Committee
of the State Association will have the respon-
sibility of securing necessary professional
and biographical data regarding physicans in
their respective areas, making recommendations
regarding civilian needs in the districts, and
advising as to the availability or essentiality of
physicians for military or civilian service.
Such information will be obtained through
personal investigation and through consultation
with the Military Advisory Committees of the
various County Medical Societies. A request to
each County Medical Society asking it to name
such a committee will be sent out in the near
future by President Swartz.
DOCTOR-DRAFT LAW
The Doctor-Draft Bill passed in August by
Congress, was signed by the President on Sep-
tember 9. Details of administration are being
worked out according to Selective Service and
military regulations, and will be issued on the
basis of authority granted by the law.
Following are interpretations of provisions of
the law issued by the Washington Office of the
A. M. A. shortly after the law was transmitted
to the President.
Who Must Register? Physicians and dentists
who have not reached the age of 50 and are not
members of military reserves. Veterinarians,
optometrists, pharmacists., osteopaths and/or
other specialist categories if specified by the
President. (Law specifically states that it does
not apply to military reserves; they are already
subject to military orders.)
Who Are Eligible for Draft, and in What
Order Will They Be Called? Any registrant
(above) is subject to induction if acceptable to
the military. The law provides that registrants
will be called up on the following priority:
1. Former A. S. T. P. and V-12 men who have
not served on active duty (military, coast Guard
or Public Health Service) and others deferred
from service to continue their education during
World War II, and who have had less than 90
days of active duty (military, C. G., or PHS).
2. Members in the above groups who have had
more than 90 days active duty (military, C. G.,
or PHS) but less than 21 months.
3. With no reference to above groups, those
who did not have active service, (military, C. G.,
or PHS) subsequent to September 16, 1940;
this .could include postwar medical graduates
as well as other physicians who have not served
and have not reached their 51st birthday.
4. All others, including World War II non-
reserve veterans. Men in this group to be called
on basis of extent of duty; those with least duty
first, etc.
When Will Draft Take Effect? Not until the
President sets a time for registration. Nothing
official, but registration deadline probably in next
few weeks. Men will register at “appropriate
points of registration” in community. After
registration, Selective Service will place the man
in one of four classes listed above. Then, if to
be called, he will be ordered up for his physical.
Following this, 21 days to set affairs in order
before reporting to Armed Forces Induction
Station. Subsequently he will be offered a com-
mission and assignment to a service.
Can Registrant Get Reserve Commission?
Yes, if acceptable to military. If the man applies
for and is granted a reserve commission, he will
come under military orders and Selective Service
will not process him further.
Who Gets the $100 Pay Bonus? Every reserve
officer called to duty, on voluntary or involuntary
basis, receives the extra $100 per month. Men
required to register under this act also may
qualify for the $100 — but only if they volunteer
prior to their actual induction.
Who Is Eligible for Deferment? Actual defer-
ment is at the discretion of local Selective Serv-
ice boards. However, the law states that “the
President is authorized to provide for” certain
deferments. Action under this clause would be
based on the registrant’s previous military serv-
ice, his dependency status and any undue hard-
ship that might ensue.
Will Profession Advise Selective Service on
Men to be Called? Yes. The law provides for
establishment of a National Advisory Committee
“which shall advise SS system and coordinate
work of state and local volunteer advisory com-
mittees with respect to selection of needed . . .”
professional personnel. Committee will be com-
posed of men “outstanding in medical, dental
and allied services.”
Medical and Dental Professions Must be Rep-
resented on the National Committee, but rep-
resentation of other professions not required.
Law does not control local advisory committees;
whether these are established and made effective
depends on local conditions.
Will Draft Create Critical Doctor-Shortage
Areas? Conceivably it might. But law itself
attempts to set up safeguards. It says the
National and state and local committees shall
“give appropriate consideration to” civilian as
well as military medical and dental requirements.
Another section underscores this policy: “Main-
tenance of national health, safety or interest”
should be considered in granting deferments. In
calling up reserves, Army commanders also under
orders to give careful consideration to doctor-
shortage areas.
How Many Will Be Drafted? Military medical
1006
The Ohio State Medical Journal
officers hope enough men now will volunteer to
meet requirements. They are prepared to use
law’s authority for mandatory inductions, but
are confident that these cases will be rare. They
are hopeful that the $100 bonus, which is denied
to men involuntarily inducted under this act, will
attract registrants to volunteer.
Other Provisions: One section of law author-
izes transfer of medical officers from one service
to another, with consent of the officer and of
services involved. Officer protected in promotion,
retirement and pay . . . Another provided that
any persons who have served in armed forces
or PHS after September 16, 1940, and is recalled,
may be “promoted to a grade commensurate
with his education, experience and ability.” . . .
Law states “it is the sense of Congress” that
Selective Service deferments will be granted
to premedical, predental and allied students in
numbers equal to the present such enrollment.
This ruling more or less formalizes present
Selective Service policy and sets a total figure
for deferments in each professional category . . .
Inductees under doctor-draft required to serve
21 months . . . Anticipation is that Advisory
Committees will operate like Procurement and
Assignment of World War II . . . Bonus of $100
now goes to all reserves, whether called up
voluntarily or involuntarily; on this Congress
reversed comptroller general, who had ruled that
reserves called up involuntarily not eligible . . .
Doctor-draft law, an amendment to Selective
Service Act, expires with that law next July,
unless extended by Congress. (Entire law has
been covered by above outline.)
Vinson Says 5,000 More Military Doctors
Needed by Next July 1. In House debate on
the doctor-draft bill, Chairman Vinson of the
Armed Services Committee cited these figures on
military medical lineup:
Overall: 6,226 doctors now on active duty;
total of 11,250 needed by next July 1, on basis
of present military manpower planning for
2,500,000 men.
Army: 20,000 participated in A. S. T. P. program,
of whom 12,500 served on active duty and 1,000
were discharged for physical or other reasons.
Of remaining 6,500, about 2,000 failed to graduate
for various reasons, and 1,500 of those in prac-
tice would be ruled out for physical and other
reasons. This leaves approximately 3,000 men,
educated in whole or in part by Army, who
have not served and would be first to be called up.
Navy: 11,176 trained in whole or part in V-12
program; 5,872 of these have served at least two
years on active duty. This leaves 5,304 with
no service, but 1,429 of these are in Reserve and
subject to call. Of remaining 3,875 enrolled in
program, 1,262 did not finish school. This leaves
at the most 2,613 who have finished school and
would be eligible.
On paper, these sources alone — A. S. T. P. and
V-12 — could supply all military medical require-
ments for the next year. Requirements, 5,024;
A. S. T. P. and V-12, 5,613. However, military
planners have warned that physical handicaps,
practice in doctor-shortage areas and other fac-
tors will reduce this potential supply well below
the requirements.
Military’s Past Handling of Medical Manpower
Comes in for Sharp Criticism. Preceding vote
on the doctor-draft bill, several members of the
House took the opportunity to register sharp
criticism of the way physicians had been used
by the Armed Forces in World War II.
To these criticisms, Mr. Vinson repeatedly
replied that he had assurance from the three
Surgeons General that physicians would not be
wasted this time.
RESERVE OFFICER PRIORITIES
Shortly after passage of the doctor-draft act
— in fact, on September 7 — Secretary of Defense
Johnson (who subsequently resigned) issued an
order to the Army, Navy and Air Force estab-
lishing new priorities in calling medical and
dental reserve officers to active duty.
These orders were in effect as this issue
went to press. It is problematical at this time
whether these orders will be permitted to stand
or will be rescinded by General Marshall, who
has been named as Johnson’s successor.
Following is the full text of Johnson’s memor-
andum to the armed services on priorities in
calling up reserve officers:
Memorandum for the Secretary of the Army
Secretary of the Navy
Secretary of the Air Force
Subject:
Priorities to be observed in calling medical
and dental reserve officers to active duty.
By direction of the President, the military
departments will strictly observe the following
order of priorities in calling to active duty medi-
cal and dental reserve officers who are not mem-
bers of organized reserve units:
First Priority:
Medical and dental reserve officers who were
V-12 or A.S.T.P. participants, and who have had no
prior military service as commissioned medical
or dental officers. It is desired that substantially
all this group of officers be called before calls
are made to the individuals in the second priority.
Second Priority:
Medical and dental reserve officers who were
V-12 or A.S.T.P. participants, and who have had
prior military service. These individuals will
be classified by numbers of months of previous
active duty, and will be called in inverse order
of the number of months of previous active
duty they have to their credit. It is desired
that substantially all of this group of officers be
for October, 1950
1007
called before calls are made to the individuals
in the third priority.
Third Priority:
Other reserve officers.
Exceptions :
Exceptions may be made to the above priorities
in the case of medical reserve officers who have
not yet completed twelve full months of medical
internship. These individuals, if actively pur-
suing a medical internship, will be granted a
delay in call-up until they have completed a total
of twelve full months.
Additionally in special cases, where a military
department can show a military need for the
services of a particular individual or group of
individuals with special qualifications whose prior
service might otherwise tend to warrant their
delay in call-up under the policy enunciated above,
exceptions may be made so as to authorize their
recall to duty, but then only after obtaining the
approval of the Director of Medical Services.
Attention is invited to the memorandum of
July 20, 1950, addressed to the Secretaries of the
military departments by which the military serv-
ices were authorized to make calls into the
Federal service of certain organized units and
of individual members of the Reserve. The sec-
ond paragraph of that memorandum indicated
that advance notice to me of the proposed
issuance of orders of categories of specialists
in the Reserve was required. In keeping with
that directive, I desire specific notification of
all plans with reference to future calls to be
made for all medical and dental officers, and I
wish to receive them sufficiently in advance
of the proposed publication of orders so that
they can be reviewed in my office.
In addition, to the extent that medical and
dental reserve officers who are not members
of organized reserve units have heretofore
been ordered to duty but have not yet reported
for duty, in a priority order other than the
one set out above, I want the Secretary of each
of the military departments to review its pro-
cedures in issuing such calls, in order to elimi-
nate inequities to the maximum possible extent.
The Director of Medical Services will request
information from the military departments which
will permit me to be kept fully informed monthly
of the status of all medical and dental personnel
called to active duty.
DRAFT NOT OPERABLE YET
Until the new regulations were put into effect
the Department of Defense had exercised no
right to review calls for medical reserve officers.
The three services had made their own de-
cisions on the number of officers to be called,
the time of call and the categories of specialists
affected. These must all clear through the
Department of Defense now before taking effect.
It must be kept in mind that the Selective
Service act permitting the drafting of physicians
has not become operable and cannot until a
registration date has been announced and induc-
tion machinery put into operation.
For that reason the armed services may have
to call certain medical reserve officers to active
duty to meet existing needs. However, all are
hoping to keep such calls at a minimum, antic-
ipating a large number of volunteers from
among physicians eligible to the draft. The
services point out, nevertheless, that some re-
serve officers may have to be called to fill im-
portant specialty posts which cannot be filled by
volunteers because of their lack of qualifications
and experience.
SITUATION IN OHIO
The Army is at present calling to active duty
a certain number of Ohio medical reserve of-
ficers in certain specialty categories. Advice
of officers of the Ohio State Medical Association
in the selection of these officers with respect
to their availability was solicited and given. An
effort was made to clear as available only medi-
cal reserve officers whose services were not
absolutely necessary in civilian practice and
only those with the least amount of World
War II service. Priorities taking into consider-
ation the time spent on active service in World
War II were set up and followed.
Since the Ohio quota of 38 medical reserve
officers for the present call was established, new
instructions have been issued to Army com-
manders which should reduce the number of
World War II officers to be called from 50 to 75
per cent. How this will affect Ohio is not
known definitely but in all probability Ohio will
not have to furnish as many World War II
medical reserve officers as anticipated and orders
issued to some already to report for active duty
may be rescinded.
STATEMENT OF SURGEON GENERAL
Following is an explanation issued by the
Surgeon General of the Army on September 12.
According to the statement the new move,
taken in view of legislation providing for selec-
tive induction of physicians, dentists and mem-
bers of other allied professions, will have the
effect of limiting the recall of officers with
World War II service to a maximum of 364
physicians, 126 dentists and 29 veterinarians.
The actual number recalled will be consider-
ably less than this figure, it was estimated.
The new special quotas restricting World
War II recalls will have no effect on total
Army Medical Service recall requirements, ac-
cording to Major General R. W. Bliss, Army
Surgeon General. The new policy will, however,
have the effect of strengthening the preferred
status of professional officers with World War II
service, thereby reflecting the active duty
priorities contained in the new legislation.
Since it is estimated that 90 to 120 days will
be required after the passage of the legislation
before physicians, dentists and others actually
enter military service, the policy is an interim
measure, designed both to protect those with
the most military service and assure an adequate
1008
The Ohio State Medical Journal
number of professional officers for the Army
before the new legislation becomes effective.
HOW IT WILL WORK
This is the way it is expected to work:
Each Army commander will still have the
same over-all quota of Army Medical Service
personnel as originally announced. However,
his quota will now consist of two parts — the
new special quota and the balance of his over-all
allocation. In filling the special quota, every
effort will be made to fill it insofar as grade,
specialty and numbers permit, with volunteers,
including former A.S.T.P. students with no active
service, and reserve officers with no World
War II service. If necessary, officers with
World War II service may be recalled when
others are not available in the required grades
and specialties. The balance of the over-all
quota must be filled with volunteers and reserve
officers without wartime service and will not
be filled with World War II officers.
All officers with World War II service not
included in recalls for the special quota in
each Army area will be temporarily deferred
from recall, except those assigned to duty with
alerted National Guard or Organized Reserve
units. The policy will not apply to officers
assigned to these units.
NAVY STARTS CALLING V-12 S
As soon as Congress had passed the doctor-
draft law, the Navy started calling up its
1,200 reserves who participated in the V-12
program. By the time this group is in uniform,
the Navy expects that another 2,500 or so former
V-12’s who were not in the reserves will be
made available, either as volunteers or under
the mandatory provisions of the new law. This
means that for the next few months Navy will
be able to greatly reduce, but not entirely elimi-
nate, its calls on World War II medical veterans,
according to Washington observers.
Appointment and concurrent assignment to
active duty as Reserve Officers of women phy-
sicians, dentists, and allied specialists, has been
authorized, it was announced by the Department
of the Army.
Appointments will be in grades from first
lieutenant to colonel, depending upon age, experi-
ence, and professional qualifications. The pay,
allowances, dependency and retirement benefits
which accrue to male officers will apply to the
women medical reservists.
Women physicians and dentists will also draw
the $100 a month professional pay allowed above
the base pay of their commissioned rank. They
will be eligible for service in every type of
military medical facility, with the exception of
forward medical installations in combat zones.
A similar policy has been announced in regard
to women physicians who wish to receive reserve
commissions in the Air Force.
AIR FORCE
Physicians who received all or part of their
training under the A. S. T. P. or the Navy V-12
programs and who do not have commissions with
other military services are eligible to receive
commissions in the U. S. Air Force Medical
Service, Major General Harry G. Armstrong,
Surgeon General of the Air Force, announced.
POLICY ON RESERVE UNITS
A policy under which profesisonal medical
service officers assigned to Reserve or National
Guard units called to active duty will be re-
called only to the extent they can actually be
utilized, has been announced by the Department
of the Army.
Two general types of units will be affected
by this policy. The first includes Army divisions,
headquarters of medical battalions and groups,
medical clearing companies, medical field lab-
oratories, field hospitals, mobile army surgical
hospitals, and all non-medical units with medi-
cal personnel included in their organizations.
Units included in the second group are evacu-
ation hospitals, convalescent centers, general
and station hospitals, general laboratories, hos-
pital trains, and general dispensaries.
For the first group, the policy will be to call
all medical service officers, including physicians,
dentists and nurses, to duty with their units.
However, only the minimum required for actual
training will remain with their units during the
training period. For example, although an in-
fantry division is authorized 42 physicians, only
17 will be retained by the division during its
training period. The balance will be assigned to
the hospital serving the division. Provision has
been made for rotation to assure that each
physician has the greatest possible opportunity
to continue a balanced medical practice, both
with the unit in the field and at the station
hospital. All the division dental officers would
be utilized at the camp hospital or dental clinic.
For units falling in the second group, only
the professional personnel actually required for
training or support will be recalled. The balance
of the assigned medical service officers will re-
main ajt home until a short time before the
unit is actually ready for operation. Thus, in
the case of a 1,000-bed general hospital, only
three physicians and two nurses will initially
be called to duty with the unit. The balance
of physicians and nurses will await a warning
order for the unit’s deployment. Dental officers
will be used in the same manner as those as-
signed to units falling in the first group.
All Medical Service Corps officers and en-
listed personnel assigned to all types of units
will be called to active duty with their units.
for October, 1950
1009
T__ 1 1 ft Comments on Current Economic and Social
HI V/ lli v/ piIllOll* Questions and Professional Problems;
. - Suggestions Regarding Organized Activities
SOCIALIZED MEDICINE THE REAL
ISSUE ON NOV. 7
As fodder for the 1950 General Election cam-
paigns, the Democratic National Committee, over
the signature of William M. Boyle, Jr., its chair-
man, has issued a bulletin plugging the Truman
scheme of national compulsory health insurance.
If anyone wanted tangible evidence that the
issue of socialized medicine is definitely a poli-
tical issue this Fall, there it is.
Mr. Boyle’s comments are, as usual, disarm-
ing; full of half-truths and mis-statements.
In the first place, he contends that the Tru-
man program is not “socialized medicine.” Since
when isn’t a medical program controlled by
government and financed from tax funds, so-
cialized medicine?
The bulletin, using material from the Com-
mittee for the Nation’s Health for reference,
protests that voluntary medical and hospital
plans are woefully inadequate, contrasting them
to what he calls “national health insurance.”
Naturally, no voluntary, private enterprise proj-
ect is recognized as adequate to those who favor
a socialistic state. In the second place, the
Truman scheme would not be insurance, as there
would be no gearing of benefits to income —
it would be nothing but a medical dole, paid for
by compulsory taxation of one kind or another.
Mr. Boyle alleges that the cost of the Truman
scheme would be $48 per year per average family.
That statement is entirely fallacious. He and
everyone else knows that the cost per family
would be considerably higher, simply because
everyone would be assessed taxes indirectly to
meet the difference between the Social Security
payroll tax and cost of the Truman scheme.
Mr. Boyle sneers at the “lavish advertising
fund of the A. M. A.” but says nothing about
the millions of dollars which have been spent
by Social Security Administrator Ewing to
promote compulsory health insurance and about
the horde of press agents on the payroll of
that bureau, most of whom are engaged in
publicizing this and other pet socialistic projects
of the bureau.
Physicians, and others, who want no part of
compulsory health insurance, in other words,
socialized medicine, should realize that when they
go to the polls on November 7 to cast their
votes for a candidate to the next U. S. Congress,
they will be voting indirectly on the issue of
socialized medicine. There can be no doubt
of that — Mr. Boyle has left no alternative. They
should know how the candidates stand on this
question — then vote accordingly.
TWO-YEAR RULE ON FILING
W. C. FEE BILLS AND REPORTS
There seems to be some confusion and mis-
understanding on the part of some physicians re-
garding the so-called two-year rule of the Ohio
Industrial Commission applying to the filing of
fee bills and reports of injuries. Failure of
some physicians to conform to the rule has
barred them from receiving compensation for
services rendered to claimants.
Rule No. 6 of the Commission adopted on
August 9, 1940, and still in effect, reads as
follows:
“Time Limitation on Filing Bills and Reports
of Injuries. Fee bills for medical, hospital and
nursing services and for medicines and ap-
pliances, are forever barred from payment unless
they are filed within two years from the time
such services were supplied, or within six
months from the time the Commission has as-
sumed jurisdiction in a contested or re-opened
case. Claims for injuries must be filed within
two years from the date of injury.”
This rule appears in the Fee Schedule Booklet
issued by the Commission. It has been pub-
licized repeatedly by The Journal. Neverthe-
less, some physicians apparently are unaware
of it.
The two-year rule starts on the day services
were rendered — not from the date of the last
treatment, as some physicians believe. The rule
will not be waived by the Commission unless ex-
traordinary circumstances exist.
Therefore, it behooves each physician to file
his fee bills and reports on Workmen’s Com-
pensation cases very promptly. In fact, other
rules of the Commission make it mandatory for
a physician to file such blanks at intervals of
60 days at the most.
Unless the Commission receives these bills
and reports at frequent intervals, it cannot keep
up with the progress of cases, an important
point in the huge administrative machinery of
the Commission.
HOW TO SET UP AN
OFFICE AND WHERE
Writing in Fixture, a bulletin issued by the
California Medical Association for medical stu-
dents, interns and residents, Dr. Frank F.
Schade offers young physicians some excellent
advice on how to set up an office and where. Ex-
cerpts from his timely article follow:
“Have no illusions. It will be difficult for the
first few years, if you set up on your own. If
that is your plan, decide where you want to
1010
The Ohio State Medical Journal
— Council on Pharmacy and Chemistry, New and
Nonofficial Remedies, J.A.M.A. 743:815 (July 1) 1950.
"A high percentage of cases of seasickness and
carsickness can be aborted or prevented by
suitable doses of dimenhydrinate (Dramamine).”
DRAMAMINE Brand of Dimenhydrinate — for the prevention or
treatment of motion sickness — is supplied in 50 mg. tablets and in liquid form.
RESEARCH IN THE SERVICE OF MEDICINE
for October, 1950
1011
live, and go there to practice. Wherever you
go, it will be difficult, so go to the place where
you want to spend the rest of your life, to rear
your family, to be a member of the community.
“Care should be taken in selecting your office
site and in purchasing equipment. Consider the
funds you have available, or that you can bor-
row, and then keep within your budget. Large,
pretentious offices are not necessary at the start.
The larger the offices, the more equipment and
furniture will be necessary; you won’t need a lot
to begin with, and you must keep your initial
expenditures down.
“Choose the location for your office carefully.
Avoid old, run-down and deteriorating areas.
What will the area be like in ten or more
years? The fewer times you move your office,
the better, so choose with an eye to the future.
“Once the location is chosen, the lease is
very important. Read it carefully. If you have
an attorney, consult him about it.
“Furnishings and equipment should be kept
to the minimum compatible with good taste, com-
fort and efficient care of your patients. For the
waiting room comfortable, serviceable furniture
should be stressed, keeping in mind such factors
as wearing quality of upholstery, ability to be
cleaned readily and resistance to staining. Large,
multiple seating units, such as davenports, should
be avoided. Good lighting is essential. Above
all, keep the reading material for your waiting
patients up to date ... as magazines become
outdated, dispose of them, and don’t depend
upon the old, cast-off magazines from home for
your waiting room.
“The amount of professional equipment neces-
sary will vary somewhat with the type of prac-
tice and the location, the maximum being needed
for suburban or rural general practice. The
usual mistake is to purchase too much and too
great a variety of instruments and other equip-
ment. You can always add as you go along, as
your practice increases and as the necessities
arise. Deal with good, reputable firms, and keep
in mind that the actual price paid does not always
determine value. There can be no substitute for
quality.”
DOCTORS NEED THIS
KIND OF PUBLICITY
“Lima Beane” who pens a column for the
Lima News recently addressed the following
open letter to the physicians of Allen County:
“Dear Doctors: Your generous donation of
time and effort in conducting Lima’s pre-school
clinics proves that you have the welfare of the
entire community in mind. The clinics them-
selves are a wonderful thing. They tend to
raise the general health level throughout the
city. The doctors who handled the clinics are
to be congratulated.”
That’s the kind of publicity the medical pro-
fession should have in these days when too
many folks don’t know about the good things
which many physicians are doing for their com-
munity. Also, let this be a lesson to those
physicians who are failing in their community
obligations and responsibilities. We join “Lima
Beane” in congratulating the physicians of
Allen County on a job well done.
ALLEGES “OHIO DOCTORS
BACKING TAFT”
“Ohio Doctors Backing Taft,” reads a head-
line on an article published in the July 28
edition of the Akron Labor News.
According to that paper: “Ohio’s medical as-
sociations have thrown their weight and fund-
raising machinery behind Senator Taft’s cam-
paign for re-election.”
Perhaps the Akron Labor News meant to say
that individual physicians are working for Taft.
In fact, it states: “One group, the Ohio Phy-
sicians Committee for Taft is engaged in setting
up a political committee of medical men in each
of Ohio’s 88 counties.”
Another paragraph of the article is intriguing,
especially the source of the information. Quote:
“According to the Committee for the Nation’s
Health, which exposed the doctors’ dabbling
in politics, these groups are to campaign for
Taft with ‘special literature, radio and news-
paper messages, group meetings and intensive
work by representatives in the field’.”
Now that the doctors of Ohio have been prop-
erly “exposed” they can “dabble” to their
heart’s desire. If they want to “dabble” for
Taft, the Akron Labor News tells them how to
do it.
P. S. Chicago, Aug. 9 — (AP) — William Green,
president of the American Federation of Labor,
said today the AFL and the CIO is united “to
bring about the defeat of Sen. Taft of Ohio.”
Green and the AFL executive council met
today with Joseph D. Keenan, director of the
AFL labor league for political education, to
discuss the fall election campaigns.
“We are confident we will defeat Sen. Taft as
we did Sen. Brooks of Illinois, Sen. Ball of Min-
nesota, and Sen. Revercomb of West Virginia,”
Green told a news conference.
Keenan said the AFL and CIO jointly will
raise about $100,000 to fight against Taft’s re-
election in Ohio.
“We have decided to concentrate on a pro-
gram to get out the vote of labor and its
friends between Aug. 15 and Oct. 1,” he said.
CHANCE FOR DOCTORS IN
RURAL AREAS TO ACT
The Ohio Farm Bureau. News in an appeal
to its members to vote at the November 7 election,
points out that in the May, 1950, primary elec-
tions, only 17.8 per cent of rural Ohio’s potential
voters went to the polls.
Those who are interested in good government
should do some missionary work among the rural
folk. They are as a rule sound, conservative
people — the kind of people who support sound,
well-qualified candidates when they vote.
Here is a chance for physicians in rural and
semi-rural areas to get in some good licks.
1012
The Ohio State Medical Journal
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LUMINAL9 SODIUM
for October, 1950
1013
They should talk to their patients about this,
urging them to get out of a rut and exercise
their right to have a voice in governmental
affairs.
THE PROBLEM OF RISING
HOSPITAL COSTS
The problem of rising hospital costs — the
biggest portion of each dollar spent for medical
care — has hospitals worried, physicians worried
and patients worried.
The reasons for this are enumerated in the
following article published in a recent issue of
the Columbus Academy of Medicine Bulletin,
which article, also, reveals that there does not
appear to be much hope for a change in the
situation in the near future:
% ;Jc
“Why does a hospital room cost so much more
than a hotel room ? ”
Every physician must have heard that plain-
tive query from hundreds of patients. The
hospital people hear it, too — frequently.
Last month a group of hospital superin-
tendents, admitting officers and medical social
workers made an effort to explain the hospital’s
side of the story.
The program was called “Hospitals Talk It
Over” and it was part of a series of “Institutes
on the Community and Its Resources.” The meet-
ing was held at Mees Hall, Capital University,
and was attended by about 100 persons, mostly
social workers.
Mr. Erwin C. Pohlman, superintendent of
Grant Hospital, gave a careful breakdown on the
“average cost of a hospital visit for the average
hospitalized patient.” The figures are based on
1949 operations at Grant Hospital, but other
hospital officials agreed that the figures would
come close to the average at all hospitals.
In answer to the opening question, “Why does
a hospital room cost so much more than a hotel
room?” Mr. Pohlman pointed out that 71 per
cent of the hospital’s charges to the average pa-
tient are for services that would not be pro-
vided in a hotel.
The average amount collected per patient was
$118.16.
Of this amount $40.91 was spent by the hos-
pital for nursing service and education, $24.44
for food, $7.02 for medical and surgical costs,
$6.20 for pharmacy supplies, and $5.84 for lab-
oratory.
The remaining amount was spent on plant
operation and maintenance, administration,
housekeeping and textiles, and laundry. ,
Another breakdown showed that 64 per cent
of the amount collected per patient was used
for salaries and 36 per cent for other services.
Another question frequently asked about hos-
pitals is this: “Since hospitals charge for their
services, why do they have to receive gifts and
put on special drives?”
Mr. Pohlman gave a plain answer to that.
The hospital received an average of $118.16
in payment for each patient last year. The
average cost per patient was $117.17.
That leaves a net cash surplus per patient
of 99 cents.
The average hospital has from 5,000 to 10,000
patients a year. This would mean an annual
net surplus of $5,000 to $10,000 to cover costs
of replacement of used equipment, moderniza-
tion, depreciation, expansion.
It is obvious that the available surplus will
not cover these necessities.
Mr. Robert M. Porter, superintendent of
Children’s Hospital, said his hospital had found
it necessary to purchase $45,000 worth of
equipment alone in 1949.
Unless there is a decided change in general
economic conditions in the country, it is not
likely that hospital costs will go down in the
near future. It is more likely that they will
go up. One reason that the costs may increase
is the average rate of pay of hospital em-
ployees— $5.00 a day — which may have to be
raised. It may become necessary to put hos-
pital employees on a five-day week. This also
would increase costs. And if a retirement plan
should become necessary for hospital employees,
costs would go up again.
The average total cost of hospitalization per
patient per day was $14.57 in 1949, Compared
to the average total cost of $6.39 per patient per
day in 1940, this is a 128 per cent increase in
nine years.
But improved medical and surgical care, better
drugs and improved skills have reduced the
length of stay of the average hospital patient
from 11 days in 1940 to 8.1 days in 1949. The
average total cost of hospitalization per patient,
therefore, has increased only 68 per cent. This is
comparable to other increases in the cost of
living.
Although average per diem costs may con-
tinue to rise, average cost per patient for his
entire hospital stay may hold fairly level in the
future, it was pointed out, because continued im-
provement in medical care may be expected to
reduce the average hospital stay even further.
In our opinion, data such as the above should
be brought to the attention of the public in
every possible way. Unfortunately, many per-
sons do not understand the financial problems
of hospitals. Unfortunately, too many persons
do not distinguish between the costs of hos-
pitalization and the costs of professional services.
If they believe the costs of illness are too high,
they are inclined to place all the responsibility
on the shoulders of the medical profession, fail-
ing to realize that there are others who take a
share of the medical care dollar; failing to
understand why some of these costs are at their
present high level.
’TWOULD BE FUNNY IF
IT WEREN’T SO SERIOUS
Columnist Dorothy Thompson ended one of
her recent syndicated newspaper articles on the
Korean situation with the following quip:
“Our leaders perennially refuse to analyze
the minds of this country’s enemies. They can-
not remember 21 years back, nor do they read
even what is all written down.
“Alternately they coaxingly patronize the
greatest emperor of all the Russians, as ‘Lncle
Joe,’ or repulsed, pettishly cry, ‘barbarian
bandit!’ And then when the inevitable happens,
they are caught holding, not a gun, but a public
health program.”
1014
The Ohio State Medical Journal
measured in minutes
Upjohn
Rapid anticoagulant effects are
available with Heparin Sodium
preparations, developed by Upjohn
research workers. In a matter of
minutes, coagulation time can be
lengthened to offset danger from
thrombosis and embolism. With
Depo#-Heparin Sodium, prolonged
effects lasting 20 to 24 hours may be
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Therapy with these Upjohn anti-
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* Trademark , Reg. U. S. Pat. Off.
Medicine ... Produced with care ... Designed for health
THE UPJOHN COMPANY, KALAMAZOO 99, MICHIGAN
for October, 1950
1015
Do You Know?
• • •
Dr. W. Wendell Green, Toledo, was elected
secretary of the American Proctologic Society
at its annual meeting in Los Angeles, July 2-5.
Other officers are: Dr. Hout R. Allen, Little
Rock, Ark., president; Dr. Robert A. Scar-
borough, San Francisco, president-elect; and Dr.
Rufus C. Alley, Lexington, Ky., treasurer.
^ H* H*
Dr. K. W. Ascher, assistant professor of
ophthalmology at the University of Cincinnati,
gave a lecture on “Contact Lens and Aqueous
Veins” at the 16th International Congress of
Ophthalmology held in London, England, July
17-22. He also presented an extensive exhibit
showing the development of present knowledge
about aqueous veins since their detection in 1941.
rfc rfi ^
I . .
Public Health Service grants totaling $230,773
are for research in four non-federal institutions on
atherosclerosis. One of the grants in amount
of $57,903 was made to the Cleveland Clinic.
It will be used for research in the field of
lipoproteins and arterial disease under direction
of Dr. Irvine H. Page.
* * *
Dr. E. Herndon Hudson, director of the Ohio
University Health Service, Athens, since 1940,
has been named director and chief medical ad-
visor of United Nations World Health Organ-
ization in Iraq. He will have the status of an
international civil servant. Dr. Hudson has
been given a year’s leave of absence from his
Athens post.
* * *
Major General Lewis Hershey, Selective Serv-
ice Director, testified at a committee hearing
in Washington that close to 60 per cent of
draftees are unacceptable, but that not more
than 50 per cent of these are for physical rea-
sons. “I think we are rejecting more men now
on the mental tests than we did in World
War II,” he said.
JfC
Dr. Charles C. Higgins, Cleveland, was elected
vice-president of American Association of Genito-
urinary Surgeons at its annual meeting.
* * *
The fifth annual postgraduate course in dis-
eases of the chest, sponsored by the American
College of Chest Physicians, will be held October
16-20 at the St. Clair Hotel in Chicago. Details
of the meeting may be obtained by writing the
American College of Chest Physicians, 500 N.
Dearborn Street, Chicago 10, Illinois. Veterans
wishing to apply under the GI Bill may also
receive information at this address.
Classes began September 11 for the second
group of 12 medical record library technicians
to receive 50 weeks of specialized training at the
U. S. Marine Hospital, Baltimore, Md. Grad-
uates are given the opportunity of joining the
public health service, although there is no obliga-
tion.
He H* #
Alpha Epsilon Delta, national premedical
honorary fraternity has announced a national
conference on premedical education to be held
at Lake Placid, October 21-22, at the Lake
Placid Club. Those wishing to attend may write
Alpha Epsilon Delta, 303 Upland Road, Haver-
town, Pa.
He % H5
The seventh annual meeting of the American
College of Chest Physicians will be held Novem-
ber 12 and 13 in St. Louis, Mo. The group is
meeting at the Hotel Statler jointly with the
Southern Medical Association. The program com-
mittee for the meeting is composed of Hollis E.
Johnson, M. D., Nashville, Tenn., chairman, and
Otto C. Bantigan, M. D., Baltimore, Md.
He ^ %
Physicians who wish to place scientific exhibits
at the Clinical Session of the A. M. A. in Cleve-
land, December 5-8, should apply at once. Ap-
plication blanks may be obtained from the Di-
rector, Scientific Exhibit, American Medical As-
sociation, 535 N. Dearborn St., Chicago 10.
He H1 H5
In an average year accidents result in the death
of more than 5,000 preschool children between
the ages of 1 and 4. This is greater than
the annual number of deaths from diphtheria
in this age group nearly a quarter of a century
ago, when this disease was considered an out-
standing cause of child deaths.
H« * *
Improved methods for separating and preserv-
ing blood components of interest in atomic energy
research will be sought in a program* admin-
istered by the American Red Cross under a
contract with the Atomic Energy Commission.
Among technical personnel who will be engaged
in the research are Dr. Charles A. Doan, dean
of the Ohio State University College of Medicine,
and Dr. Warren E. Wheeler, also of the College.
♦ * *
At the third annual meeting of the Neurosurgi-
cal Society of America, September 14 - 16 at
the Cloisters, Sea Island, Ga., the following were
among those on the program: Dr. William A.
Nosik, Dr. George S. Phalen and Dr. Julius Wol-
kin, all of Cleveland, and Dr. Rex H. Wilson,
Akron.
1016
The Ohio State Medical Journal
AU R EOM VCI N CRYSTALLINE
in Tularemia
Tularemia , which is a serious problem in many parts of
this country , can be successfully treated with aureomycin.
All types of tularemic infection , with or without complications ,
respond promptly to the administration of this antibiotic .
A ureomycin has also been found effective for the control of the following
JL3l infections : acute amebiasis, bacterial and virus-like infections of the eye,
bacteroides septicemia, boutonneuse fever, acute brucellosis, common infec-
tions of the uterus and adnexa, resistant gonorrhea, Gram-positive infections
(including those caused by streptococci, staphylococci, and pneumococci),
Gram-negative infections (including those caused by the coli-aerogenes
group), granuloma inguinale, H. influenzae infections, lymphogranuloma ve-
nereum, primary atypical pneumonia, psittacosis (parrot fever), Q, fever,
rickettsialpox, Rocky Mountain spotted fever, subacute bacterial endocarditis
resistant to penicillin, surgical infections, tick-bite fever (African), and typhus.
Capsules: Bottles of 25, 50 mg. each capsule. Bottles of 16, 250 mg. each capsule.
Ophthalmic: Vials of 25 mg. with dropper; solution prepared by adding 5 cc. of distilled water.
LEDERLE LABORATORIES DIVISION america.v Cjanamul company 30 Rockefeller Plaza, New York 20, N.Y.
/or October, 1950
1017
Buckeye News Notes . . .
Akron — Dr. Carl E. Krill participated in the
International Pediatric Association meeting in
Zurich, Switzerland, this summer.
Bryan — Dr. Alfred G. Goll was the subject of
a feature article in the Bryan Times upon com-
pletion of 50 years of practice in July.
Chardon — Dr. Lucy Stone Hertzog spoke be-
fore the Childs Taylor Chapter of the D. A. R.,
where she outlined the origin of socialized medi-
cine and its continuing threat in this country.
Cleveland — Dr. I. M. Hinnant recently addressed
the Churchmen’s League on the subject, “The
Doctor Looks at Socialized Medicine.”
East Cleveland — Dr. Jess J. Woodworth has
been appointed head of the Department of
Obstetrics and Gynecology at the Huron Road
Hospital. He has been on the staff of the
hospital since 1942.
Orrville — Dr. Robert P. Ulrich, Toledo, described
the use of radium in treating diseases to mem-
bers of the Rotary Club.
Painesville — Dr. Ewing H. Crawfis, superin-
tendent of the Cleveland Receiving and Cleve-
land State Hospitals, spoke before the Kiwanis
Club on the subject of mental illness.
Piqua — Dr. George A. Woodhouse, Pleasant
Hill, spoke before the Women’s Auxiliary of
Piqua Memorial Hospital on “Socialized Medi-
cine.”
Quaker City — Dr. M. S. Lawrence addressed
the Rotary Club on the subject of the county
health board set-up, its history in Guernsey
County and its functions.
Toledo — Dr. Maryloo Spooner, who recently
completed her internship at Harper Hospital,
Detroit, has been appointed on the staff of the
Toledo Hospital Institute of Medical Research
to conduct studies in the fields of cancer. She
is the daughter of Dr. John P. Spooner, of
Toledo.
Youngstown — Two physicians addressed civic
clubs on the subject of “Defeat Plan No. 27” in
July. Dr. C. A. Gustafson presented the dis-
cussion to the Rotary Club and Dr. W. C. Auten-
reith spoke before the Lions Club.
Youngstown — Four additional physicians re-
cently announced opening of practices. They
are: Dr. William E. Sovik, Dr. Aam A. Lerro,
Dr. Edward H. Jones, Jr., and Dr. D. E. Beynon.
Youngstown — Dr. John LoCricchio, recently di-
rector of pathology and laboratory medicine at
St. Vincent’s Hospital, Bridgeport, Conn., has
been appointed director of the Department of
Pathology at St. Elizabeth’s Hospital. He suc-
ceeds the late Dr. William Dean Collier, de-
partmental head since 1936.
A. M. A. Clinical Session To Be
Held in Cleveland, Dec. 5-8
The Fourth Clinical Session of the American
Medical Association, designed primarily for the
general practitioner, will be held in Cleveland,
December 5-8.
The scientific sessions and the scientific and
technical exhibits will be presented in the Cleve-
land Municipal Auditorium. Meetings of the
House of Delegates will be held in the Statler
Hotel. These sessions of the body elected to
govern the affairs of the A. M. A. are attracting
more and more non-delegate physicians each year.
Outstanding clinical teachers with recognized
ability as speakers will headline the scientific
demonstrations. Actual cases will be presented
and discussed. Diagnoses, treatment and preven-
tive measures as they fit into daily practice will
receive the greatest attention.
Each clinical session will be limited to an
attendance of 100 physicians. These small
groups will make it possible for the general
practitioner to enter actively into the discussion
and to inquire about his own cases. Leading
men in each of the fields under discussion will
be available to help with the problems presented.
The steadily climbing registration of general
practitioners at the clinical sessions and the
comments of those participating indicate these
meetings are valuable means of keeping abreast
of developments in medicine. It is hoped that
a record number of physicians will take advan-
tage of the opportunity in December to attend.
The program has been designed with that in
mind.
Complete details of the meeting will be pub-
lished in The Journal of the A. M. A. several
weeks before the session.
Information regarding hotel accommodations
and blanks for making hotel reservations are
being published in current issues of The Journal
of the A. M. A.
Radiological Society of N. A.
The 36th Annual Meeting of the Radiological
Society of North America will be held in Chicago,
December 10-15, with headquarters at the Palmer
House. Scientific Exhibits will be displayed in
the Palmer House. More than 60 papers as well
as refresher courses are on the program. All
members of the medical profession are invited.
Postgraduate Course in Allergy
The American Academy of Allergy in coopera-
tion with the Faculty of Medicine of McGill
University, is sponsoring a Postgraduate Course
in Allergy October 26-28. There will be a fee
of $40. Applications and requests for additional
information should be addressed to Dr. Bram
Rose, McGill University Clinic, Royal Victoria
Hospital, Montreal, Canada.
1018
The Ohio State Medical Journal
tibiotics
therapy
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daily by mouth m divide c
.sted for acute infection .
.capsules, bottles of 16 and
. capsules, bott es of 2o,
capsules, bottles of 2d.
4 m
' n i \ |
§
f- " J|aF
T<
: lift : ■ :t I
lllli at*
Co,
1. King, E. Q.; Lewis, C. N.; Welch, H.;
Clark, E. A., Jr.; Johnson, J. B.;
Lyons, J. B.; Scott, R.B., and Comely,
P. B.t J. A. M. A. 143:1 (May 6) 1950.
2. Herretl, W. E.; Heilman, F. E.;
Wellman, W. E., and Bartholomew, L.
Proc. Staff Meet. Mayo Clin.
25:183 (Apr. 12) 1950
A.:
f :
i II U...^ .i
Pfizer
Antibiotic Division
CHAS. PFIZER & CO.. INC., Brooklyn 6. A . Y.
for October, 1950
1019
In Memoriam . . .
Alva C. Baker, M. D., Dayton; Illinois Medi-
cal College, 1902; aged 79; died August 26. Dr.
Baker practiced at Brookville for about 37
years before moving to Dayton ten years ago.
Surviving are his widow, a son and a brother.
Byron R. Burgner, M. D., Springfield; Cleve-
land-Pulte Medical College, 1900; aged 74; died
August 31. A former Cleveland physician, Dr.
Burgner had been residing in the Masonic Home
in Springfield.
Cosper C. Burton, M. D., Ironton; University
of Cincinnati College of Medicine, 1910; aged 68;
died August 30; member of the Ohio State Medi-
cal Association and the American Medical As-
sociation through 1946; president of the Lawrence
County Society, 1932-1934, and its delegate dur-
ing the same period. Dr. Burton served his
entire medical career in Lawrence County with
the exception of time he spent with the Army
Medical Corps during World War I. He was
a member of the Methodist Church, the Elks
Club, and was active in several Masonic orders.
He served for several years on the City Health
Board and was vice-president and a director of
the Etna Building and Loan Company. Surviving
are his widow, a son, three sisters and a brother.
Henry Graefe, M. D., Sandusky; New York
University College of Medicine, 1908; aged 65;
died August 30; former member of the Ohio
State Medical Association and the American
Medical Association through 1926. Dr. Graefe
began his practice in Sandusky in 1910 and
continued until 1927 when he retired because
of ill health. During World War I he served
with the Medical Corps. Surviving are his widow,
a son, a daughter and three sisters.
Walter R. Griess, M. D., Cincinnati; Miami
Medical College, 1897; aged 74; died August 17;
member of the Ohio State Medical Association
and a Fellow of the American Medical Associa-
tion; member of the International College of
Surgeons and Fellow of the American College of
Surgeons. Dr. Griess served all of his profes-
sional career in Cincinnati. He had been presi-
dent of St. Mary Hospital, chief of the surgi-
cal department at Deaconness Hospital, a direc-
tor and member of the staff of the orthopedic
department at Bethesda Hospital and director
of surgery at Children’s Hospital. He had lec-
tured at the College of Medicine and had served
as dean of the College of Pharmacy and as a
trustee of the University of Cincinnati. He held
memberships in a number of professional so-
cieties, also the Cincinnati Club, the Queen City
Club and several Masonic orders. Surviving are
his widow, two brothers and a sister.
Ralph E. Hatfield, M. D., Cincinnati; University
of Michigan Medical School, 1931; aged 45;
died August 11 while returning home from a
trip in the East; member of the Ohio State
Medical Association and the American Medical
Association; Fellow of the American College of
Surgeons. Dr. Hatfield served all of his medical
career in Cincinnati with the exception of time
spent during World War II in the Navy where
he attained the rank of lieutenant commander.
From 1935 until 1942 he had served as health
commissioner of Norwood. He was a member of
the Methodist Church, Maketewah Country Club,
Sigma Alpha Epsilon and Alpha Kappa Kappa.
Surviving are his widow, two sons, his father,
and two sisters.
Frank Lande, M. D., McConnelsville; Univer-
sity of Louisville School of Medicine, 1921;
aged 61; died August 28; member of the Ohio
State Medical Association and a Fellow of the
American Medical Association; member of the
American Society of Clinical Pathologists. Dr.
Lande was for several years director of Rocky
Glen Sanatorium, having resigned last May
to resume private practice. He was a veteran
of both World Wars and was a member of the
Masonic Lodge. Surviving are his widow, a
sister and a brother.
Solomon H. Lesinger, M. D., Philadelphia, Pa.;
Western Reserve University School of Medicine,
1921; aged 53; died August 11; member of the
Ohio State Medical Association through 1930;
listed in the 1950 A. M. A. Directory as a
member residing in New York City. Dr. Lesinger
formerly practiced in Cleveland. He had been
on the staff of French Hospital in New York and
had joined the staff of Jewish Hospital in
Philadelphia only two weeks before his death.
James S. Mariner, M. D., Youngstown; Ohio
State University College of Medicine, 1916;
aged 64; died August 14; member of the Ohio
State Medical Association and the American
Medical Association. Dr. Mariner resided in
Youngstown and maintained his practice in both
Youngstown and Campbell. For 20 years he
was health commissioner of Campbell. He was
a veteran of World War I. Surviving are a
daughter, a son, three sisters and three brothers.
John F. Morey, M. D., Crestline; Eclectic Medi-
cal College, Cincinnati, 1923; aged 55; died
August 14; member of the Ohio State Medical
Association and the American Medical Associa-
tion. Dr. Morey had practiced in Mansfield
from 1929 until about two years ago when he
moved to Crestline. He was a member of the
American Legion, having served in the Medical
1020
The Ohio State Medical Journal
Corps during World War I, and was a member
of the Masonic Lodge. Surviving are his widow,
a son, a daughter and a sister.
Anna L. Preston, M. D., Marietta; University
of Michigan Medical School, 1896; aged 87; died
August 29. Dr. Preston had practiced for many
years in Marietta. She had retired a number of
years ago.
Francis N. Richardson, M. D., Cleveland; Cleve-
land-Pulte Medical College, 1900; aged 78; died
August 18. Dr. Richardson had practiced in
Cleveland since completion of his education. He
was a member of the Episcopal Church and the
Cleveland Yacht Club.
Harley H. Sink, M. D., Columbus Grove; Cleve-
land- Pulte Medical College, 1903; aged 74; died
August 13; member of the Ohio State Medical
Association and the American Medical Associa-
tion; vice-president of the Putnam County Medi-
cal Society, 1925, 1929 and 1948; president, 1931
and 1942; delegate, 1943. Dr. Sink had prac-
ticed medicine in Columbus Grove for 47 years.
, In addition to his professional activities, he was
active in several Masonic orders and in the
Methodist Church. Surviving are his widow,
two daughters, a sister and a brother, Dr. O. O.
Sink, of Smithfield.
Daniel M. Skinner, M. D., Hamilton; Univer-
sity of Cincinnati College of Medicine, 1912;
aged 63; died August 25; former member of the
Ohio State Medical Association and the American
Medical Association through 1946; Fellow of the
American College of Surgeons. Dr. Skinner
had practiced in Cincinnati from 1912 to 1917,
moving his practice to Hamilton after World
War I. He was in service during the First
World War. He had retired because of ill
health several years ago. Surviving are his
widow, two daughters, a sister and two brothers.
Otto E. Weilhamer, Jr., M. D., Cincinnati; Uni-
versity of Cincinnati College of Medicine, 1949;
aged 24; died August 26 while on a vacation trip
in Mexico City. Dr. Weilhamer had recently
completed an internship at Harper Hospital in
Detroit. His parents and a sister survive.
St. Luke’s Hospital, Cleveland
Scheduled October Symposia
Saint Luke’s Hospital, 11311 Shaker Boulevard,
Cleveland, is offering weekly symposia during
October. Following are features of the programs
for the meetings of October 11, 18 and 25.
Wednesday, October 11 — Peptic Ulcer.
“The Roentgenological Diagnosis of Peptic
Ulcer,” Dr. H. F. Inderlied, St. Luke’s Hospital.
“The Pathology of Peptic Ulcer,” Dr. Rafael
Dominguez, St. Luke’s and Western Reserve Uni-
versity College of Medicine.
“The Evaluation of Recent Medical Concepts
of Treatment,” Dr. E. E. Woldman, St. Luke’s.
“The Evaluation of Recent Concepts of Surgi-
cal Treatment,” Dr. D. M. Glover, St. Luke’s
and Western Reserve.
Wednesday, October 18 — Congenital Heart Dis-
ease.
“Evaluation and Clinical Diagnosis,” Dr. A. D.
Nichol, St. Luke’s.
“Roentgen Manifestations and Diagnostic As-
pects,” Dr. D. D. Brannan, St. Luke’s.
“Special Investigative Procedures,” Dr. Charles
A. White, St. Luke’s and Cleveland Children’s
Diagnostic Heart Center.
“Types Remedied by Surgical Therapy,” Dr.
Earle B. Kay, St. Luke’s.
Demonstration of Cases.
Wednesday, October 25 — Endocrinology.
“The General-Adaptation-Syndrome and the
Diseases of Adaptation,” Dr. Hans Selye, Uni-
versity of Montreal.
“Therapeutic Use of ACTH and Cortisone,”
Dr. Selye.
Presentation of Cases, Dr. E. E. Beard, St.
Luke’s and Western Reserve.
RESTHAVEN
A strictly modern convalescent hospital, specially
designed and scientifically equipped for the spe-
cialized care of the aged, convalescent, or cancer
patient.
Accredited by American Medical Association.
Complete cooperation to the attending physician.
For descriptive folder, call or write
M. YOUNG, Business Manager
Telephone FA. 2535 or FA. 4893
813 Bryden Road Colnmbus, Ohio
for October, 1950
1021
Washington Roundup . . .
Social Security Program Is Greatly Expanded by New Law; Governors
Get Model Mental Hygiene Law; Profit on Army X-Rays Not Excessive
The Social Security Law as amended (H.R.6000,
signed by the President on August 28), although
specifically excluding physicians under the pro-
visions for covered self-employed workers, is of
particular interest to doctors who are employers
or employees. Also it is of general interest to
all because of extensive changes in the whole
Social Security structure.
An estimated ten million additional workers
will be covered under provisions of the revised
act.
Under the new provisions for coverage of self-
employed workers, physicians are specifically
excluded as are certain other professional persons
and farmers.
Domestic workers in private homes who are
employed by a single employer for at least 24
days in a calendar quarter for which they re-
ceive wages of at least $50 are covered. In
general, if a person has a maid for one day in
the week she does not come under provisions of
the act; if a person has a maid for two or
more days in the week, she must be covered.
The Commissioner of Internal Revenue is
authorized to prescribe the method by which
taxes are to be collected from domestic workers’
wages. A “stamp plan” has been suggested,
but has not as yet been authorized.
Farm workers and domestic workers in farm
homes are covered. A farm worker becomes
eligible after he works continuously for one farm
operator for three months and then continues
to work for him on a full-time basis on at least
60 different days every three months and earns
$50 or more in cash wages every three months.
The program has been expanded to include
government workers under certain conditions,
employees of some non-profit organizations, etc.
The term “employee” has been redefined to in-
clude many more persons.
New provisions for coverage go into effect on
January 1, 1951. Increased benefits went into
effect as of September 1, 1950.
Benefits have been increased considerably.
For example, the average primary benefit (from
which other benefits are determined) was ap-
proximately $26. Under the revised act it will
be approximately $48.30.
Taxable wages are increased from a maximum
of $3,000 to a new maximum of $3,600. The
tax rate for employer and employee will be: IV2
per cent through 1953 (same as at present);
2 per cent for 1954 through 1959; 2% per cent
for 1960 through 1964; 3 per cent for 1965
through 1969; and 314 per cent for 1970 and
subsequent years.
:-c % ^
Federal Security Agency has sent a model
mental health law to all state governors. Based
on the recommendations of the National Advisory
Mental Health Council and the 1950 Governors’
Conference, the law was prepared by Dr. Robert
H. Felix, director of the National Institute of
Mental Health, and Alanson W. Willcox, gen-
eral counsel of F. S. A.
Grants-in-aid to states represents the largest
single item in the Federal Security Agency bud-
get for mental health. Of the $10,000,000 alloted
for mental health programs, $3,500,000 goes to
states and local communities. Copies of the
model law may be obtained from National In-
stitute of Mental Health, Public Health Service,
Bethesda 14, Md.
>|; >);
Despite alleged abuses in fee charges for
x-ray examinations of Army inductees, a House
subcommittee is satisfied that there was “no
unreasonable compensation.”
The investigating committee was appointed
after it was disclosed that some roentgenologists
in the midwest were taking in as much as
$1,000 a day, handling as many as 200 chest
x-rays per day.
Representative Paul J. Kilday (D-Texas),
chairman of the House Armed Services Sub-
committee, said at the conclusion of a one-day
hearing: “The evidence has not shown unreason-
able compensation. The Army soon will be able
to make nearly all of its own x-ray examina-
tions. In the case where the fees paid private
specialists seem excessive, an effort will be made
to reduce them.”
Testimony of witnesses at the investigation
brought out the following facts:
1. Charges of $5 per each chest picture and
interpretation were not excessive in comparison
with prevailing charges. Major Gen. George
Armstrong said Veterans Administration charged
Army $5 for such service, and that V. A. al-
lowed $10 when it contracted with a private
roentgenologist. In the Washington area, charges
for the same service were as high as $15.
2. Navy is not involved with private roent-
genologists; it does not give chest-x-rays until
recruits reach training centers, where Navy
personnel screen them, using relatively inex-
pensive processes. Air Force is not involved
1022
The Ohio State Medical Journal
THE NEW YORK POLYCLINIC
MEDICAL SCHOOL AND HOSPITAL
(Organized 1881)
THE PIONEER POST-GRADUATE MEDICAL INSTITUTION IN AMERICA
For the GENERAL PRACTITIONER
Intensive full time instruction covering those subjects
which are of particular interest to the physician in
general practice. Fundamentals of the various medical
and surgical specialties designed as a practical review
of established procedures and recent advances in medi-
cine and surgery. Subjects related to general medicine
are covered and the surgical departments participate in
giving fundamental instruction in their specialties.
Pathology and radiology are included. The class is ex-
pected to attend departmental and general conferences.
For the GENERAL SURGEON
A combined surgical course comprising general surgery,
traumatic surgery, abdominal surgery, gastroenterology,
proctology, gynecological surgery, urological surgery.
Attendance at lectures, witnessing operations, examina-
tion of patients pre-operatively and post-operatively
and follow-up in the wards post-operatively. Pathology,
radiology, physical medicine, anesthesia. Cadaver demon-
strations in surgical anatomy, thoracic surgery, proc-
tology, orthopedics. Operative surgery and operative
gynecology on the cadaver.
OBSTETRICS AND GYNECOLOGY
A full time course. In Obstetrics : Lectures ; pre-natal
clinics ; witnessing normal and operative deliveries ; op-
erative obstetrics (manikin). In Gynecology: Lectures;
touch clinics; witnessing operations; examination of pa-
tients pre-operatively; follow-up in wards post-opera-
tively. Obstetrical and gynecological pathology. Anes-
thesia. Attendance at conferences in obstetrics and
gynecology. Operative gynecology on the cadaver.
UROLOGY
A combined full time course in Urology, * covering an
academic year (8 months). It comprises instruction in
pharmacology; physiology; embryology; biochemistry;
bacteriology and pathology; practical work in surgical
anatomy and urological operative procedures on the
cadaver; regional and general anesthesia (cadaver) ;
office gynecology; proctological diagnosis; the use of the
ophthalmoscope; physical diagnosis; roentgenological in-
terpretation; electrocardiographic interpretation; der-
matology and syphilology; neurology; physical medicine;
continuous instruction in cystoendoscopic diagnosis and
operative instrumental manipulation; operative surgical
clinics ; demonstrations in the operative instrumental
management of bladder tumors and other vesical lesions
as well as prostatic resection.
For Information Address
345 WEST 50th STREET MEDICAL EXECUTIVE OFFICER NEW YORK CITY 19
INGLESIDE FARM INGLESIDE HOME
Hospitals for Nervous and Mental Disorders
VIEW AT INGLESIDE FARM
THE FARM - Chardon, Ohio
Telephone Chardon 355
Medical Director, Neil T. McDermott, M.D.
THE HOME - 8821 Euclid Ave.
Cleveland, Ohio Cedar 5416
Mabel A. Woodruff, Director
Facilities for
Chronics and Convalescents
for October, 1950
1023
because, like the Navy, it makes chest-x-rays
only after recruits have reported for duty.
3. On Defense Department approval, Army
instituted the private contract system after it
had released most of its surplus World War II
x-ray equipment to hospitals and clinics in
great need of it. Under peace time conditions
Defense Department believed the private con-
tract system would save money.
4. Army now is taking some of its own sur-
plus equipment out of storage, and soon will
be in a position to do almost all of its own
x-ray examinations.
Ohio Drivers’ Licenses Now Expire
On Licensee’s Birthdays
Drivers in Ohio are purchasing their oper-
ators’ licenses under a new formula this year.
Formerly licenses expired on September 30. The
1950 licenses have this notation: “Expires on
Licensee’s First Birthday After September 30,
1950.”
R. E. Foley, registrar of the State Bureau of
Motor Vehicles, issued the following informa-
tion in regard to the new licenses:
The new licenses are good for three years.
The old license is good until the individual’s
first birthday after September 30, 1950. In
other words, a person whose birthday is on
or before September 30 may use the 1950 license
until his birthday in 1951.
New licenses may be obtained 30 days before
or at any time during the 30 days preceding the
individual’s birthday.
A person may get the new license at any time
for three months following his birthday (but
may not drive legally in the meantime).
If a license is not obtained within three
months after the driver’s birthday, he will be
required to take a test the same as a new
driver.
University of Michigan Fall
Postgraduate Courses
The University of Michigan Medical School,
Ann Arbor, is offering the following postgraduate
courses during the fall:
“Clinical Internal Medicine,” Thursday after-
noons, October 5 - December 21; January 10-
April 19.
“Clinical Exercises for Practitioners,” Wed-
nesdays— October 18 - December 20.
“Special Pathology of Neoplasms,” twice a
week — September 26 - November 17.
“Diagnostic Methods. Clinical and Laboratory
Interpretation,” November 7-10.
“Cancer,” January 16-19.
Further information may be obtained from
Dr. H. H. Cummings, chairman, Department of
Postgraduate Medicine, University Hospital, Ann
Arbor, Mich.
■ mmmM ■
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DOCTORS
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tags, cysts, small tu-
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and for other technics
by electrodesiccation,
fulguration, bi-active
coagulation.
Now, completely re»
designed the new
HYFRECATOR
provides more power
and smoother control
. . . affording better cos-
metic results and great-
er patient satisfaction.
Doctors who have used
this new unit say it pro-
vides for numerous new
technics and is easier,
quicker to use.
$4950 COMPLETE
Send for descriptive bro-
chure, ,e Symposium on
"Electro desiccation and Bi-
Active Coagulation" which
explains the HYFRECA-
TOR and how it works.
THE BIRTCHER CORPORATION
5087 Huntington Drive Los Angeles 32, Calif
To: The BIRTCHER Corp., Dept. os.
5087 Huntington Dr., Los Angeles 32, Calif.
Please send me free booklet, "Symposium on
Electrodesiccation and Bi-Active Coagulation.”
Name.
Street-
City.
.State.
1024
The Ohio State Medical Journal
for October, 1950
1025
Licenses Through Endorsement by
State Medical Board
The Ohio State Medical Board has issued
licenses to practice medicine and surgery in
Ohio to the following physicians, through en-
dorsement of their licenses to practice in other
states:
June 16, 1950 — Gertrude L. Blackshear, Cleve-
land, Univ. of Wisconsin; Tibor Agoston, Co-
lumbus, Univ. of Budapest; William H. Burrow,
Toledo, Univ. of Arkansas; Patrick R. Leonard,
Columbus, Univ. of Nebraska.
August 8, 1950 — Scharrold O. Adams, Cleve-
land, Univ. of Michigan; Robert J. Atwell, Co-
lumbus, Duke Univ.; Walter Baum, Columbus,
New York Univ.; Hugh N. Bennett, Youngstown,
Cornell Univ.; Caroline I. Buttrick, Kent, Johns
Hopkins Univ.; Robert M. Callicott, Utica, Col.
of Medical Evangelists; Lee M. Cattell, Jr.,
Cleveland, Univ. of Michigan; Ralph A. Clave,
Cleveland, State Univ. of Iowa; Jack L. Colgal-
zier, Dayton, Univ. of Nebraska; Roy A. Edwards,
Jr., Columbus, Med. College of Va.
Francis W. Hare, Jr., Akron, Duke Univ.;
Ward D. Heinrich, Cleveland, Hahnemann; Rob-
ert H. Hines, Minerva, George Washington
Univ.; David B. Johns, Cincinnati, Univ. of
Pittsburgh; John W. King, Cleveland, Yale Univ.;
Sidney A. Kottler, Springfield, Vanderbilt Univ.;
James S. Krieger, Cleveland, Univ. of Mich.;
John Leland, Centerville, Emory Univ.; Jack
M. Mosely, Cleveland, La. State Univ.; Carl J.
Nutini, Cincinnati, Univ. of Louisville;
Charles E. Peck, Euclid, New York Univ.;
Joseph G. Peil, Middletown, Indiana Univ.;
Herbert A. Raskin, Toledo, Wayne Univ.; Oscar
D. Ratnoff, Cleveland, Columbia Univ.; John P.
Reed, Jr., Columbus, Univ. of Minn.; John W.
Robertson, Jr., Cleveland, Howard Univ.; Roger
B. Scott, Cleveland, Johns Hopkins Univ.; Benson
R. Snyder, Cincinnati, New York Univ.; George
A. Streeter, Wickliffe, Johns Hopkins Univ.;
Dorothy B. Suyemoto, Cincinnati, Univ. of Michi-
gan;
Samuel A. Trufant, Cincinnati, Tulane Univ.;
Glen B. Van Atta, Belle Center, George Wash-
ington Univ.; Robert E. Wybel, Akron, Harvard;
Genevieve G. Dutton, Athens, Medical College of
Virginia; Wayne W. Dutton, Athens, Medical
College of Virginia; Ralph L. Maddox, Hicksville,
College of Medical Evangelists; Norman M.
Minde, Youngstown, Univ. of Buffalo; Fiorindo
A. Simeone, Cleveland, Harvard; Samuel Gingold,
Cincinnati, Syracuse; Lewis D. Telle, Cleveland,
Univ. of 111.
W. H. MILLER, M. D.
328 East State Street
COLUMBUS 15, OHIO
X-RAY DIAGNOSIS AND THERAPY
FEVER THERAPY
RADIUM
TELEPHONES
Office
MA. 3743
Residence
EV. 5644
The Wendt -Bristol
Company
Two complete ethical stores in
Columbus
51 E. State St.
721 N. High St.
for the convenience of the Physicians and
Surgeons — and the many people they serve
Two Prescription Departments
maintained in a high class manner with
twenty-one registered Pharmacists
Other Complete Departments
OFFICE EQUIPMENT
PHYSIO THERAPY APPARATUS
HOSPITAL SUPPLIES
W-B Pharmaceutical Supplies
JOBBING STOCKS ALL LEADING
MANUFACTURERS
Antitoxins and Vaccines in Special
Refrigeration Plants
Prompt Service on Phone Orders
1026
The Ohio State Medical Journal
Following are the names of new members of
the Ohio State Medical Association, since Aug-
ust 4, 1950. The list shows the county in which
they are affiliated, city in which they are prac-
ticing, or temporary addresses in cases where
physicians are taking postgraduate work.
ALLEN COUNTY
Hugh J. Savage, Lima
FAIRFIELD COUNTY
Rudolph W. Pedigo,
Lancaster
FRANKLIN COUNTY
Thomas J. Trythall, Jr.,
Groveport
GALLIA COUNTY
Oscar W. Clarke, Galli-
polis
John C. Markley, Galli-
polis
Franklin K. Schaefer,
GaLipolis
HAMILTON COUNTY
Arthur T. Evans, Cincin-
nati
Melvin B. Fishman, Cin-
cinnati
John M. Glenn, Cincin-
nati
John N. Hannum, Cin-
cinnati
Melvin A. Lucas, Cin-
cinnati
James Mackay McCord,
Cincinnati
Hilmer W. Neumann,
Cincinnati
R. C. Pogge, Cincinnati
Elmer A. F. Schlueter,
Cincinnati
Paul A. Schuster,
Cincinnati
Roland F. Shirley, Cincin-
nati
Stanley H. Wilier, Cincin-
nati
JEFFERSON COUNTY
James L. Childs,
Steubenville
LUCAS COUNTY
Christopher G. Palans,
Toledo
James E. Schaal, Maumee
MAHONING COUNTY
Robert J. Heaver, Youngs-
town
MARION COUNTY
Robert C. Campbell,
Marion
A. J. Willey, Marion
MEIGS COUNTY
William H. Jeric,
Pomeroy
RICHLAND COUNTY
Max D. Garber, Mans-
field
TUSCARAWAS COUNTY
Paul W. Ebert, D'over
Max L. Rohrer, New
Philadelphia
Clinic in Cleveland Matches
Cardiacs to Job Demands
The Work Classification Clinic opened recently
in Cleveland under direction of the Cleveland
Heart Society and after approval by the Cleve-
land Academy of Medicine. Principal function
of the clinic, the second of its kind in the United
States, is to evaluate the working capacity of
persons stricken with a heart ailment.
The clinic performs the following four func-
tions: Appraises the cardiovascular system of
the victim; analyzes the total physical capacity
of the individual; analyzes the demands of the
specific job; and strives to match the physical
capacity of the cardiac to the job demands.
Dr. Herman K. Hellerstein, research cardi-
ologist at University Hospitals, is director of
the unit. A panel of specialists sits twice a
week to review cases. The panel consists of
Drs. Edward M. Kline, Harold Feil and A.
Carleton Ernestene.
■Medical • Dental Management-
Of Cincinnati
WILL SURVEY AND STUDY
YOUR BUSINESS AFFAIRS
Our experience working exclusively
in physicians’ and dentists’ offices
makes impartial judgment possible.
WILL GIVE EXPERT
ATTENTION TO
Preparing your tax returns.
Handle tax examinations.
Managing your practice and office.
Install simplified but adequate books.
Instruct secretary in keeping books.
Audit these books.
Report to you every month.
Guide general office routine.
Compare fees with similar practices.
Service patients' accounts —
No commission.
Assist in your public relations.
Advise in buying & selling practices.
Reviewing Your Estate
Investments — insurance — trusts.
ALL SERVICE STRICTLY
CONFIDENTIAL
You may arrange for an interview in
your office — No Obligation. You may
discontinue our service at any time,
and we reserve the same privilege. We
render service to clients within 100
miles of Cincinnati. Our rates on a
month-to-month basis are Surprisingly
Low.
—Medical - Dental Management—
Of Cincinnati
514 U. S. F. & G. Bldg. 24 East Sixth St.
Cincinnati 2, Ohio
It is emphasized that the clinic offers neither
diagnostic nor therapeutic services.
GArfield 5160
Clayton L. Scroggins Raymond E. Scroggins
William H. Scroggins III
for October, 1950
1027
Ninth District To Convene in
Scioto County, Oct. 12
The Hempstead Academy of Medicine will be
host to the Ninth District of the Ohio State
Medical Association with a scientific program on
Thursday, October 12. The meeting will be held
at the Chez Paree in Wheelersburg, which is a
few miles east of Portsmouth on Highway 52.
The one-day course on “Mother and Child”
will be conducted by Dr. Thomas E. Shaffer and
Dr. Allan C. Barnes, both of the Ohio State
University College of Medicine, Columbus. Dr.
Shaffer is professor of pediatrics, director of
student health at the University and consultant
to the Neonatal Nurseries of University Hos-
pital. Dr. Barnes is professor and chairman
of the Department of Gynecology and Obstetrics.
The following features are scheduled:
2 p. m. — “The Infertile Couple,” the practical
office approach to the diagnosis and treatment of
the sterile couple — Dr. Barnes.
3 p. m. — “The Rh Negative Mother.” Specifi-
cally and definitely what to do and what to
recommend for the pregnant woman who is Rh
negative; management of the newborn in these
cases — Dr. Shaffer.
4 p. m. — “Dietary Management of Pregnancy
and Its Complications.” No chemistry, but what
should be eaten and why; how these patient
instructions can be modified for some of the
commoner complications of pregnancy — Dr.
Barnes.
5 p. m. — “Problems of the Neonatal Period.”
The new-born child and some of its emergency
complications and congenital difficulties — Dr.
Shaffer.
6:30 p. m. — Dinner.
8 p. m. — “The School Child.” The Ohio law on
school health examinations and how it affects
the practitioner. The tests that are of value
and those that are not — Dr. Shaffer.
9 p. m. — “The Use of the Female Sex Hormones
in General Practice.” The endocrine products
and programs that can be expected to work,
and those which have little reasonable chance
of helping the patient — Dr. Barnes.
The U. S. Public Health Service reported the
following figures on prevalence of poliomyelitis
in Ohio: Week ending September 2, 1950, 98
cases; week ending September 3, 1949, 171
cases; total (beginning with the 12th week of
each year) for 1950, 445; total for 1949 (same
period), 886; five-year median, 1945- 1949, (same
period) 304.
According to statisticians of the Metropolitan
Life Insurance Company, there are more
than 250,000 diabetics in the labor force in this
country at the present time.
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The Ohio State Medical Journal
Northwestern Association Schedules
Program at Lima, October 17
The Northwestern Ohio Medical Association
has scheduled its annual scientific program at
Lima on October 17. The meeting will be held
at the Shawnee Country Club with registration
beginning at 9:30 a. m. The group has arranged
with a team from the University of Wisconsin
Medical School to conduct the scientific sessions.
Following are features of the program:
“The Third Stage of Labor — Normal and Ab-
normal,” Dr. John W. Harris, professor and
chairman, Department of Obstetrics and Gyn-
ecology.
“The Chemosurgical Method for the Micro-
scopically Controlled Excision of External Can-
cer,” Dr. Frederic E. Mohs, associate professor of
chemosurgery.
“The Role of Proctoscopy in General Practice,”
Dr. Karver L. Puestow, professor of clinical
medicine.
“Drug Allergy,” Seymour B. Creapea, assist-
ant professor of internal medicine and chairman
of the Department of Allergy.
“The Growing Field of Postgraduate Edu-
cation,” Dr. Robert C. Parkin, coordinator of
graduate medical education.
Communications in regard to the meeting
should be directed to Dr. Ralph E. Rasor, presi-
dent of the Northwestern Ohio Medical Associa-
tion, or Dr. E. H. Evans, secretary, both of
Findlay.
Medical Advisory Committee for
Blood Bank Named
A regional medical advisory committee to the
Red Cross Blood Program in this area was
organized at a meeting held September 14, at
the Seneca Hotel. Attending the meeting were
chairmen of the medical advisory committees
in the 23-County area serviced by the Columbus
Regional Blood Center.
Elected to serve on the executive committee
of the regional medical advisory committee are
Dr. Harve M. Clodfelter, Columbus, Chairman;
Dr. J. G. Parker, Delaware, Vice-Chairman;
Dr. T. W. Geoghegan, Fostoria; Dr. K. F. Lowry,
Troy; Dr. J. M. Goodman, Athens; Dr. Robert
W. Wolford, Mansfield; Dr. John C. Drake, Mt.
Vernon; Dr. H. M. Crumley, Chillicothe.
The over-all policies for the medical phases
of the Red Cross Regional Blood Program are
made by the medical advisory committee for
each county. The purpose of the regional ad-
visory group is to coordinate these policies.
Dr. Clodfelter has served on the medical ad-
visory committee of the Blood Center prior to its
opening on December 7, 1948.
There are 27 Red Cross chapters in this
regional area.
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American College of Physicians
Midwest Meeting, Nov. 18
The Midwest Regional Meeting of the American
College of Physicians will be held at the Memorial
Union Theater on the campus of the University
of Wisconsin, Madison, Saturday, November 18.
Registration will begin at 8 a. m. and the
scientific meetings will be followed by a social
hour and dinner to be held at the Loraine Hotel
beginning at 5:30 p. m.
The day will be filled by the presentation of
scientific papers. In addition, a scientific exhibit
will be provided at the Memorial Union Theater.
All physicians and their wives are invited.
Entertainment has been provided for the ladies.
Additional information may be had from Dr.
Robert C. Parkin, coordinator, The University
of Wisconsin Medical School, Madison, Wise.
Reservations for luncheon and dinner should be
made through Dr. H. M. Coon, 1300 University
Ave., Madison 6, Wise.
Eighth District Schedules Meeting
At Newark, October 5
The fall meeting of the Eighth District of the
Ohio State Medical Association has been sched-
uled at the Moundbuilders Country Club, Newark,
Thursday, October 5.
The following features have been announced:
1:30 p. m. — “Principles of Topical Therapy in
Dermatology,” Dr. Arthur J. Tronstein, Newark.
2:30 p. m. — “Treatment of the Skin and Skin
Lesions by X-ray and Radium,” Dr. Arnold D.
Piatt, Newark.
3:30 p. m. — “Medicgl Aspects of Atomic War-
fare,” Dr. George L. Sackett, Cleveland.
Business meeting following scientific discus-
sion with Dr. James B. Johnson, Newark, Dis-
trict President, presiding.
6:30 p. m. — Banquet with the Auxiliary.
Fellowship Grants
Two Ohio men were awarded fellowship grants,
part of a $261,700 Federal grant. A total of
89 students in 20 states and two foreign coun-
tries received fellowships awarded on recom-
mendation of the Fellowship Boards of the six
National Institutes of Health (Heart, Cancer,
Mental Health, Experimental Biology and Medi-
cine, Microbiology, and Dental).
Ohio recipients are Harvey C. Knowles, Chil-
dren’s Hospital Research Foundation, Cincinnati,
$3,600, determination of changes in concentra-
tion of intracellular electrolytes in severe diabetic
and other states; and Max Schlamowitz, Ohio
State University, $3,600 investigation of the
properties and biological functions of the gal-
actogens.
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ANNOUNCES CONTINUOUS COURSES
SURGERY— Intensive Course in Surgical Technic,
two weeks, starting Oct. 23, Nov. 27. Surgical
Technic, Surgical Anatomy & Clinical Surgery,
four weeks, starting Oct. 9, Nov. 6. Surgical
Anatomy & Clinical Surgery, two weeks, starting
Oct. 23, Nov. 20. Surgery of Colon & Rectum,
one week, starting Oct. 16, Nov. 27. Breast &
Thyroid Surgery, one week, starting Oct. 2. Thor-
acic Surgery, one week, starting Oct. 9. Gall-
Bladder Surgery, ten hours, starting Oct. 23.
Fractures and Traumatic Surgery, two weeks,
starting Oct. 9.
GYNECOLOGY — Intensive Course, two weeks, start-
ing Oct. 23. Vaginal Approach to Pelvic Surgery,
one week, starting Nov. 6.
OBSTETRICS — Intensive Course, two weeks, start-
ing Nov. 6.
MEDICINE — Intensive General Course, two weeks,
starting Oct. 2. Gastro-enterology, two weeks,
starting ' ct. 16. Gastroscopy, two weeks, start-
ing Oct. 23. Electrocardiography & Heart Disease,
four weeks, starting Oct. 2.
DERMATOLOGY Formal Course, two weeks, start-
ing Oct. 16. Informal Clinical Course every two
weeks.
CYSTOSCOPY — Ten Day Practical Course every two
weeks.
PEDIATRICS — Informal Clinical Course every iwo
weeks.
General, Intensive and Special Courses in all
Branches of Medicine, Surgery and the Specialties
TEACHING FACULTY — ATTENDING
STAFF OF COOK COUNTY HOSPITAL
Address
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CHICAGO 12, ILLINOIS
1030
The Ohio State Medical Journal
Activities of County Societies . . .
CLINTON
Members of the Clinton County Medical So-
ciety and their wives held a dinner meeting
at the Snow Hill Country Club on Aug. 2. Dr.
Edward B. Headley, new commissioner of the
Clinton County Health District, and Mrs. Headley
were guests at the meeting. Following a busi-
ness session, Dr. Kelley Hale, Wilmington,
showed color pictures of his recent trip to the
West.
DARKE
“British Socialism and America’s Number One
Lesson” was the subject of a discussion by Dr.
John Martin, Dayton, at the Sept. 19 meeting
of the Darke County Medical Society in Green-
ville. The dinner meeting was attended by
members, their wives and guests.
GUERNSEY
The regular meeting of the Guernsey County
Medical Society was held Sept. 7 at the Cam-
bridge State Hospital, with Dr. Reo M. Swan,
president, in the chair, and 16 members present.
Dr. Arthur T. Hopwood, superintendent of the
hospital, was in charge of the scientific progam
and had invited members of the Society to be his
guests for luncheon. A fine meal was enjoyed
by all.
After luncheon, members were conducted to
one of the spacious assembly rooms of the hos-
pital for business and scientific meetings.
Contents of some important bulletins from
the A. M. A. and the Ohio State Medical Asso-
ciation were called to the attention of members
by the secretary. Members delinquent in paying
their A. M. A. dues for 1950 were reminded.
The probable order of sequence in which doctors
would be called by the Armed Forces was
mentioned.
Doctors and their families were reminded of
the importance of being registered so as to be
able to vote in the coming election.
Next came the scientific portion of the pro-
gram, in charge of Dr. Hopwood, ably assisted
by members of his resident staff, Drs. Martin
and Latta. Each doctor presented two illustra-
tive cases of mental illness along with pertinent
history and examination findings. The patients
whose cases had been presented were brought
into the room and leading questions asked of
them by the presenting doctors.
The following cases were represented:
1. Two cases of paresis — one who had re-
ceived early and adequate antiluetic therapy
(penicillin, fever, mapharsen and bismuth), and
another whose paresis had existed for about
five years before proper therapy. The early case
had apparently made a good recovery whereas
the late case had shown but little improvement.
2. Cases of cerebral arteriosclerosis and of
Altheimer’s disease (organic psychosis).
3. Cases of chronic delirium tremens and
schizophrenia.
At the conclusion of this fine meeting, the
president expressed the thanks of the Society
for Dr. Hopwood’s hospitality. — Gordon Lawyer,
M. D., Sec’y.-Treas.
LORAIN
“Current Problems Affecting the Ohio Medi-
cal Association,” was the subject of a discussion
by Dr. Fred W. Dixon, Cleveland, President-Elect
of the Association, at the Sept. 12 meeting of
the Lorain County Medical Society. Memorial
addresses in behalf of the late Dr. Benjamin
Carlson and the late Dr. Robert Hancock were
given by Dr. Peter A. Etzkorn and Dr. J. T.
Fawcett, respectively.
MIAMI
Medical-economic problems of the medical
profession were discussed at the Sept. 8 meeting
of the Miami County Medical Society in the
Stouder Hospital, Troy.
Society sponsored radio health programs are
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Complete facilities for training Re-
tarded and Epileptic children educa-
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Recreational facilities include rid-
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Catalogue on Request
G. H. MARQUARDT, M. D.
Medical Director
BARCLAY J. MacGREGOR
Registrar
29 Geneva Rd., Wheaton, Illinois (near Chicago)
for October, 1950
1031
broadcast over Station WPTW, Piqua, every
Saturday at 10:30 a. m. The current series in
September was “Your Child Goes to School.”
MAHONING
Dr. M. A. Blankenhorn, professor of medicine,
University of Cincinnati College of Medicine,
spoke at the Sept. 19 meeting of the Mahoning
County Medical Society in the Elks Club.
Announcement of three coming meetings were
made as follows:
Oct. 17 meeting guest speaker will be Dr. A.
R. Moritz, professor of pathology, Western Re-
serve University School of Medicine.
Nov. 14 meeting speaker will be Dr. Howard
F. Root, member of the Joslin group in Boston
and president of the American Diabetic Society.
The meeting will coincide with the national
Diabetic Detection Week drive.
The December meeting will feature the election
of officers.
PUTNAM
Matters relating to organization and the
military emergency were discussed at the Sept.
5 meeting of the Putnam County Medical So-
ciety at Columbus Grove. The next meeting
will be held at Witteborg’s Restaurant, Co-
lumbus Grove, at which time the 50- Year Pin
and Certificate of the Ohio State Medical Asso-
ciation will be presented to Dr. Charles W. Bird,
of Continental.
SUMMIT
Dr. Spafford Ackerly, professor and chairman
of the Department of Psychiatry, University of
Louisville School of Medicine, was guest speaker
at the Sept. 5 meeting of the Summit County
Medical Society. His subject was “The Prob-
lem of the Adolescent.” The meeting was held
in the Nurses’ Home of the Akron City Hospital.
TUSCARAWAS
Members of the Tuscarawas County Medical
Society and Auxiliary were guests at the country
home of Dr. D. D. Hostetler, Sugarcreek, for
an outing on Aug. 9.
Retirement of Assistant Surgeon General R. E.
Dyer, director of the National Institutes of
Health, has been announced. He has accepted
an appointment as director of research at the
Robert Winship Clinic of Emery University
Medical School, Atlanta, Ga.
The Schering Corporation has announced the
establishment of another Research Fellowship
in Endocrinology at Rutgers University. The
grant is valued at $2,300, and is intended to
support fundamental research by graduate stu-
dents in the field of steroid hormones.
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1032
The Ohio State Medical Journal
• • •
Woman’s Auxiliary
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
President — Mrs. George W. Cooperrider, 1828 Bryden Road,
Columbus
President-Elect — Mrs. Farrell Gallagher, 1527 W. Clifton
Blvd., Lakewood
Vice-President — Mrs. E. P. Greenawalt, 1707 St. Paris Road,
Springfield
Recording - Secretary — Mrs. Ross Knoble, 219 - 44th St.,
Sandusky
Corresponding Secretary — Mrs. Oscar Jepsen, Canal Win-
chester
Treasurer — Mrs. A. Paul HancufT, 3551 Maxwell Road,
Toledo 13
Past-President — Mrs. C. W. Kirkland, 4805 Guernsey Street,
Bellaire
CHAS. F. BOWEN, M. D.
332 East State Street
COLUMBUS 15, OHIO
X-RAY DIAGNOSIS
AND
TREATMENT
OF
CLARK
Mrs. E. W. Keefer, chairman of public rela-
tions for the Clark County Auxiliary, supervised
the auxiliary’s medical exhibit at the Clark
County Fair in August. Assisting on the com-
mittee were Mrs. W. D. Beasley, Mrs. E. R.
Hargett, Mrs. G. F. Ross, Mrs. George Smith
and Mrs. John Summers. Members of the
auxiliary turned out in force to lend assistance.
The care of babies during their first year of
life was a feature of the exhibit. The Fall
“get-together” of the group will be held at
the home of Mrs. Harold Shanklin on Sept. 18.
HAMILTON
Mrs. Richard D. Bryant, president of the
Woman’s Auxiliary to the Hamilton County Medi-
cal Society, was hostess to her new board early
in September at a luncheon at the Cincinnati
Woman’s Club. Plans were made to sponsor a
dinner-dance for the group’s Scholarship Fund.
A similar dinner-dance held this past year en-
abled the Auxiliary to give $200 to the Univer-
sity of Cincinnati College of Nursing and Health,
and $1,000 to the University of Cincinnati Col-
lege of Medicine — half the amount goes to the
Medical College Library and half to aid medi-
cal education through scholarships.
MAHONING
The Mahoning County Auxiliary kept actively
engaged during the summer months in helping
toward the defeat of Reorganization Plan No. 27.
Under supervision of its president, Mrs. William
H. Evans, the members cooperated with its
County Society by mailing some 3,000 letters
and circulars protesting the passage of this bill.
The group also has made an intensive effort
to get all county members, their wives and adult
members of their families registered so that
they will be eligible to vote in November.
An informal dance was scheduled for Sept. 23,
proceeds of which go toward the Nurses’ Schol-
arship Fund.
Mrs. Evans’ official family includes: Mrs. Paul
J. Mahar, vice-president; Mrs. Samuel Zoss,
CANCER
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H. M. BRUNDAGE, M.D., Director
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Telephone: MAin 2490
for October, 1950
1033
treasurer; Mrs. A. E. Rappaport, secretary;
Mrs. John Rogers, corresponding-secretary; Mrs.
C. A. Gustafson, president-elect. This year marks
the tenth anniversary of the organization of the
Mahoning County Auxiliary.
ROSS
The Woman’s Auxiliary to the Ross County
Academy of Medicine, entertained the state presi-
dent, Mrs. George W. Cooperrider at its first
dinner meeting of the season Sept. 7, at the
Warner Hotel. Other guests at the meeting in-
cluded Mrs. W. F. Heine, president of the
Pickaway County Auxiliary, Mrs. Ray Carroll
of Circleville and Mrs. Frank J. Lacksen of
Columbus. Mrs. Walter E. Kramer, president,
conducted the business session that followed the
dinner, and introduced Mrs. Cooperrider who
gave highlights of the national convention held
in June in San Francisco. The speaker also
discussed auxiliary plans for the coming year
and gave suggestions for work and projects of
the local group.
Mrs. Heine spoke on the activities of the
Pickaway group and told of its accomplishments
during the past year. Mrs. G. Howard Wood,
chairman of the Nurses’ Loan Fund, reported
on the meeting of her committee. Other com-
mittee chairmen gave reports.
According to a census made January 1, 1950,
by the Public Health Service, 25,081 public
health nurses were in public work in 1950, which
was 1,708 more than the number reported in
1949.
COMING MEETINGS
Ohio State Medical Association, Annual Meet-
ing, Netherland Plaza, Cincinnati, April 24-26,
1951.
A. M. A. Clinical Session, Cleveland, December
5-8.
Eighth Councilor District Fall Meeting, Mound-
builders Country Club, Newark, October 5.
International College of Surgeons, U. S. Chap-
ter, Annual Assembly, Cleveland, October 31-
November 3.
Medina Community Hospital, Scientific Pro-
gram, Westfield Country Club, LeRoy, October 4.
Sixth Councilor District Postgraduate Day, St.
Francis Hotel, Canton, October 4.
Ninth Councilor District Fall Meeting, The
Chez Paree, Wheelersburg, October 12.
Northwestern Ohio Medical Association, Annual
Scientific Program, Shawnee Country Club, Lima,
October 17.
Ohio Society of Allergists, Seneca Hotel, Co-
lumbus, October 7-8.
Second District Annual Program and Banquet,
Biltmore Hotel, Dayton, October 18.
INDEX TO ADVERTISERS
Abbott Laboratories
Ann Arbor School, The
Ar-Ex Cosmetics, Inc.
Ayerst, McKenna & Harrison, Ltd._
Baker Laboratories, Inc
Bell, Kathryn S., Inc.
Birtcher Corporation, The
Bowen, Charles F., M. D.
Camp, S. H., Company
_ 961
.1032
1035
. 943
. 946
1032
1024
1033
958
Capital City Welding Co 1029
Cincinnati Sanitarium 950
Clinical and Pathological Laboratory 1033
Coca-Cola Company 1025
Columbus Orthopaedic Appliance Co 1030
Cook County Graduate School of Medicine 1030
Davies, Rose & Co., Ltd. 945
General Electric X-Ray Corp.._- 960
Hanger, J. E., Inc. 1028
Harding Sanitarium 951
Ingleside Home, Inc 1023
Lederle Laboratories, Inc. 1017
Insert Between
964 and 965
963
950
Lilly, Eli, and Company.
Maltbie Laboratories
McMillen Sanitarium
Mead Johnson & Company
Medical-Dental Management
Medical Protective Company
Mercer Sanitarium, The
Merck & Company, Inc.
Miller, W. H., M. D
M & R Dietetic Laboratories, Inc.
New York Polyclinic Medical School.
Num Specialty Company
Oak Ridge Sanatorium
Back Cover
1027
1028
951
947
1026
953
1023
1035
952
Parke, Davis & Company 1036, and
Inside Back Cover
Pfizer, Charles & Co., Inc 1019
Pogue, The Mary E., School 1031
Quincy X-Ray & Radium Laboratories 1035
Resthaven . 1021
Rexair Division, Martin-Parry Corp. 1025
Rupp & Bowman Company 1029
Sandoz Pharmaceuticals, Inc. 962
Sawyer Sanatorium 941
Schering Corporation 959
Schmid, Julius, Inc 956
Searle, G. D. & Company 1011
Squibb, E. R., & Sons.
Stoneman Press
Upjohn Company
Wander Company
954 and 955
962
1015
964
1026
Wendt-Bristol Company
Wickhaven Sanitarium 951
Windsor Hospital 951
Winthrop-Stearns, Inc 1013
Wyeth, Inc 957
1034
The Ohio State Medical Journal
Gtallilied Adve.’iti&eme+ttl
Rates: 50 cents per line. Minimum charge of $1.00 for each insertion. Price covers the cost
of remailing answers. Forms close 16th of the month preceding publication.
FOR SALE : Brown-Berger cystoscopes, urethrascope,
metal and glass instrument cabinet. Box 95, Ohio State
Medical Journal.
OPPORTUNITIES FOR PHYSICIANS: Are you inter-
ested in a position of one of our county or district health
departments? Salary $5,600 to $7,200, with $70 a month
travel allowance. Public health scholarships available with
liberal stipends. Men and Women physicians eligible. Felix
J. Underwood, M. D., Mississippi State Board of Health,
Jackson, Miss.
WANTED : Thoroughly competent physician for In-
dustrial office. Must be graduate of Class A School with
adequate hospital training. Salary $6,000.00. 200 Republic
Bldg., Cleveland 15, Ohio.
WANTED: General practitioner to locate in Ohio rural
community. Death of two former resident physicians
leaves the community without adequate medical service.
Residence available ; excellent school ; three Protestant
churches ; good water and sewage systems ; open staff hos-
pital 8 miles ; financial assistance if needed. Write W. W.
Windham, Rushsylvania, Ohio.
Columbus — Dr. Emmerich von Haan recently
was promoted to the rank of Colonel in the
Army Medical Corps Reserve. He is command-
ing officer of the 49th Evacuation Hospital, a
Reserve unit affiliated with Ohio State Univer-
sity. His commission was presented by Brigadier
General Edward T. Kirkendall, Columbus, senior
Reserve physician in Ohio.
According to experience among industrial
policy holders of the Metropolitan Life Insurance
Company, the lowest first-quarter death rate for
influenza and pneumonia was established for
the first three-months of this year. This is in
spite of a widespread outbreak of both diseases.
FOR SALE : G. E. Model B. Electrocardiograph with
regular AC current and auxiliary A battery connections
with carrying case and stand. Perfect condition. $300.
W. T. Wilkins, Jr., M. D., Phone 1950, Piqua, Ohio.
WANTED : Resident in psychiatry, or psychiatrist with
one or two years experience, for acute service for 80-bed
Receiving Hospital. Apply for particulars. Eugene E.
Elder, M. D., Supt., Youngstown Receiving Hospital, Youngs-
town, Ohio.
FOR SALE : Established general practice of 39 years : also
drugs and equipment. Office available ; small, progressive
village on Lake Erie ; physician recently deceased. Box 114,
Vermilion, Ohio.
WANTED : Thoroughly competent woman physician for
Industrial Office. Must be graduate of Class A School
with adequate hospital training. 200 Republic Building,
Cleveland 15, Ohio.
WANTED : Woman physician to do Obstetrics and
Pediatrics ; assist older well-established F. A. C. S. Excel-
lent hospital facilities ; salary and percentage from start.
Minnesota License or National Board Part 1 & 2. Suburb
of Twin Cities ; apartment available. Wonderful oppor-
tunity for future. Box 612, Ohio State Medical Journal.
PRO TEM in Columbus or vicinity while awaiting military
recall. Why not take a week’s vacation now ? Box 620,
Ohio State Medical Journal.
HEALTH COMMISSIONER wanted for full-time position
in a recognized General Health District. Salary open.
Write: R. E. Merrill, M. D., Acting Health Commissioner,
Fulton County Health Department, Wauseon, Ohio.
PUBLIC HEALTH NURSE wanted for full-time position
in a recognized General Health District. Salary open.
Write: R. E. Merrill, M. D., Acting Health Commissioner,
Fulton County Health Department, Wauseon, Ohio.
WANTED: Registered Medical Technician, Dayton; Private
Laboratory. Answer, Box 619, Ohio State Medical Journal.
RADIUM and RADIUM D+E
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FOR ALL MEDICAL PURPOSES
Est. 1919
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of women who could wear no other
polish used.
At last, a nail polish for your allergic patients.
In 7 lustrous shades. Send for clinical resume: S? AR-EA
C&imetiei.
AR-EX COSM ETICS, I NC. 1036 w. van buren st., Chicago 7, ill.
for October, 1950
1035
Unexpected side effects sometimes nullify the anticipated benefits oi
antibiotic therapy. With CHLOROMYCETIN, such side effects rarel>
interfere with its well-known efficacy in a wide range of disorders,
Chloromycetin
CHLOROMYCETIN is well tolerated. Reactions are infrequent, and
those that do occur are slight. Interruption of treatment because of
severe reactions is rarely necessary.
Here’s medicine that sweets-loving small fry (and
many adults) really enjoy — sulfadiazine-sulfamerazine
disguised in orange-colored, candy-flavored cubes.
Mothers find Duozine Dulcet Tablets easy to admin-
ister in exactly the prescribed dosage. You’ll find them
effective in many systemic infections. The combined sul-
fonamides are independently soluble in the urine, with the
result that high blood levels can be maintained with small
likelihood of crystalluria and renal damage.
Duozine Dulcet Tablets, sulfadiazine-sulfamerazine in
equal parts, are available in 0.3-Gm. and0.15-Gm. potencies,
bottles of 100. Mighty "take-able” med- ft p p . .
ication when sulfonamides are indicated. V/LUTTOiX
. S'*"
Use tt
See that the Rx reads
TRADE MARK
(SULFADIAZINE-SULFAMERAZINE COMBINED, ABBOTT)
® MEDICATED SUGAR TABLETS, ABBOTT
for November, 1950
1043
*7 <4e PUylicicuiA feo-ahlUelh
By JONATHAN FORMAN, M. D.
Santa Claus, M. D., by W. M. Bauer, M. D.,
t$2.75. The Bobbs-Merrill Co., Indianapolis 7,
Ind.) states the physicians' side of the con-
troversy on compulsory prepayments for sick-
ness benefits. The Doctor of Health Education
for the American Medical Association makes a
good case for the efficiency of our present Ameri-
can medical care program on basis of present
day health. He explodes the myth of our poor
health. Here you will find the answers to all
the misinformation put out by those who propose
to take over the medical care of America, what-
ever their motive may be. Here are also the
details of the positive constructive steps that are
being taken to help the individual solve his own
medical care problems. All the ammunition that
a physician needs to defend himself, his profes-
sion, and his country from socialization after
the pattern of Karl Marx.
The First Anesthetic — The Story of Craw-
ford Long, by Frank K. Boland, M. D. ($3.00.
University of Georgia Press, Athens, Ga.), is
the work of a professor of surgery at Emory
University who has worked tirelessly to estab-
lish Long’s priority. Dr. Boland has produced
a persuasive and readable story.
Has Your Child a Cleft Palate? (Apply.
Commission for Handicapped Children, Spring-
field, Illinois), is the story of the cleft palate
and of how children who have this condition
may be helped medically and educationally. The
pamphlet has been prepared for use in connec-
tion with the training given by properly qualified
speech correctionists.
Acrylic Plastics in Dentistry, by Jacob R.
Schwartz, D. D. S., ($11.00. Dental Items of In-
terest Publishing Co., Inc., Brooklyn, N. Y.)
brings us up to date on this important question
of plastics.
Microphthalmos and Anophthalmos With or
Without Coincident Oligophrenia, by Torsten
Sjogren and Tage Larsson, (Ejnar Munksgaard,
Norregade 6, Copenhagen) , is a clinical and
genetic-statistical study, presenting 137 cases of
patients with blindness.
Compulsory Medical Care and the Welfare State,
by Melchior Palyi, ($2.00. NaVl. Institute of
Professional Services, Inc., Chicago, III.), is
an analysis based on a special study of govern-
alized medical care system on the continent of
Europe and in England. The first comprehen-
sive survey on compulsory medical care in
various countries. The emphasis is on the major
economic, political, and social implications and
resultants. The publishers are interested in
wholesaling it to you. You will do a service
if you buy a copy for your more influential
patients.
Research in Medical Science, edited by David
Ezra Green, Ph. D., and W. Eugene Knox, M. D.,
($6.50. MacMillan Company, New York City),
presents some 26 different aspects of medical
research reviewed by a representative of the
particular field. So we have an intimate pic-
ture of the methods and problems which in-
culcate medical research.
The Pioneer Doctor in the Ozarks White River
Country, by Amy Johnson Miller, ($2.50.
Burton Publishing Company, 722 Main St.,
Kansas City 2, Mo.), is a daughter’s portrait
of her father, John Cable Breckenridge John-
son, M. D. It is not Art but it is good local
history. More of us should take time to record
the events in the lives of our families so that
future historians of our Universities can get
a true picture of our times. If we have the
money we should have the records published
and distributed to the younger members of our
clan. If we are short of funds, I suggest that
we forego the monument over our graves, or
ask our friends to forego the flowers and give
the money to a fund for the publication of our
manuscript. If we are entirely short of funds
for this purpose, prepare the manuscript and
turn it over to the Historical Society who will
keep it available for future scholars. Mrs.
Miller is to be congratulated for her effort. We
who are interested in local history know that
without such manuscripts future scholars will
not have the necessary materials with which to
do their work. There is no better source of
knowledge about our past than what Society did
to its physicians, and what its physicians did
for it.
Freud: Dictionary of Psychoanalysis, edited
by Nandor Fodor and Frank Gaynor, ($3.75.
The Philosophical Library, Inc., New York City),
is an attempt to preserve the sacred memory
of the master by giving us his definitions of
terms. Are we to infer that there can be
no change? Reminiscent of Samuel Thomson.
Lipidoses: Diseases of the Cellular Lipid
Metabolism by Siegfried J. Thannhauser, M. D.,
($12.00. Second Edition. Oxford University
Press, New York City). While the book gives
us the chemical facts, the author insists that
physical and chemical means in medicine should
1044
The Ohio State Medical Journal
never replace, but rather supplement, the art
of seeing, feeling, and listening. The idea of
“engineer of health,” he says, “is a deplorable
misconception of the physician of the future.” The
volume is another revised reprint from Oxford
Loose-Leaf system.
Penicillin and Streptomycin in the Treatment
of Infections, by Chester S. Keefer, M. D., and
Donald G. Anderson, M. D., ($2.50. Oxford
University Press, New York City) is a separate
reprint from the Oxford Loose-Leaf Medicine.
Monographs on Surgery, 1950, edited by B.
Noland Carter, M. D., Cincinnati General Hos-
pital, ($12.50. Thomas Nelson & Sons, Neiv
York City), represents a distinct change in
policy of the publisher. Instead of the loose-
leaf form, a bound volume is to be offered an-
nually.
Gynecologic Diagnosis, by Robert Tauber,
M. D., ($6.00. Thomas Nelson & Sons, New
York City) is devoted solely to diagnostic mat-
ters, including 30 problems offered for mental
exercise and stimulation in addition to the prac-
tical training in the art of diagnosis.
Proctology in General Practice, by J. Peerman
Nesselrod, ($6.00. W. B. Saunders Co., Phila-
delphia, Pa.), is the fruit of years of labor in
the study, laboratory, operating room, at the
bed-side, and in the consultation room, by one
of our best specialists in the field.
Malaria: The Biography of a Killer, by Leon
J. Warshaw, M. D., ($3.75. Rinehart & Co.,
New York City), is the history of the world’s
greatest killer.
Essential Urology, by Fletcher H. Colby, M. D.,
($8.00. Williams & Wilkins, Baltimore, Md.),
is a text based upon the subject as practiced
at the Massachusetts General Hospital.
Diseases of the Eye, Ear, Nose, and Throat.
A Text for Nurses, by Albert P. Seltzer, M. D.,
($4.00. McGraw-Hill Book Co., New York City),
is based upon not only the author’s years as a
teacher of nurses, but also by the writings of
many specialists, in an effort to give a sound
basis for the essential information of the stu-
dent nurse.
The Mystery of Sex and Race Regeneration,
by R. Swinburne Clymer, M. D., ($3.00. Fourth
Edition. Philosophical Publishing Co., Quaker-
town, Pa.), presents the spiritual approach of
“an old fashioned” clergyman with an M. D.
degree. The author is positive in his con-
demnation of all the “evils of sex.”
Medical Entomology, by Robert Matheson,
($7.50. Second Edition. Comstock Publishing
Co., Ithaca, N. Y.), has assumed much greater
importance than its first edition. In the light
of our World War II experience, insects have
become recognized as having an important role
in human welfare.
Magic Cloak, A Contribution to the Psychology
of Authoritarianism, by James Clark Maloney,
M. D., ($5.00. Montrose Press, W ake field,
Mass.), is actually a discussion of the unconscious
influences in the choice of our occupation. Most
individuals wear a magic cloak. “Out of fear
and helplessness, in a terror-ridden world, the
individual pulls about his shoulders the character
of a supreme being. The cloak fits so snugly
that sooner or later he becomes unable to dis-
tinguish between himself and the illusionary-
assumption of majesty.”
How To Stop Killing Yourself, by Peter J.
Steincrohn, M. D., ($2.95. Wilfred Funk, Inc.,
New York City), gives a new slant to the im-
portance of rest, contemplation and relaxation.
An excellent technique for the job it is intended
to do.
Breast Deformities and Their Repair, by J. W.
Maliniac, M. D., ($10.00. Grune & Stratton,
New York City), presents the knowledge and ex-
perience of a distinguished plastic surgeon. Most
of us are not interested in this subject; First,
because we are ignorant of what is being done,
and, Secondly, because those disfiguring enlarge-
ments, not associated with disease, do not in-
terest us because we have been trained to think
of disease, not health or happiness. The book is
illustrated with 116 persuasive photographs,
many of the “before and after” variety. This
book should be in the library of every hospital
and every surgeon who deals with the human
breast.
A Primer For Diabetic Patients, by Russell M.
Wilder, M. D., ($2.25. Ninth Edition. W. B.
Saunders Company, Philadelphia, Pa.), presents
an outline of treatment for diabetes with diet
and insulin, including directions and charts for
the use of physicians in planning diet prescrip-
tions as practiced at the Mayo Clinic.
Food For Better Living, by Irene E. McDer-
mott, Mabel B. Tulley, and Florence Williams
Nicholas, ($2.60. J. B. Lippincott Company,
Philadelphia, Pa.), is based on the conviction
that study of food by high school students
should stress the essential relationship between
the adequate handling of the food problem in
the home, and the good family life.
Selected Questions and Answers, Vol. 3, ($3.00.
The Amer. Medical Association, 535 N. Dearborn
St., Chicago, III.) have been taken from the
“Queries and Minor Notes” Department of The
Journal of The A. M. A. Five hundred and sev-
enteen pages are listed under 42 headings. If you
do not keep a complete file of The Journal in your
library, then you will find this volume most
handy as a book of reference. Again I feel that
busy interns should have a copy in their library.
for November. 1950
1045
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JOHN J. GEDERT, M. D., Resident Physician M. M. RIDDLE, M. D., Eye, Ear, Nose ond Throat
1046
The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association , a scientific society , non-profit corporation , with a definite
membership , for scientific and educational purposes.
Yol. 46 November, 1950 No. 11
Jonathan Forman, M.D., Editor
Charles S. Nelson, R. Gordon Moore,
Managing Editor — Bus. Mgr. Asst. Managing Editor
The Problem of the Cross-Eyed Child
LEWIS V. KOGUT, M. D.
The Author
• Dr. Kogut, Cleveland, Ohio, is a graduate
of Stritch School of Medicine of Loyola Univ.,
Chicago, 1934; diplomate. The Amer. Bd. of
Ophthalmology, 1940; fellow, Amer. Academy
of Ophthalmology and Otolaryngology. On
courtesy surgical staff, St. Alexis Hosp. and
Marymount Hosp., Cleveland.
THE subject of cross-eye is too extensive
to be more than touched upon in a paper
of this type. Although the literature in
various periodicals on all phases of cross-eye
is abundant, the purpose of this paper is not
directed primarily to the ophthalmologist, but to
the pediatrician and to the general practitioner
who first come in contact with the cross-eyed
child. The various diagnoses, types, and severity
of cross-eye present is outside the realm of this
paper. It is the aim of the writer to present
the subject with sufficient simplicity so that
knowledge of this subject will be comprehended
hy all observers who are concerned with the
promotion of normal visual function in this par-
ticular aspect. It should be emphasized that,
if results of any value are to be obtained, the
work should be carried out by those who have
special knowledge of the subject. Only too
•often have patients been seen who received
treatment by unqualified persons and by whom
•definite harm had been done.
Cross-eye or squint is essentially the involve-
ment of the extraocular muscles and of the
sensory-psychic visual apparatus. In general,
it may be said that any obstruction to proper
fusion of stimuli from the two eyes may cause
a squint. This may be caused by interference
with the formation of the image on the retina,
<or its perception, by opacities in the various
parts of the eye, by anatomical and developmental
■defects of the ocular muscles, the retina, and
optic nerve; by inflammatory changes, and by
trauma causing direct or indirect injury to the
•central nervous system. By far the most com-
mon cause is an error of refraction, especially
Submitted March 13, 1950.
marked differences in refraction between the
two eyes. Severe farsighted patients who at-
tempt to compensate for the error by strong
accommodation, in so doing over-converge either
eye.
The onset of cross-eye in early or late child-
hood presents a problem of management to the
parent and to the physician. The cross-eyed
child is not only unattractive in appearance, but
also suffers physiologically, from the lack of
binocular vision, fusion, and depth perception.
As soon as the parents are aware of this condi-
tion, they seek consultation from various sources,
some professional but more often non-profes-
sional. This latter advice is frequently mis-
leading, and erroneous. Any suggestion that a
child will outgrow this condition is dangerous
information that may result in irreparable dam-
age, such as mental suffering on the child’s
part, mal adjustment in society, and the loss of
useful vision.
DEVELOPMENT OF EYES
At birth most babies are farsighted. This is
soon outgrown and at the age of eight years
the eyes reach a normal state. If the develop-
1061
ment of the eyes falls behind that of the rest
of the body, the child remains farsighted for
the rest of his life. In other words farsighted-
ness is due to a relatively short antero-posterior
diameter of the eyeball. If this lengthening
process of the eyeball continues beyond the
normal state, it then produces a condition of
nearsightedness. A farsighted child usually has
normal vision in that he may see 20/20 or
even better, but this conditon requires continuous
extra effort on the eyes to secure normal vision.
If this process of constantly focusing excessively
is more than usual, the ciliary muscle becomes
very powerful. In the process of this accom-
modation there is a tendency for the eyes to
turn in or to converge more than usual. This
is one of the causes for cross-eye, particularly
in children from the ages ranging from one to
four years. Relaxation of this muscle is seldom
attained unless some drug as atropine is used
in the eyes. This produces a dilation of the
pupils and the muscle of convergence is relaxed
and this may reduce the deviation entirely.
If this is the case the eyes become straight and
glasses are the cure instead of surgery. Some-
times this condition may be corrected by glasses
which eliminate the excessive focusing. But if
the farsightedness is only a precipitating factor
and not the entire cause, glasses will straighten
the eyes only partially or temporarily. The re-
mainder of the crossing requires correction by
other methods.
A child learns to use his eyes together in
fusion at about the age of five years. This
consists in bringing images of objects together
for presentation to the brain as one image. If
the eyes can be straightened before fusion
takes place, they will work together and binocu-
lar single vision is maintained which is the
normal process. This is one of the chief reasons
why the cross-eyed child should be corrected
early, that is, before the age of five. To advise
the parents at this stage to let the child alone,
and presume that he will grow out of it, means
not only a lost eye as far as a useful function-
ing organ is concerned, but usually means re-
sorting later to tedious surgery, which if success-
ful will only result in a cosmetic correction —
that is, “a straight eye”; however, the vision is
lost.
DETERIORATION OF CROSS-EYE
forced to use the poor eye. This is done by
covering the good eye with a patch. This should
be constant for a definite period in order that
the vision may be restored as quickly as pos-
sible because time is of the utmost importance.
If the vision has been restored in the weaker
eye by patching and by glasses and the eyes
are still not straight in a period of six months
then surgery is almost invariably required to
attain the cure.
In another type of cross-eye the child may
use one eye and then the other but never both
together. The child uses one eye to see and the
other crosses and vice versa. In other words,
the eye will alternate for vision while its
mate will always cross. In this type, the vision
in each eye is preserved because each eye is
stimulated to see, but fusion is absent. Only
one eye fixes and therefore the eyes never work
together. To maintain fusion the eyes must
have simultaneous macular perception, in other
words, the size of the two images presented to
the brain must be identical.
USE OF EXERCISES LIMITED
There is much erroneous information regard-
ing the use of eye exercises. It is only the pa-
tient with a certain type of cross-eye, whose
eyes are crossed slightly when wearing glasses,
that can be cured by eye exercises alone. Eye
exercises do not strengthen weak muscles.
Their sole function is to teach the child to use
his two eyes together as a team. There is
nothing more futile than for one whose eyes are
severely crossed, to take extensive exercises
week after week in the hope that the eyes will
miraculously become straight.
CONCLUSION
In conclusion it can be said that the amount
of lost vision caused by cross-eye is in direct
ratio to the duration of the squint. Cor-
rection of this defect of the eyes can be at-
tained by glasses, eye exercises or surgery.
Patient, parent, and physician must be aware
that only early, and accurate diagnosis is most
urgent to obtain satisfactory results. Proper
professional consultation is able to indicate the
type of therapy that may be required for this
condition. Treatment should be instituted as
soon as the child shows any signs of turning of
the eyes.
Aureomycin and chloramphenicol have become
established as highly effective broad spectrum
antibiotics. Terramycin, a third member of this
group of compounds, possesses highly activity
against a wide range of infections. It has not
exhibited toxicity, and side-effects have not con-
stituted a problem in therapy. Its spectrum
of activity most closely resembles that of
aureomycin. — Vernon Knight, M. D., N. Y. State
J. M.
It is commonly believed that a cross-eyed in-
dividual sees double. This is not true because
or the “good eye” is used to
the cross-eye or the “poor
because it is not in the line
” for binocular vision, the
eye ^^^ial^pKoses vision through disuse or
failure tocre^lop vision. Before the child can learn
how to fuse, this lost vision must be restored
and fortunately it will return if the child is
1062
The Ohio State Medical Journal
Relation of Blood Cholesterol to Basal Metabolic Rate*
R. W. KISSANE, M.D., RICHARD BROOKS, M. D., and THOMAS E. CLARK, M. D.
THERE is a widespread impression that a
relationship exists between basal metabolic
rate and blood cholesterol, especially low
basal metabolic rates and high blood cholesterol.
This has been the result of various statements
that have appeared in the literature.1' 2’ 3' 4> 5’ 7
However, Mason, Hunt and Hurxythal8 concluded
there was no definite correlation but that there
is a marked elevation of blood cholesterol in
myxedema. In order to determine whether or
not correlation existed a sample of 102 cases
was investigated.
METHOD
The 102 otherwise normal persons were un-
selected but taken in the order in which they
presented themselves for examination. There
were 59 women and 43 men with an age spread
of from 15 to 67 years. Basal metabolism rates
were determined with the standard preparation
and then on three types of commercial machines.
The spread of the basal metabolic rates was
from minus 38 to plus 41. All blood cholesterol
determinations were fasting, obtained at the
same time that the basal metabolic rate w*as
determined. The same technicians were em-
ployed on all cases. The data obtained were
treated mathematically to obtain the Pearson
correlation coefficient. There were 77 persons
of the entire group that had minus basal meta-
bolic rates, but none had myxedema. These
were taken as another group and the Pearson
correlation coefficient obtained.
DISCUSSION
Thurstone8 has stated “Every scientific prob-
lem can be stated most clearly if it is thought
of as a search for the nature of the relation
between two definitely stated variables. The
correlation coefficient is a pure number, a con-
stant which indicates the degree of relation be-
tween two variables. It varies from plus 1 to
minus 1. When the relation is perfect and
positive, the correlation coefficient is plus 1.
When the relation is perfect but inverse, the
correlation coefficient is minus 1. When there
is no relation whatever between the two vari-
ables, the coefficient is zero. Other vales of the
coefficient indicate intermediate degrees of rela-
tion.” The correlation coefficient between the
basal metabolic rates and blood cholesterol of
the 102 normal persons was .079, and between
the 77 persons with low basal metabolic rate was
* From the Medical Departments of the Ohio State Univer-
sity, College of Medicine and White Cross Hospital, Colum-
bus, Ohio.
The Authors
• Dr. Kissane, Columbus, is a graduate of
Ohio State Univ. College of Medicine, 1918;
diplomate, Amer. Bd. of Internal Medicine in
Cardiology; fellow, Amer. College of Physi-
cians; member, Scientific Council, Amer. Heart
Assn.; chairman, senior attending staff, medi-
cine and cardiology. White Cross hospital;
professor of medicine in cardiology, Ohio
State Univ.
• Dr. Brooks, Columbus, is a graduate of
Ohio State Univ. Coll, of Medicine, 1940;
member, Amer. Med. Assn., Cols. Academy
of Medicine, Amer. Heart Assn.; junior at-
tending— medicine, White Cross hospital; asst,
clinical instructor, dept, medicine, College of
Medicine, Ohio State Univ.
• Dr. Clark, Columbus, is a graduate of
Ohio State Univ. Coll, of Medicine,, 1940;
associate, Amer. Coll, of Physicians; fellow,
Amer. Med. Assn.; member, Amer. Assn, for
Advancement of Science; Amer. Heart Assn.;
Amer. Federation for Clinical Research; mem-
ber of cardiological staff. White Cross hos-
pital; attending staff, Children’s Hosp.; cour-
tesy staff, University hosp.; clinical instructor
in cardiology, Ohio State University.
minus .072. This indicates no relation between
the variables.
CONCLUSION
There is no relation between basal metabolic
rate and blood cholesterol.
There is no relation between low basal meta-
bolic rate and blood cholesterol.
REFERENCES
1. Epstein, A. A., and Lande, Hermann : Studies on Blood
Lipoids. I. The Relation of Cholesterol and Protein Defici-
ency to Basal Metabolism. Arch. Int. Med., 30:563-577,
Nov., 1922.
2. Hawk, P. B., and Bergeim, Olaf, : Practical Physi-
ological Chemistry. Philadelphia, P. Blakiston’s Son and
Co., Inc.
3. Bodansky, M., and Bodansky, O. : Biochemistry of
Disease. New York, The MacMillian Co.
4. Green, A. M. : Iodine and Cholesterol Metabolism in
Patients with Primary Myxedema. Arch. Int. Med., 67 :114,
1941.
5. Levison, S. A., and MacFate, R. P. : Clinical Labor-
atory Diagnosis. Philadelphia, Lea and Febiger, 1946.
6. Mason, R. L., Hunt, H. M., and Hurxthal, L. M. : Blood
Cholesterol Values in Hyperthyroidism and Hypothyroidism,
Their Significance. New England Med. Jour., 203 :1273-1278,
Dec. 25, 1930.
7. Hess, J. H. : Blood Cholesterol and Creatine Excre-
tion in the Urine as Aids to Diagnosis and Treatment of
Hypothyroidism. Ann. Int. Med., 8 :607, 1935.
8. Thurstone, L. L. : The Fundamentals of Statistics.
New York, The MacMillan Co., 1925.
for November, 1950
1063
Psychosocial Factors in the Pathogenesis of a Peptic
Ulcer in an 89- Year Old Man
CHARLES K. HOFLING, M. D.
The Author
• Dr. Hofling, Cincinnati, Ohio, is a grad-
uate of Univ. of Cincinnati College of Medi-
cine, 1946; member, Cincinnati Academy of
Medicine; instructor in psychiatry, Univ. of
Cincinnati College of Medicine, and Cin-
cinnati General Hospital.
THE initial symptom of peptic ulcer at the
age of 89 years makes of a case a relative
medical curiosity. Onset of peptic ulcer is
most frequent during the third, fourth and fifth
decades, somewhat uncommon in the seventh,
and decidedly so in the ninth. Because of his
advanced age with a life-long history of good
health, the acute onset of symptoms following
a clear-cut change in the immediate environ-
ment, and finally the verification of the nature
of the lesion by direct exploration and at autopsy,
the patient here presented is well suited to
offer corroborative evidence for certain widely
held views regarding the importance of psy-
chological factors in the pathogenesis of peptic
ulcer. One may legitimately suspect some
etiological importance to lie in those circum-
stances immediately preceding the development
of a pathological state which the random vicis-
situdes of nearly a century had not brought on.
CASE HISTORY
The patient, R. M., was an 89-year old white
widower, a retired policeman, who came to the
receiving ward of the Cincinnati General Hos-
pital on July 27, 1947, vomiting red blood. The
present illness dated back only six weeks,
beginning with marked dyspepsia and anorexia.
Tarry stools had been noted for about four
weeks and moderate epigastric pain (coming on
within 15 to 30 minutes after ingestion of
food) for two weeks. Massive gastric hemor-
hage with transient loss of consciousness oc-
curred on the morning of admission.
Direct examination showed an alert, pleas-
ant, well-preserved old man. The temperature
was 99°; pulse was 80 per minute; and blood
pressure was 130/80 millimeters of mercury.
The physical findings were essentially normal
with the following exceptions; many senile
keratoses, edentia, a soft apical systolic murmur,
a slightly enlarged liver, epigastric tenderness,
and an enlarged prostate.
Several of the laboratory studies were con-
tributory. The hemoglobin was 7.5 grams per
100 cubic centimeters. The red cell count was
2.2 million and the white count was 13,600 per
cubic millimeter. A stool guaiac test was
strongly positive. Emergency X-rays of the
upper gastroenteric tract (Hampton technique)
showed a large penetrating ulcer on the lesser
curvature of the stomach and the absence of
esophageal varices.
A tentative diagnosis of gastric carcinoma
was made. Although there was no further
hematemesis, the patient was operated upon on
August 1, 1947. At operation the lesion was
found to have the characteristics of a benign
ulcer. Accordingly, only an excision of the
From the Department of Psychiatry, College of Medi-
cine, University of Cincinnati, and the Cincinnati General
Hospital.
ulcer was done. The pathologist’s report, after
microscopic examination of the specimen, was
acute and chronic gastric ulcer with no evidence
of malignant degeneration. The patient’s hos-
pital course was favorable. Because of his age
and spry, friendly manner, he was a favorite
with the nurses and received an unusually great
amount of care and attention. Medical and
surgical management was routine except for
digitalization, which was instituted because of
minimal postoperative signs of cardiac decom-
pensation. Mr. M. was discharged from the
hospital on August 26, 1947.
PAST HISTORY REVIEWED
A review of the patient’s past history is of
particular interest. Mr. M. had enjoyed ex-
ceptionally good health, having seen a physician
only once in his life (for a urinary ailment)
prior to the present illness. Epigastric pain,
melena and hematemesis had never been noted.
There had been occasional mild dyspepsia, but
the patient had had, for the most part, an un-
usually keen appetite. Mr. M. had noted a
tendency toward obesity, kept in check by the
exercise his occupation required. The patient
had never been a true alcoholic, but his con-
sumption of beer and whisky had been above
average. He had also been a steady smoker.
Mr. M. was the oldest of three siblings sur-
viving infancy and had, from a rather early age,
contributed to the family income by selling
newspapers and doing odd jobs. His parents
had both lived to old age; the father died at
87 and the mother at 76. The patient lived
at home until his marriage at the age of 27.
This marriage, a basically happy one, lasted
58 years, terminating with the wife’s death in
1943. Immediately afterwards the patient went
to live with his son and daughter-in-law, with
whom he remained until the present illness.
The situation in the son’s home, however,
was not a satisfactory one. The patient’s
daughter-in-law had been at first willing to
“humor” the old man, but had become steadily
more and more tired of this role. There were
arguments about the quality of the meals. The
patient stated that his daughter-in-law made
no effort to please him in this respect (as his
wife had done). Six weeks before admission
there had been a quarrel with a subsequent at-
tempt to patch things up. Four weeks before
admission the daughter-in-law laid down the
1064
The Ohio State Medical Journal
ultimatum that the only condition on which she
would permit the patient to continue living at
the house was that he would obtain his own
meals, either preparing them himself or eating
at a restaurant. It will be recalled that the
former date corresponds with the onset of the
patient’s dyspepsia and anorexia, and the latter
with the onset of melena.
The patient lived for one year following this
first admission until August 21, 1948. He stated
that he had lived alone during this year, being
too proud to try to get along with the children
on their terms. He prepared some of his meals
and obtained the others in restaurants. During
this time there were two other admissions, one
on December 6, 1947, and one terminally. On
both of these admissions the presenting com-
plaints were of epigastric pain and vomiting
of blood. On the December admission the pa-
tient responded well to conservative medical
management. On the final admission it was
found on X-ray that there was a perforation of
a gastric ulcer into the lesser peritoneal sac.
A jejunostomy was performed, and the usual
supportive measures were taken, with care for
hydration and nutrition. The patient’s condi-
tion on admission, however, had been poor. He
was uremic and anemic, and survived the opera-
tion by only two days. The portion of the
necropsy report relevant to the patient’s gastric
condition noted chronic peptic ulcer with re-
cent acute exacerbation and extensive erosion
of the wall of the stomach.
DISCUSSION
Throughout most of a very long life the pa-
tient was in a singularly good position to have
his dependent needs met, i. e., to have good food
and drink, to be taken care of, and to be loved
in a maternal way. He lived at home until 27
years of age and had the added support of hav-
ing his parents live until he himself was past
middle age. He found a wife who took good
care of him for nearly 60 years. He, himself,
made a good adjustment during this time,
achieving some actual independence. Finally,
so long as his son and daughter-in-law acted
affectionately toward him, the patient continued
to do well. It was only after meeting, for the
first time in his long adult life, real frustration
of dependent needs (perhaps increased by the
emotional regression of extreme old age) that
the patient developed his severe gastric symp-
toms. Thus, this patient’s history tends to
support the view that a frustration of depend-
ent needs is, under certain conditions, a sig-
nificant factor in the pathogenesis of peptic ulcer.
The clinical entity of myelofibrosis was first
described by Heuch in Germany in 1879. This
disease usually has as its early symptoms pur-
pura, epistaxis or hematemesis. It is charac-
terized further by slowly progressive weakness,
abdominal pain, splenomegaly, bone pains, and
a refractory anemia. With the anemia there are
an associated thrombocytopenia, leukopenia and
immature red and white cells in the peripheral
blood stream — J. Kentucky State M. A.
The Story Behind the Word
Some Interesting Origins of Medical Terms
Coroner — A contraction or corruption of the
word crowner, which is the old and proper
spelling of this term. It formerly designated
an officer acting for the interest of the Crown-
in England. A coroner now is a County Officer
whose duty it is to inquire into the causes of
violent or sudden deaths.
Formication — A sensation resembling that
caused by ants creeping or crawling on the
skin. It is a descriptive term and is derived
from the Latin word formica, the ant.
Coracoid — This bony process projecting from
the upper margin of the neck and head of the
scapula was named by Galen. In shape it has
some resemblance to the bill or beak of a bird
and the term is derived from the Greek work:
corax, a raven or crow.
Toe — This word can be traced back to the
Anglo-Saxon word “tan,” a shoot, and the
Dutch word “teen,” a twig. The toes evidently
were regarded as shoots, twigs, or branches of
the foot.
Deaf — This word is founded on the notion of
stopping an orifice. Dead and deaf have the
same primary origin, the Gothic, dauths; the
Icelandic, daudr, or daufr, the Swedish, dod;
and the German, todt; all meaning deprived of
life, senseless, or inactive.
Leg — A descriptive term derived from the Ice-
landic word “leggr” meaning a stalk or stem and
is comparable to the Gaelic word “lorg” mean-
ing a staff or support.
Lisp — A word which is imitative of the sound
of this speech defect. It is derived from the
Anglo-Saxon word “wlispian” and is comparable
to the Dutch word “lispen” and the Swedish
word “laspa.”
Hyoid Bone — This bone was described by Her-
ophilus and is named for its resemblance in shape
to the Greek letter U or upsilon. The Greek
letter upsilon is aspirated as “hy” and this
together with the Greek “eidios,” or like, forms
the word.
Egophony — This form of modified vocal res-
onance was described and named by Laennec.-
The term is peculiarly descriptive and is derived
from the Greek words “aix or goat” and “phone
or voice.” It consists of a wavering nasal
tone not unlike the bleating of a goat.
Abduct — A term descriptive of the function or
action. It literally means to draw or lead
away from and is derived from the Latin, ab
or from, plus ducere, to lead or draw.
Androgen — The name of this male sex hormone
literally means, man-maker. It is derived from.
the Greek words, aner, or man and genesthai,.
to make or be produced.
— Harry Wain, M. D., Mansfield, Ohio.
for November, 1950
10 65
Posture — Its Role in Obstetrics and Gynecology
LEONARD B. GREENTREE, M. D.
The Author
• Dr. Greentree, Columbus, Ohio, is a grad-
uate of University of Louisville School of
Medicine, 1932; M. Sc. (Med.) University of
Pennsylvania, 1950; diplomate, American Board
of Obstetrics and Gynecology; clinical assistant
professor, dept, of obstetrics-gynecology, Col-
lege of Medicine, Ohio State University.
SO far, very little in medical literature has
appeared concerning the importance of good
posture in obstetrics and in gynecology.
Obstetricians have begun to be aware of this
importance, and so have gynecologists; but
so far the most common procedure has been to
turn over to orthopedic surgeons the few pa-
tients in most obvious need of help, and do little
for the others. The writer submits that more
stress on posture by the obstetrician-gynecologist
for practically all patients will result in better
health during and after pregnancy, do much to
improve the individual patient’s figure (an im-
portant consideration to many women in child-
bearing), and be of beneficial effect for many
gynecological patients part of whose difficulties,
at least, may be faulty posture,
Faulty posture is almost universal. It tends
to be ignored because the body can compen-
sate to an amazing extent for partial deficiency
and also because many people are satisfied with
second and third-degree health, having forgotten
— or never having known — what first-degree
health is.
Good posture is dependent on four factors:
1. A normal spinal curvature.
2. A firm foundation for the body to rest on.
3. A firm abdominal wall and pelvic floor.
4. A high diaphragm with an adequate range
of excursion.
Let us consider these points in order.
EXAGGERATED SPINAL CURVES
In faulty posture, the curves of the spine
become accentuated, causing the supporting
musculature and ligaments to become over-
stretched and the intervertebral foramina to be-
come constricted. (Figure 1-b.) The narrowed
foramina may cause a mechanical irritation of
the spinal nerve roots which pass through
them.1 In late pregnancy, the gravida throws
her shoulders back and straightens her neck and
head causing an increase in her lumbar lordotic
curve. (Figure 1-c.) In a person with faulty
posture at the onset of pregnancy, the super-
imposed pregnancy with its tendencies toward
poor postural changes could conceivably cause
a breakdown of hitherto strained but compen-
sated muscles and ligaments along with a
mechanical nerve root radiculitis.
Since there is a marked exaggeration of the
Department of Obstetrics-Gynecology Ohio State Univer-
sity College of Medicine, Columbus, Ohio.
spinal curves during the latter part of pregnancy,
the gravida is advised to rest several times
daily, by lying down flat on her back with a
folded pillow under her knees. No pillow is
placed under her head but a small one is placed
under the small of her back. The bed should
be firm, if not, a fracture board should be
placed under the soft mattress. This position
flattens the spine, and in doing so, relieves the
aching back due to the exaggerated lumbar
lordosis. During the puerperium, the spinal
curves can be flattened by having the patient
lie with her face down, and with a pillow folded
lengthwise under her abdomen. This face-prone
position would also tend to throw a retro-
displaced uterus forward.
FAULTS OF LOWER EXTREMITIES
A functional or correctable scoliosis may be
described as a bad way of standing and is almost
always due to a shortened lower extremity. This
can be a readily demonstrated by placing a book
under one foot of the normal subject. (Figure 2.)
Scoliosis seldom causes pain in children but
frequently does in adults. One can cause dis-
appearance of a functional scoliosis by either
having the patient lie down or by putting lifts
on the heel of the shoe of the shortened leg.
Bates2 likens the lower extremities to the
foundation of a house. If the legs are unequal,
the body superstructure must be strained to
maintain an upright position. Ober3 believes
that most lame backs, some of them of twenty-
five years’ duration, will be cured by equalizing
the lengths of the lower extremities accurately.
It is difficult to measure the lower extremities
accurately. Carnett4 avoids error by having the
patient stand with her feet together while the
examiner, seated behind the patient, compares
the relative level of his own index fingers which
are placed at the highest points of the patient’s
iliac crests. The amount of shortening is then
determined by placing wooden blocks of vari-
1066
The Ohio State Medical Journal
able measured thicknesses under the foot of the
short side to bring the iliac crests to the same
level.
ESSENTIAL FOOT EXAMINATION
The functional capacity of a foot depends on
two factors: (a) the weight-bearing line and
(b) where the foot is rigid or flaccid. A person
with a good weight-bearing line has a good
foot regardless of the height of the arch. A
person with a faulty weight-bearing line has
a poor foot regardless of the height of the
arch, because the foot will be subjected to muscu-
lar strain. The weight-bearing line is deter-
mined by having the patient stand with her
feet parallel and four inches apart, and then
by dropping a plumb line from the center of
the patella. Normally, the plumb line should
fall between the first and second toes. With
a poor weight-bearing line, the plumb line will
fall medial to the great toe.
A flaccid foot with a poor weight-bearing line
can be made into a good foot by either exercis-
ing its supinator muscles or by relieving the
strain through placing a slight wedge base
inwards in the heel of the shoe along with a
proper arch support. A rigid foot cannot be
made into a good foot, but it can be improved
by either breaking up the adhesions of the
tarsal joints and then by having the foot
held in the supination position.5
A shortened Achilles tendon (heel-cord) can
cause a patient considerable discomfort if she
is advised to wear low-heeled shoes. Normally,
the heel-cords allow the feet which are at right
angles to the legs, to be bent or dorsiflexed an-
other 15 3. If a shortened heel-cord is present,
the patient is either allowed to continue wear-
ing high-heeled shoes or to take heel-cord stretch-
ing exercises.
CONTRACTED TISSUES
Contracted iliotibial bands, hamstring muscles,
and anterior fascia lata along with other pos-
tural faults, trauma and diseased conditions
are the common causes of low backache. Con-
tracted iliotibial bands and hamstring muscles
limit straight leg flexion at the thigh and
prevent the patient from touching her toes
with her fingers when her knees are extended.
The iliotibial band is seen as a taut tendon
on the lateral side of the thigh, and is readily
demonstrated by Ober’s test. Contracted anterior
fascia lata limits flexion of the knee. Stretch-
Fig. la. Normal Posture Fig. lb. Faulty Posture Fig. lc. Normal Late
Pregnancy
Fig. 2 Functional Scoliosis
Due to Elongation of Right
Lower Extremity by a
Book
for November, 1950
1067
mg exercises are of real value in relieving the
symptoms due to these contracted tissues.
FASCIAL OVERSTRETCHING
Normally, the abdominal musculature has
enough tone to allow only a light relaxation of
the anterior abdominal wall. The circumference
of the nulliparous abdomen at the level of the
xiphoid should normally be greater than that
taken at the level of the umbilicus. The pendu-
lous abdomen which appears following parturi-
tion and the increased waistline of the “middle-
age spread” is due chiefly to the relaxation
of the fascial layers enclosing the atonic ab-
dominal wall musculature. Since this over-
stretched fascia contains little or no elastic
fibrils, it will not regain its original shape
readily even though the muscle tone is improved
later on.
Prevention of fascial overstretching rather
than treatment for it should be the goal in
dealing with the problem of a pendulous ab-
domen, since most attempts to correct a relaxed
abdominal wall in pregnancy are liable to result
in failure. The use of a maternity corset al-
lows the gravida with a pendulous abdomen to
have temporary good body mechanics, though
Tier abdominal muscles and fasical support may
be gravely at fault. However, in the absence
of a pendulous abdomen, the use of a maternity
corset in normal obstetrics should be discour-
aged, since its use tends to cause a loss of
abdominal muscle tone along with a resultant
fascial weakness.
CORRECTIVE EXERCISES
The large gluteal and abdominal wall muscles
are the chief supporting muscles of the back.
As soon as. the pain of an acutely lame back
disappears with rest on a firm bed, Ober3 pre-
scribes gluteal and abdominal wall exercises to
improve the tone of these muscles.
1. Glutei Maximi Exercise: Squeeze the but-
tocks together as if holding a coin between them,
and then relax them. Gradually increase until
the exercise is done at least fifty times, twice
daily.
2. Progressive-resistance exercises are the
most effective forms of exercise to increase the
strength and work capacity of both normal and
atrophic muscles.0 These exercises can double
the power of normal muscle within four to
six weeks.
Progressive-Resistance Abdominal Wall Exer-
cise: The patient lies flat on her back with her
toes hooked under a couch or bed bar, or with
someone holding her legs down below the knees.
With her hands placed behind her neck or
Tiead, she raises hferself to the sitting position.
This is repeated ten times at least twice daily.
3. Douthwaite7 has shown how voluntary
muscles can be contracted and relaxed at will
3068
without causing gross body movements. These
static muscular contractions are invisible to
onlookers, and can thus be practiced in public
places.
Invisible Abdominal Wall Exercise: While
pressing her buttocks together, the patient
pushes the muscle over her “stomach” in and
out at least fifty times, twice daily.
Invisible Pelvic Floor Exercise: The levator
ani muscles are exercised by alternately draw-
ing up and relaxing her anus at least fifty times,
twice daily. These exercises can be done while
she is standing, sitting, or lying down.
The diaphragm plays an important role in
normal body mechanics. Not only is it the chief
respiratory muscle; it is also an important pump
in the transport of venous blood back to the
right heart. Thus faulty diaphragmatic action
can cause a venous stasis along with an in-
creased predisposition to phlebothrombosis and
varicosities. Anatomically, a low-lying dia-
phragm can also interfere with the normal func-
tion of both the thoracic and abdominal viscera
by:
1. Dragging on its attachments to the peri-
cardium, stomach, and liver, and
2. Direct encroachment on the autonomic
coeliac plexus which to a large extent controls
the activities of the abdominal viscera.
Diaphragmatic Breathing Exercises are dem-
onstrated to the patient, in view of the impor-
tance of the diaphragm in normal body me-
chanics. She is instructed to rebreathe whereby
each expiration is slightly less than the inspir-
ation, so that by the end of the fifth inspira-
tion, the chest cage is expanded and held
highly. Expiration is then accomplished by an
upward, inward pull of the lower abdominal
muscles.
SUMMARY
Applying the principles of normal body me-
chanics can be a useful adjunct to other meas-
ures employed in obstetrics and gynecology.
Good posture often notably improves the health
and figure of the patient. This paper has at-
tempted to show:
1. The standards of normal posture.
2. Methods of making postural examinations.
3. The importance of an orthopedic consulta-
tion when unusual postural defects are present.
4. Procedures whereby good posture is main-
tained and faulty posture is improved.
BIBLIOGRAPHY
1. Goldthwaite, J. E., Swain, L. T., Kuhns, J. G. : Essen-
tials of Body Mechanics in Health and Disease. Ed. 4.
Philadelphia, J. P. Lippincott, 1945.
2. Bates, W. : Arch. Phys. Therapy, 12:416, 1935.
3. Ober, F. R. : J.A.M.A., 137:139, 1948.
4. Carnett, J. D., and Bates, W. : J. Health & Phys. Edu.,
4:28, 1933.
5. Wiltberger, B. : Personal Communication.
6. De Lorme, T. L ., Schwab, R. S., and Watkins, A. L. :
J. Bone & Joint Surg., 30-A :834, 1948.
7. Douthwaite, A. H. : Treatment in General Practice.
Articles from B. M. J., London. H. K. Lewis & Co., VoL 2,
1936.
The Ohio State Medical Journal
#£DIUl
“The value of
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in reducing
crystalluria and
renal complications
is based on
■,'j
“It has been confirmed
by several independent
groups of investigators
in rigorous
practical tests at
the bedside.”
(Lehr, D.rJ.A.M.A., Feb. 5, 1949.)
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sulfonamide
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Each 5 cc. of syrup (approx. one teaspoonful)
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Aneurysm of Left Common Iliac Artery Producing
Thrombosis of Spermatic Artery and Vein
With a Review of the Literature
PAUL J. SHANK, M. D.
The Author
• Dr. Shank, Dayton, Ohio, is a graduate
of the Univ. of Michigan Medical School, 1926;
Master of Science in Surgery, graduate Medical
School, Univ. of Pennsylvania, 1943 ; diplomate,
Amer. Bd. of Surgery; fellow, Amer. College
of Surgeons; chief of surgery and senior sur-
geon, Good Samaritan Hospital; courtesy sur-
gical staff, Miami Valley Hosp. and St. Eliza-
beth Hosp., Dayton.
THIS is the history of a (male) farmer 70
years of age who had always enjoyed
good health until his present illness. While
butchering, he lifted a side of beef and
was seized with a pain in his left testicle. Ap-
proximately one hour later, while eating his
noon meal he became nauseated, vomited and
the pain became more intense. His family
physician was called and diagnosed the case as
a strangulated left inguinal hernia. He gave
him XA grain of morphine sulfate and advised
him to be admitted to the hospital. The pa-
tient refused this advice and remained quiet
for most of the afternoon. At about 6:00 p. m.
the pain returned and the family physician was
called and gave him again XA grain of morphine
sulfate and sent him to the hospital.
The patient was examined by the author at
approximately 9:00 p. m. and found him in
a state of mild shock. The examination
was essentially negative, except for the ab-
domen. In the left inguinal canal and scrotum
there was a firm tender mass which could not
be reduced into the abdomen. The blood count
on admission was white blood cells: 20,700, 87
per cent polymorphonuclears, 15 per cent of
which were stabs, 11 lymphocytes and 2 eosin-
ophils. The urinalysis was essentially negative
except for a trace of albumin and 10 white
cells per high power field. A diagnosis of left
strangulated inguinal hernia was made and
operation was advised.
OPERATION
The patient was given 1000 cubic centimeters
of 5 per cent glucose in distilled water before
being taken to the operating room. Local anes-
thesia of 1 per cent novocaine® was used
to infiltrate the tissues. A left inguinal skin
incision was made and carried down through
the subcutaneous fat. It was noted that tis-
sues were quite edematous. Upon incising
the fascia the entire spermatic cord with its
vein and artery were very hemorrhagic and
thrombosed. Thorough exploration of the cord
revealed no sac. The peritoneum was opened
at the internal abdominal ring. The examining
finger was inserted and a pulsating aneurysm
was palpated. Due to the complete thrombosis
of the spermatic vessels it was decided to com-
pletely remove the testicle, cord and its con-
tents. This was done. The true condition could
not be determined at this time. The internal
abdominal ring was closed, the fascia and skin
was closed in layers. He withstood the opera-
tion fairly well considering his state of shock.
His blood pressure never rose above 90 and on
several occasions dropped down as low as 70.
The following day the white blood cell count
dropped to 14,240, the red cell count was 4,090,000
with 82 per cent polymorphonuclear, 15 of which
were stabs and 18 lymphocytes. The Wasser-
Submitted March 21, 1950.
mann and Kahn tests were taken the first post-
operative morning, and were negative.
The postoperative convalescence was quite
stormy and was progressively a downhill course.
He received daily intravenous infusions of 5
per cent glucose, amigen® and blood. However,
in spite of all this treatment he did not react.
The blood pressure constantly remained around
90/70. On the fifth postoperative day the
hemoglobin was 60 per cent, red cell count was
3,410,000, white cell count was 14,300 with a dif-
ferential count of 84 per cent polymorphonu-
clear leukocytes, 35 of which were non-filamented
cells and 16 lymphocytes. He had had two trans-
fusions up until this time, but it was apparent
there was red cell destruction in view of the
anemia that was present. He died on the 8th day.
POSTMORTEM OBSERVATIONS
A postmortem examination was made, the
results of which are as follows: “Body is that
of a fairly well nourished seventy-year old white
male. Chest: There are many bilateral pleural
adhesions with areas of consolidation, heart
musculature firm, no valvular abnormalities,
coronaries are smooth. The aorta: There is an
aneurysm about the size of an orange found in
the left common iliac artery about a half-inch
below the bifurcation of the abdominal aorta.
The aneurysm has ruptured on the lateral sur-
face. The abdomen: the entire left abdominal
cavity contains a large retroperitoneal organized
blood clot. The aorta and common iliacs are
quite arteriosclerotic. The diagnosis: A rup-
tured aneurysm of the left common iliac artery.”
LITERATURE REVIEWED
The literature is abundantly filled with cases
of aneurysm of various areas of the body, but
surprisingly scant in respect to aneurysm of
the common iliac artery. One paper deals with
the bilateral involvement, another with obstruc-
tion to delivery, while a third by Zimmerman^
for November, 1950
1069
which simulated a peiinephritic abscess. Hol-
combe1 collected a series of 172 aneurysms over
a period of ten years and of these only two
were confined to the common iliac. Crisp2 found
eleven common iliac aneurysms out of 552 cases
of aneurysms. He stated that the order of
frequency in the iliac group is, ilio-femoral L,
ANEURYSM
of SeH common
*f*«c artery
producing
thrombosis
of spermatic
artery
and vein.
femoral 2, external iliac 3, common iliac 4, in-
ternal iliac 5. Lucke3 and Rea3 in an analysis
of 12,000 of their own, and 160,145 collected
autopsies, found aneurysms in 1452; or one in
every 111 patients examined postmortem — an
incidence of 0.9 per cent. Garland4 in his
12,000 postmortems found the incidence of
aneurysms to be 2.2 per cent. In Garland4 and
Lucke and Rea’s3 series syphilis was the most
frequent cause, the abdominal aorta, thoracic
aorta and splenic artery. Highest incidence of
aneurysms was between 36 and 40 years. Gar-
land4 in his 12,000 consecutive autopsies found
167 cases of aneurysms. The most frequent
site of aneurysm was in the aorta. He states
that aneurysms of the large arteries of the ex-
tremities are uncommon. In all of these series
syphilis played an important part in the produc-
tion of the aneurysm, being the etiological
factor in from 20 to 100 per cent. Arterioscler-
osis was also rather frequent. Both Lucke3 and
Garland4 stated that bacterial infections can
cause aneurysm, usually of the mycotic type.
MYCOTIC ANEURYSMS
Aneurysms developing during the course of
bacterial endocarditis and some of the acute in-
fectious diseases with concomitant bacteremia
form a distinct clinical group and are known as
mycotic aneurysms. Blakemore5 in a recent ar-
ticle described 32 cases of aneurysms of the ab-
dominal aorta admitted to the Presbyterian Hos-
pital and states that arteriosclerosis was the
cause of the aneurysm in 26 of these cases.
These aneurysms were fully developed, fusiform
in shape and arose from the abdominal aorta,
three or more centimeters distal to the origin
of the renal arteries. Syphilis was the etiological
agent in six of the 32 cases, these aneurysms
being sacular and causing vertebral bony erosions
in four instances. From the latter group the
aneurysms arose distal to the renal arteries in
only one of the six cases. There were only
two females in the entire group of 32 cases
having arteriosclerotic aneurysm. The average
age of those with arteriosclerotic aneurysm was
60 years, while it was 42 years for the syphilitic
group. Aside from the fact that the arterio-
sclerotic aneurysm is usually fusiform, it seems
likely that there may be another factor account-
ing in part for the bony erosion; namely, en-
longation of the abdominal aorta. The popliteal
artery and the lower abdominal aorta are the
common arteries affected by the arteriosclerotic
aneurysm. So it is readily seen that aneurysm
of the common iliac artery is a rarity.
Now let us discuss the still rarer condition
of a thrombosis of the spermatic vessels being
produced by pressure from the aneurysm. The
author in an extensive review of the literature
has been unable to find any case in which there
is aneurysm of the left common iliac artery
which has produced a thrombosis of the sper-
matic vessels by pressure or from any cause.
Rives6 from the Mayo Clinic reports a case of
ureteral obstruction caused by aneurysm of the
iliac artery. He reports that the autopsy re-
vealed an arteriosclerotic aneurysm of the right
common iliac artery which had ruptured and
caused partial obstruction on the right ureter,
a hydronephrosis grade II and a beginning
pyonephrosis. The ureter was compressed be-
tween the right common iliac artery and the
aneurysm at the point of crossing the artery.
(See figure.) In the author’s case, the sper-
matic vessels were compressed against the
vertebral bodies and abdominal aorta to the
medial side, with the aneurysm exerting its
force from the lateral side. This was found to
be the true condition at postmortem examination.
CONCLUSIONS
A rare and unusual case of an aneurysm of
the left common iliac artery producing pressure
against the spermatic vessels with a resultant
thrombosis of those vessels is presented. A
short review of the literature is given.
BIBLIOGRAPHY
1. Zimmerman and Holcombe, quoted by Whiteside, W. C. :
A Leaking Non Specific Aneurysm of the Common Iliac
Artery, with Effective Treatment by Wiring. Brit. J.
Surg. XXVI, 624-628, Jan., 1939.
2. Crisp : Appendix to the Treatise on the Structure,
Diseases, and I Injuries to Blood Vessels. London, H.
Teape and Son, 1851.
3. Lucke, B., and Rea, M. N. : Studies on Aneurysm.
J. A. M. A., 77:935, 1921.
4. Garland, H. G. : The Pathology of Aneurysms : a
Review of 167 Autopsies. J. Path, and Bacteriol., 35:334,
1932.
5. Blakemore, Arthur N. : The Clinical Behavior of
Arteriosclerotic Aneurysm of the Abdominal Aorta : a
Rational Surgical Therapy. Annals of Surgery, 126
No. 2:195-207, August, 1947.
6. Rives, Hugh F., and Cook, Edward N. : Ureteral Ob-
struction Caused by Aneurysm of the Iliac Artery. Min-
nesota Medicine, Vol. 29, 143-144, February, 1946.
1070
1 he Ohio State Medical Journal
Solitary Nonparasitic Cyst of the Liver
H. H. PEVAROFF, M. D.
THE incidence of solitary nonparasitic cyst
of the liver is sufficiently rare to warrant
the report of this case. Up to the year of
1948 there were 192 cases in the literature.
These reported cases include all ages but the
cysts are most commonly found between the
ages of 40 and 50. As stated by Montgomery
there have been only 27 cases under the age of
thirteen years.
CASE REPORT
F. S., female, age 51, was admitted to the
Mount Sinai Hospital of Cleveland, Ohio, on
December 18, 1948. She had a long history of
about five years of indigestion, nausea and
pain in the right upper quadrant radiating to
the back and shoulder. Physical examination
revealed an obese woman not acutely ill. There
was moderate tenderness in the right upper
ouadrant but there were no palpable masses.
Blood and urine studies were normal. Chole-
cystogram revealed the presence of one large
calculus in an otherwise normally functioning
gall bladder. Barium studies of the stomach
and duodenum were normal. The preoperative
diagnosis was chronic cholecystitis with chole-
lithiasis.
Operation: On December 20, 1948, under gen-
eral anesthesia the abdomen was opened through
an upper right transverse incision. A large,
smooth-walled bluish-colored cystic mass im-
mediately presented itself. This mass measured
approximately 7*4 centimeters in diameter and
was situated in the antero-inferior portion of
the right lobe of the liver, immediately under
the gall bladder to which it was lightly attached.
The gall bladder was large, thickened and
elongated and contained the large calculus which
was described in the X-ray. To make sure that
the cyst was not part of the biliary duct sys-
tem, the gall bladder, the cystic duct, the com-
mon and hepatic ducts were completely dissected
free. It was then possible to remove the gall
bladder, with certainty that the cyst was extra
biliary in location. A line of cleavage was
readily found between the cyst wall and the
liver, and by means of careful sharp and blunt
dissection the cyst was enucleated from the liver
substance. A small amount of venous bleeding
was readily controlled with oxycel packing.
Thorough examination of the kidney, pancreas
and liver revealed no further cysts. The ab-
domen was then closed leaving a single Penrose
drain in the liver bed.
Pathologic Examination — Gross: Specimen re-
moved reveals a thin-walled translucent cyst
measuring 7*4 centimeters in diameter. The
contents are clear mucoid material. The outer
covering of the cyst is moderately hemorrhagic
whereas the inner lining is smooth, glistening
and bluish-pink in color.
Microscopic: Section of the cyst wall shows
a layer of collagenous fibrous tissue containing
a few small blood vessels. The inner lining
From the Dept, of Surgery of the Mount Sinai Hospital,
Cleveland, Ohio.
The Author
• Dr. Pevaroff, Cleveland, is a graduate of
Western Reserve Univ. School of Medicine,
1933; fellow of The American College of Sur-
geons; diplomate, the Amer. Board of Surgery;
sr. assistant visiting physician and clinician,
Div. of Surgery, Mt. Sinai Hosp., Cleveland.
varies from cuboidal epithelium to squamous
cell type. The outer wall has attached bits
of parenchymal cells and bile ducts.
Pathologic Diagnosis: Cyst of liver, 7*4 centi-
meters in diameter (Bile duct retention type).
Postoperative and Subsequent Course: There
was a moderate febrile reaction with temper-
atures up to 101 F for 5 days with gradual
return to normal. Bile drainage was profuse
for 8 days following which the drainage grad-
ually subsided. The Penrose drain was re-
moved on the 10th postoperative day and the
wound healed rapidly. The patient was dis-
charged as cured on her 12th postoperative day
and has remained well.
DISCUSSION
Nonparasitic cysts of the liver may be single
or multiple. Multiple cysts more commonly are
associated with cysts of the kidneys, pancreas,
spleen, lungs and brain. Solitary nonparasitic
WITH A 50LITARV CVST INI THE RIGHT LOBE
cysts are more common in adults. They seem
to occur more often in females than in males;
the ratio being 4 to 1. Solitary cysts are more
commonly found at the antero-inferior portion
of the right lobe of the liver. Their size varies
and symptoms are usually not produced unless
there is encroachment upon adjacent organs.
The external surface of the cysts is usually
smooth, glistening and greyish-blue. The thick-
er November, 1950
1071
ness of the cystic wall is variable; the contents
vary from clear watery to sometimes yellowish-
brown fluid and may show albumin, mucin,
cholesterol, blood and rarely bile. The correct
preoperative diagnosis is rarely made. Treat-
ment of solitary cysts is surgical extirpation
where conditions permit. Where the cyst is
too large to permit complete excision, marsupi-
alization with drainage is recommended. It is
generally agreed that these cysts are derived
from congenital malformations.
SUMMARY
A case of solitary nonparasitic cyst of the
liver in a 51-year old woman is presented. The
cyst was completely removed with complete
recovery.
REFERENCES
Alexander, R. C. : Solitary Nonparasitic Cysts of the
Liver. Edinburgh M. J. 32 :61, February, 1925.
Attix, F. F. : Nonparasitic Cysts of the Liver. Lancet,
59 :38, February, 1939.
Maes, Urban : Nonparasitic Cysts of the Liver : Report
of Two Cases. Am. Jour. Surg., 38 :68, March, 1924.
Montgomery, A. H. : Solitary Nonparasitic Cysts of the
Liver in Children. Arch. Surg., 41 : 422, 1940.
Wikle, H. T., and Charache, H. : Solitary Nonparasitic
Cyst of the Liver. A. J. Surg., 31 :345, February, 1936.
Monroe, H. Stokes, Jr. : Solitary Nonparasitic Cyst of
the Liver. Annals Surg. 116:751, November, 1942.
APHORISMS, ADAGES AND MAXIMS
“Remember to forget.”
“It is easier to worry our heads off than to
laugh ourselves to death.”
“Malnourished lawyers and malpractice suits
are closely related.”
“Some people when they die will have to climb
up to get into hell.”
“It takes as much grace to make a saint of a
Republican as it does to make a saint of a
Democrat.”
“We do not break down mentally from over-
work but rather from overworry.”
“Why spend health to get wealth and then
spend wealth to get health?”
“What will make a well person sick will make
a sick person sicker.”
“The rich and the poor reach the same level
in the cemetery.”
“The more patients a physician has the more
patience he needs.”
“Never spend money for things you don’t
need just to please people you don’t like.”
“Tombstones, like books, are made by the liv-
ing for the living.”
“Better live in the basement of heaven than
in the cupola of hell.”
“Natural forces within us are the true healers
of disease.”
“Reputation is what you have when here,
character is what you have when you go away.”
— Submitted August 15, 1950,
John J. Sutter, M. D., Lima, Ohio.
The Efficiency of Local Anaesthetics
When Used In Small Doses
The anaesthetic index, a ratio of relative
potency to relative systemic toxicity, was in-
troduced by McIntyre and Sievers in 1937 and
is especially applicable in situations where large
quantities of anaesthetic are introduced into
the body. In ophthalmology where small
amounts are used, the important factors are
tissue toxicity and the concentration necessary
to produce anaesthesia of a given duration
(E. C. 50).
No accurate method has been developed for
assessing toxicity of local anaesthetics applied
to the eye. The skin reactions to intradermal
injections of various concentrations would sug-
gest the toxicity that might be exerted on the
cornea. A series of intradermal injections
was carried out on guinea pigs and the average
diameter for each reaction measured in 24
hours. Diameter was plotted against log con-
centration and a graph obtained from which
relative toxicity was ready directly.
The E. C. was estimated by topical applica-
tion to guinea pigs’ eyes. Equal amounts of
different percentage strengths of various anaes-
thetics were instilled into the eyes for a defi-
nite period of time and the blink reflex tested
until complete return. Plotting duration of
anaesthesia against log concentration resulted in
a graph of parallel lines from which relative
potency values were readily obtained.
A series of experiments was carried on to
determine the E. C. 50 by retrobulbar injection
in guinea pigs. Corneal sensitivity was used
as the criterion of duration of block. By plotting
the latter against log concentration a relative
relationship was obtained.
With the above data available a relative
rating index for all the anaesthetics can be cal-
culated for both surface anaesthetic effects and
nerve block according to the following formulae:
Relative rating for unknown compared to
cocaine:
E. C. 50 cocaine
E. C. 50 unknown
Tissue toxicity of unknown
Tissue toxicity of cocaine
Relative rating for unknown compared to pro-
caine:
E. C. 50 procaine
E. C. 50 unknown
Tissue toxicity of unknown
Tissue toxicity of procaine
— H. S. Hamilton, M. D.,
J. F. Aikenhead, M. D.,
Toronto, Canada.
Brief authors’ abstract of paper presented at charter
session of the Association for Research in Ophthalmology,
East-Central Section, held in Cleveland, Jan. 10, 1950.
1072
The Ohio State Medical Journal
Control of Diabetes: Glycosuria an Unreliable
• t
Index to Glycemia
HENRY J. JOHN, M. D.
The Author
• Dr. John, Cleveland, Ohio, is a graduate
of Western Reserve University School of Medi-
cine, Cleveland, 1916; fellow, American Col-
lege of Physicians; member, American Dia-
betes Association; and visiting physician. Uni-
versity, St. Luke’s and Huron Road Hospitals.
ONE of the commonest fallacies in medical
practice is the belief that the presence
or absence of glycosuria may be used as
a reliable guide for regulating the dosage of
insulin, in the treatment of a diabetic patient.
This is a point which I have stressed repeatedly,
and it has also been brought out by other au-
thors. Despite the ample proof that glycosuria
and hyperglycemia may or may not exist simul-
taneously, the error of accepting glycosuria as
proof of hyperglycemia persists, both in teach-
ing and practice. From the standpoint of the
facility of technic, it would be desirable if
glycosuria were a direct index of the blood
sugar level, since the urine test is so much
simpler to perform than a blood sugar determi-
nation. Unfortunately, however, the fact re-
mains that the level of sugar in the urine may
be entirely misleading in appraising the state
of sugar metabolism in a patient who has an
abnormally high or low renal threshold for
sugar. For this reason, periodic examinations
of the blood sugar are essential in the control
of diabetes in the individual case.
This opinion is based on a study of thousands
of diabetics, during a twenty-six-year period,
subjected to simultaneous tests of the urine and
blood sugar. This clinical experience has shown
that a patient treated with a fixed insulin dosage
based on periodic blood-sugar determinations
(barring accident or some gross dietary indis-
cretion) is under far better control of the
diabetic condition than one who changes his
insulin dosage daily according to the results of
his own urine tests. The dangers of overdosage
of insulin, as a result of this practice, cannot
be minimized.
Perhaps the best way to demonstrate the
importance of recognizing the frequent disparity
in renal and blood sugars is to show the data
in actual clinical cases. Figure 1 shows infor-
mation as to the renal and blood sugars in
fifteen patients I saw recently during a two-
month period. These were all patients who
had been under treatment by other physicians
who had attempted to control the diabetes by
regulation of insulin dosage according to several
urine tests a day. The figure shows clearly
that often there was little relationship between
glycosuria or aglycosuria and the blood sugar
level at the time the urine tests were made.
Submitted May 2, 1950.
A brief review of the salient features in these
cases is presented, to demonstrate the clinical
importance of the use of proper laboratory study
in the management of diabetes.
Case 1. A woman, aged 23 years, has normal
blood sugars morning, noon and evening, when
taking 60 units of protamine zinc insulin and
6 units of regular insulin. Although there is
no hyperglycemia with this insulin dosage,
glycosuria is present throughout the day, and
is heaviest at noon.
If this patient were attempting to follow
the usual routine on the basis of urine sugar
examinations, she would be directed to take
6 to 10 units of insulin in addition to the
amount taken in the morning, and this would
very likely cause an insulin reaction in the
afternoon. In this case, it is quite obvious
that extra insulin is not indicated at noon,
despite the finding of heavy glycosuria.
Case 2. A man, aged 56, when taking 20
units of protamine zinc insulin, shows elevation
of the blood sugar morning, noon and evening,
even though there is no glycosuria at any time.
In this case, just the opposite of Case 1, if the
finding of glycosuria were used as an index
for regulation of insulin dosage, this man would
be advised not to take more insulin, when this
is obviously needed.
Case 3. A girl, aged 12 years, who is taking
30 units of protamine zinc insulin and 30 units
of insulin, displays normal blood sugar in the
morning and at noon, but the evening level is
dangerously low, — 28 milligrams per 100 cubic
centimeters. There is no sugar in the urine
in the morning, but glycosuria is heavy at noon.
According to traditional practice, this would
mean that she should receive extra insulin at
noon, which would have been really dangerous,
perhaps, in reducing the blood sugar. What
she actually needs, instead of extra insulin, is
a reduction in the insulin dosage.
Case 4. A girl, aged 13% years, receiving
26 units of protamine zinc insulin and 28
units of insulin each morning, shows slight
elevation of the blood sugar in the morning,
but at noon and in the evening, the level is
normal. Glycosuria is present throughout the
day, and is heaviest at noon, but there is no
for November, 1950
1073
Fig. 1. Blood sugar and urine sugar determinations made three times a day on 15 different diabetic patients, to
show that glycosuria is not a safe or reliable guide to the status of sugar utilization.
indication that additional insulin should be given
before lunch in this case.
Case 5. A man, aged 44, who is taking 25
units of globin insulin each morning, has normal
blood sugar throughout the day, yet glycosuria
is present at each determination and is heaviest
at noon. Here, as in Case 4, there is no in-
dication for giving additional insulin at noon,
which would be done if glycosuria were being
used as the guide.
Case 6. A little girl, aged 6 years, receiving
15 units of protamine zinc insulin and 15 units
of insulin, has normal blood sugar in the morn-
ing and at noon, but the evening blood sugar
is quite low, i. e., 40 milligrams per 100 cubic
centimeters. As in the preceding cases, gly-
cosuria is present throughout the day and is
heaviest at noon. If extra insulin were to be
given at noon, because of the glycosuria, no
doubt an insulin reaction would be precipitated.
Case 7. A young woman, aged 22 years, has
normal blood sugar on an insulin dosage of 25
units of protamine zinc insulin and 25 units
of regular insulin. The urine is free of sugar
in the morning and evening, but a trace is
present at noon. This is entirely without signif-
icance, in view of the normal blood sugar.
Case 8. A woman, aged 65 years, with an
insulin dosage of 35 units of protamine zinc in-
sulin and 20 units of insulin, displays pronounced
hyperglycemia throughout the day. However,
the urine shows only a trace of sugar at noon
and in the evening, and the morning specimen
is normal. With traditional management, her
insulin dosage would not be increased, but this
is definitely needed, in view of the blood sugar
levels.
Case 9. A man, aged 39 years, taking 20 units
of protamine zinc insulin, has normal blood
sugar in the morning and evening, but at noon,
the sugar level is 200 milligrams per 100 cubic
centimeters. There is no glycosuria at any time.
If urine examination were to be used as a guide,
there would be no change in the insulin dosage
in this case, whereas 4 to 6 units of insulin
should be added to the protamine zinc insulin
in the morning to take care of the elevation
of blood sugar occurring at noon.
Case 10. A man, aged 42 years, who is tak-
ing 35 units of protamine zinc insulin and 30
units of insulin, has blood sugar levels of 146,
52 and 108 milligrams per 100 cubic centimeters,
The urine is sugar-free in the morning and at
noon, but there is mild glycosuria in the evening.
To correct the elevation of the blood sugar in the
morning, a change to 40 units of protamine zinc
and 25 units of regular insulin is required. This
would bring down the blood sugar in the morning
and increase it slightly at noon. The finding of
glycosuria in the evening presents no indication
for additional insulin at that time of day, for that
would simply upset a fairly well controlled situa-
tion.
Case 11. A woman, aged 59 years, is taking no
insulin, but displays considerable hyperglycemia
throughout the day. There is no sugar in the
urine at any time, and hence urine examination
alone certainly would not indicate that she re-
quires a small dose of protamine zinc insulin
to control the situation properly.
Case 12. A woman, aged 49 years, who is
taking 30 units of protamine zinc insulin and 10
units of insulin, has a normal blood sugar all
three times during the day, and yet the urine
contains an excessive amount of sugar at noon
and a trace in the evening. Control of the
diabetes would be drastically upset if she were
1074
The Ohio State Medical Journal
to receive extra insulin at noon on the basis of
the urine examination.
Case 13. A woman, aged 27 years, has a nor-
mal blood sugar throughout the day with a
dosage of 30 units of protamine zinc insulin and
14 units of insulin. The urine shows a faint
trace of sugar in the morning, a trace at noon,
and 1 plus in the evening. Here again, extra
insulin in the evening would upset an ideal state
of control.
Case 14. A woman, aged 49 years, has a nor-
mal blood sugar without taking insulin. How-
ever, there is a faint trace of sugar in the
urine morning and evening and considerably
more at noon. Insulin is contraindicated, despite
the glycosuria, since the blood sugar remains at
at a satisfactory level without it.
Case 15. A man, ag;ed 57 years, receiving 40
units of protamine zinc insulin and 20 units of
insulin, has normal blood sugar three times a day.
Yet glycosuria of some degree is present in all
three determinations. This is another instance
in which glycosuria furnishes a false indication
of the need for insulin.
Overinsulinization. When glycosuria is used
as the sole guide in regulating the dosage of
insulin, it frequently happens that the gly-
cosuria persists, even when the insulin dosage
is considerably increased. Some patients are
sensitive to insulin and have an insulin reaction
under such circumstances; others do not. Some
'93 6
EXCESSIVE iHSULltf
/so REACTIONS
XH I U
a 27 IQ S
3*
?ZI
Si
e'XCtSSlv't it* sol.
Fig. 2. Studies in two cases of diabetes in which insulin
dosage had been excessive, because of the presence of gly-
cosuria.
patients have an insulin reaction with merely
a mild hypoglycemia and others may tolerate
a blood sugar level as low as 30 milligrams per
100 cubic centimeters without displaying a
reaction. The two cases illustrated in figure 2
show the enormous doses of insulin that are
sometimes given in the futile and erroneous at-
tempt to control glycosuria.
The first patient, a lawyer, aged 42 years,
was taking 170 units of insulin a day, when I
first saw him in 1936, because of a heavy gly-
cosuria. No insulin reactions occurred with
this dosage. The day after I first examined
him, I studied the blood sugar throughout the
day without any insulin at all, and this was
only moderately elevated. The following day,
he received 40 units of insulin, and after that,
only 20 units. This amount was sufficient to
control the blood sugar adequately. Hence, al-
though the excessive intake of insulin produced
no serious reactions, it was an enormous waste,
since more than eight times the amount needed
for control of the diabetes was being used .
The second patient, also a lawyer, aged 65
years, was taking 225 units of protamine zinc
insulin in two daily doses when I first saw him
in December, 1948. He was having frequent
insulin reactions which interfered with his
work, but he thought these were unavoidable,
just part of a diabetic’s sorry lot. Since he con-
tinued to show glycosuria, his physician would
not let him decrease the insulin dosage. Dur-
ing the next month, his insulin requirement was
found to be 70 units (protamine zinc insulin,
50 units, and regular insulin, 20 units). Several
examinations were required to establish adequate
control. At first I prescribed 30 units of
protamine zinc insulin, but the blood sugar levels
remained slightly evelated, so the dosage was
increased to 40 units of protamine zinc insulin
and 12 units of insulin. The result was still not
quite satisfactory, so the dosage was increased
to the 70-unit figure, on which control has re-
mained entirely satisfactory. This dosage of
70 units is considerably different, both in cost
and comfort to the patient, from 225 units he
was taking on the basis of urine examinations.
COMMENT
Despite the irrefutable evidence presented by
cases such as those cited here, which are seen
so frequently in a diabetic practice, it still re-
mains an almost universal custom to adjust the
dosage of insulin on the basis of glycosuria and
to administer extra insulin when glycosuria is
found. This is often a faulty procedure which
results from entirely faulty reasoning, for it
leaves out of account all consideration of in-
dividual differences in the renal threshold for
sugar. If the threshold is low, the patient
shows heavy glycosuria most of the time, even
when the blood sugar is low. If his threshold
is high, no sugar will show in the urine, even
in the presence of a very high blood sugar
level. To give additional insulin in the former
instance and to withhold it in the latter, on the
basis of the urine examinations, is to fail to
control the diabetic state adequately. Excessive
insulin dosage does not always produce severe
insulin reactions, but even when it does not,
for November, 1950
1075
it is a source of inconvenience, discomfort and
needless expense to the patient.
The cases presented here should make it
abundantly clear that the proper evaluation of
the sugar utilization can be made only by
determinations of the blood sugar level three
times a day, before meals. Even in the normal
person, there is some elevation of the blood sugar
after meals, but the important thing to deter-
mine is whether the blood stream is free of
excessive sugar before the next meal. When
it is, the control of the diabetic condition is
satisfactory, no matter how large or how small
the insulin dose, and regardless of the presence
or absence of sugar in the urine.
SUMMARY
The important fact, so generally overlooked,
that glycosuria is not a reliable guide for the
regulation of insulin dosage in the management
of diabetic patients, is explained and illustrated
by fifteen cases in which glycosuria was present
with normal blood sugar levels; or no sugar
was found in the urine of patients whose blood
sugar level at some time during the day was
elevated abnormally. Two additional cases are
described in which enormous doses of insulin
were actually being prescribed to patients by
other physicians in a futile attempt to control
the ever-present glycosuria. In one of these,
glycosuria remained, despite the fact that the
patient was taking more than eight times the
amount of insulin required to keep his blood
sugar normal throughout the day. Sometimes
this excessive insulin intake produces insulin
reactions and sometimes not, depending on the
individual susceptibility of the patient to insulin.
The important procedure to use in regulating
the control of diabetes is the blood sugar deter-
mination, three times a day, before meals. If
the blood stream clears itself of excessive sugar
by the time of the next meal, then all is well,
whether or not glycosuria is present. If some
excess of sugar remains in the blood stream just
before the following meal, then additional insulin
is indicated, again regardless of the urine tests.
If the blood sugar is elevated in the morning,
then the protamine zinc insulin needs to be
increased. If the level is normal in the morn-
ing, but increased at noon, then the dose of
regular insulin needs to be increased. The pur-
pose of all diabetic treatment is to achieve as
nearly as possible a normal, physiologic level
of blood sugar at all times during the day.
It is suggested that too frequently the diag-
nosis of fungus infection of the hands is made
when a nummular eczema exists. A greater
percentage of these eruptions is due to allergic
responses, most of which are dietary. — Burton
F. Barney, M. D., J. Florida M. A., 37:212, 1950.
The Liquid Therapeutic Diet
The therapeutic diet in which all solid foods
are eliminated will be found useful in the field
of general practice, in general surgery, and
also in the field of oral surgery . . . This list
may be briefly altered as the doctor sees fit.
Feeding
Time
Feeding
6 A. M. Beat together 6 ounces orange juice, 1
egg, 1 tablespoon Karo syrup.
8 A. M. 6 ounces milk, 4 ounces light cream, 1
tablespoon dried skim milk, mixed.
•
10 A. M. Cereal gruel, m»de with 1 cup milk, 1
tablespoon of oatmeal, Pablum or en-
riched cream of wheat, 1 tablespoon
dried skim milk, thoroughly cooked and
strained with 1 tablespoon of sugar
added.
12 Noon Creamed soup, made with 5 ounces of
light cream, 1 tablespoon dried skim
milk, 3 ounces of strained vegetables
(the 3 to 4 ounce prepared cans or
jars of strained baby vegetables or
meats may be used), 1 can or jar to a
serving.
2 P. M. Beat together 6 ounces orange juice, 1
egg, 1 tablespoon Karo syrup.
4 P. M. Creamed soup, made with 5 ounces of
light cream, 1 tablespoon dried skim
milk, 3 ounces of strained vegetables
(the 3 to 4 ounce prepared cans or
jars of strained baby vegetables or
meats may be used), 1 can or jar to
a serving.
6 P. M. 8 ounces of tomato or orange juice.
8 P. M. Beat together 6 ounces milk, 1 egg,
remainder of the 4 ounces of dried skim
milk, 1 tablespoon sugar. (Take vitamin
preparation with this feeding.)
Note: The 6 A. M. and 8 A. M. feedings
may both be taken at 8 A. M. for convenience
if desired. It is necessary to be fed more often
on a liquid diet. Three feedings a day are not
enough. The patient feels overfed or hungry
unless fed every two hours. If the patient is
working, several feedings may be mixed together
and placed in thermos bottles and taken to
work. Salt feedings to taste. Malt, vanilla
and other flavors may be used. It is not neces-
sary to add the dried skim milk as recom-
mended above; it may be added in greater
amounts to any feeding as long as 4 ounces a
day is consumed. The amount of dried skim
milk may be increased or decreased as the doc-
tor sees fit. — C. J. Speas, D. D. S., J. Tenn. State
M. A., 43:325, 1950.
1076
The Ohio State Medical Journal
Pericarditis Complicating Pregnancy: Case Report
DAVID H. GREEGOR, M. D.
The Author
• Dr. Greegor, Findlay, Ohio, is a graduate
of Ohio State University College of Medicine,
1941; and former resident in medicine at
Kansas City General Hospital, Kansas City,
Missouri. At present on medical staff of the
Blanchard Valley Hospital, Findlay, Ohio.
REPORTS on acute pericarditis with effusion
during pregnancy are found rather infre-
quently in medical literature. Hence, we
are reporting this case which may serve as a
reference aid to others encountering the same
problem.
CASE REPORT
The patient was a well developed, well nour-
ished, 21-year old white female with an essen-
tially negative past history. She was quite
certain that she had never suffered from any
rheumatic fever or from any of the mechanical
difficulties usually associated with poor cardiac
function. The patient claimed to have been a
very active young woman all her life and had
played basketball during her high school years.
She had had two previous pregnancies which
were uncomplicated. Up until the onset of the
present illness the patient had always been able
to run up and down stairs never noticing any
shortness of breath.
Approximately three and one-half weeks prior
to her admission to the hospital, at which time
she was entering into her fifth month of preg-
nancy, she suffered from what she considered
a mild upper respiratory infection. This was
characterized by cough and a very mild sore
throat. She recalled no chills or fever.
After suffering from this infection for three
or four days, the patient noticed the onset of
a sudden, rather severe pain through the left
chest. It was. a startling experience and ac-
companied by much coughing, although there
was no blood or blood-tinged sputum. She
believed that there was some fever accompanying
the attack. During the next week and a hall
she had alternating episodes of comfort with
periods in which there was a great deal of left
chest pain. Again, much coughing and prob-
ably fever. As the symptoms grew worse with
respect to her chest discomfort and cough, she
consulted her obstetrician who did a blood count
and physical examination and noted that the
patient was acutely ill with a hemoglobin of
only 52 per cent. She was hospitalized im-
mediately.
Upon her admission to the hospital she was
seen to lie quietly in bed with the aid of one
pillow, very pale, and breathing rapidly but
easily. Her pulse was strong and regular at
120. Blood pressure was 105/70, temperature
100.2. Examination of the head was negative.
Cervical veins were distended and pulsating.
Lung fields were clear. The area of cardiac
dullness was enlarged to the left anterior axil-
lary line and the point of maximal impulse
was felt faintly just medial to the anterior
axillary line. Heart sounds were quite faint
and there was a systolic grade 1 murmur heard
at the apex. The abdomen was negative with
the exception of the obvious 5 months’ preg-
nancy. Lymphoid system, neuromuscular, ex-
tremities, and joints were negative.
An X-ray of the chest showed the heart
to be quite large. The left border extended
Submitted March 13, 1950.
almost to the lateral chest wall and the pulsations
were very feeble. There was some increase in the
vascular lung markings and there was no dis-
placement, either posteriorly or to the right of
the barium filled esophagus. The electrocardio-
gram showed low voltage, a Q 3 which was 22
per cent of the value of the tallest R wave,
flattened ST segments with inversion of T 2
and T 4. Laboratory findings were as follows:
red blood cells 3,400,000, hemoglobin 9 grams,
white blood cells 10,100, with leucocytes 60,
segmented form, 20 “stab” form, 1 juvenile, 17
lymphocytes, and 2 monocytes. Sedimentation
rate was 10 millimeters per hour. The non-
protein nitrogen was 30.5. Three blood cultures
were negative for growth. The blood Kline
test was negative. Urine was negative with
the exception of a trace of albumin. Van den
Bergh’s test had a direct value of 0 and an
indirect value of 0.15 milligrams per 100 cubic
centimeters.
The diagnosis was considered to be acute peri-
carditis of a nonspecific or virus etiology witn
the possibility of an accompanying myocarditis.
During the next four days the following
changes took place. The patient became more
comfortable, most of the distention of the cervi-
cal veins disappeared, and the point of maximal
impulse came back to an almost normal posi-
tion. Some fine rales appeared at the right
lung base which provoked us to use small doses
of salyrgan® every two or three days and to
digitalize the patient slowly. As the patient
became digitalized the pulse gradually dropped
to between 80 and 90, the heart sounds were
more distinguishable, and a very rough almost
continuous friction rub was heard along the
left sternal border and at the apex. The tem-
perature gradually dropped to normal and sub-
normal values and the dyspnea improved. Dur-
ing the first week of hospitalization, the pa-
tient was given a trial outside the oxygen
chamber which did not prove satisfactory — con-
sequently she remained in the oxygen chamber
for several weeks.
A number of drugs and procedures were
tried more or less empirically, and it is the
writer’s opinion that none of these exerted a
beneficial effect on the patient’s course. Among
these empiric trials were a salt free diet, high
doses of salicylates, iron, liver and folic acid
oral preparations, penicillin, and ammonium
chloride. We felt that the only real benefit
was obtained from the oxygen, sedation and
for November, 1950
1077
rest; and the digitalis and salygran® were of
value during her brief course of minimal heart
failure.
After two weeks in the hospital she was
quite comfortable and had no complaints. Tem-
perature ran around 99, blood pressure normal,
and the heart size, shape, and contour by
fluoroscopy were within normal limits. How-
ever, by that time there was a very definite
friction rub at the base of the heart with a
grade 1 systolic murmur at the apex and a
systolic murmur over the pulmonic valve area.
There was no evidence of cardiac failure.
The laboratory work showed no remarkable
changes with the exception that the red blood
count had dropped to 2,600,000 with a hemoglobin
of 8.5 grams, and it was felt that the patient’s
condition and particularly her lack of increased
venous pressure, would permit the necessary
transfusions. She received 2 whole blood trans-
fusions three days apart and very slowly. No
untoward effects were noted and the red blood
count promptly ascended to 4,200,000 and the
hemoglobin to 12 grams. She no longer required
oxygen or digitalis and during the remainder
of her hospital stay was maintained on com-
plete bed rest with mild sedation.
Approximately 3 weeks after admission, she
was discharged for home where she remained at
almost complete bed rest until time for delivery.
She had no complaints and her heart findings
remained about the same for the following 2
months in that there was a grade 1 systolic
murmur at the apex with a basilar friction rub
and a basilar systolic grade 1 murmur. After
about 2 months all abnormal heart sounds had
disappeared with the exception of the grade 1
systolic murmur heard at the pulmonic valve
area. In the meantime her red blood count
had dropped from 4,300,000 to 3,600,000 and so,
twenty days prior to her labor she was given
another transfusion, slowly and without any
difficulty.
Her labor was uncomplicated and she was
delivered of a normal female infant.
At the time of this writing it has been one
year and four months since her delivery. She
has been checked repeatedly during that period
and her electrocardiographic, fluoroscopic, and
auscultatory findings have been completely
normal.
DISCUSSION
It is the opinion of most cardiologists that
the majority of cases of acute pericarditis with
effusion of nonspecific or of a rheumatic origin
in adults will eventually subside without the
aid of too many dramatic therapeutic procedures.
Hence it was more or less a safe conclusion
that pericarditis at this particular time during
the patient’s pregnancy should not have any ill
effects on her ultimate labor; presuming, of
course, that good myocardial function with the
absence of valvular damage would make its
appearance at a safe time prior to the date of
expected delivery.
It is interesting to speculate upon the etiology
in this case, and it is presumed to fall into
that category commonly known as either non-
specific or virus or idiopathic. Evidence to
support this conclusion is as follows: 1. Acute
pericarditis making its appearance for the first
time in a normal adult heart and coming to a
spontaneous remission is usually not thought
to be rheumatic in origin; 2. To the best of
our knowledge no valvular damage or myocardial
damage of permanent nature persisted in this
case; 3. Most of the sedimentation rates, PR
intervals and other stigmata of rheumatic in-
fection during the period of our patient’s acute
illness were within normal limits (although we
should add that on one occasion the sedimentation
rate went to 55 millimeters per hour).
SUMMARY
A case of acute pericarditis with effusion oc-
curring during the fifth and sixth months of
pregnancy is described.
REFERENCES
1. Hamilton, B. E. : Personal Communication.
2. Levine, S. A. : Personal Communication.
3. Hamilton, B. E., and Thompson, K. J. : The Heart in
Pregnancy and the Childbearing Age. Boston, Little,
Brown & Co., 1941.
Papaverine in Insulin Shock Therapy
Our observations clearly demonstrate that
papaverine changes the course of hypoglycemia
induced by insulin. In the high dosage in which
papaverine has been employed in this study, a
mild sedative action cannot be denied. More-
over, phenobarbital was found similarly effective
in preventing hypoglycemic reactions with insulin
dosage above control levels. Although the
anticonvulsant effect of papaverine in these
cases may have been in some measure sedative
in nature, a cerebral vascular action may also
have been operative. Certainly the occasional
observation of transient hemiparesis, hemianes-
thesia, hemianopsia, conjugate deviation of the
eyes, and sensory aphasia during hypoglycemic
shock strongly suggests an underlying vascular
derangement. Moreover, it is precisely for such
symptoms that papaverine has been shown to
exert great benefit in cases of hypertensive and
arteriosclerotic encephalopathy. The drug
would appear, therefore, to have value, not only
in the prevention of the epileptic response to
hypoglycemia but also as a prophylactic meas-
ure to avert cerebral vascular complications in
patients with latent disturbance of the cerebral
circulation. The influence of the drug in prevent-
ing ectopic beats by its quinidine-like action
upon the myocardium would also seem desirable
in insulin hypoglycemia in which cardiac ir-
regularities are frequently encountered. Simi-
larly, the coronary vasodilatation produced by
papaverine would appear to be of further value
in averting other cardiovascular complications
which occasionally arise during this form of
therapy.
From these considerations, it would seem that
papaverine through its combination of effects is
a unique drug for preventing undesirable re-
actions commonly observed in the course of
insulin shock treatment for schizophrenia. In
the dosage employed, no untoward side-reactions
were encountered. Papaverine should be recog-
nized as an effective anticonvulsant drug. — Doc-
tors Russek, Zohman, and Tamarin, N. Y. State
J. M., 50:2301, 1950.
1078
The Ohio State Medical Journal
Acute Fibrinous Bronchitis with Massive Atelectasis
FORREST W. MERICA, M. D.
The Author
• Dr. Merica, Lakewood, Ohio, is a grad-
uate of Indiana Univ. School of Medicine,
1925; fellow, Amer. Med. Assn., Amer. College
of Surgeons, Amer. Acad, of Ophthalmology &
Otolaryngology, Amer. Laryngological, Rhino-
logical & Otological Society, and Amer. Broncho-
Esophagological Society; diplomate, Amer.
Board of Otolaryngology, 1930. He is head of
the Dept, of Otolaryngology & Endoscopy,
Lakewood City Hosp.; visitant in Otolaryng-
ology & Endoscopy, Fairview Park Hospital,
Cleveland.
THE occurrence of fibrinous bronchitis, espe-
cially when complicated by massive atelec-
tasis, is so extremely rare that the
following case, in an infant, seems worthy of
report. A survey of the Index Medians for
the past twenty years yielded only one com-
plete case report in the American periodical
literature. This was published by Perlstein,1 in
1930. In the third edition of their book,
Bronchoscopy, Esophagoscopy and Gastroscopy,
published in 1934, Jackson and Jackson2 stated;
“Two cases of fibrinous bronchitis have come
to our clinic. One required bronchoscopic re-
moval of plugs of membrane from the bronchi
to relieve atelectasis. Both patients recovered
without recurrence.” They furnished no details
of these cases. All the other cases of this condi-
tion listed in the Index were in the foreign
literature, most of them in journals not acces-
sible to me. Of the cases reviewed in detail, all
were in adults, and hence the present case, in
a boy, aged 20 months, is of exceptional in-
terest.
Case Report. — A male infant, aged 20 months,
was admitted to Lakewood Hospital on Febru-
ary 20, 1948, with fever and severe dyspnea.
About five days before admission, the child
had begun to have a harsh, non-productive
cough which had become progressively more
severe, but he had not appeared ill until the
day before he entered the hospital. Then his
temperature was 103.2 °F., he became very short
of breath, had gasping and grunting respirations,
cried spasmodically and became slightly cyanotic.
The parents were unable to give any information
concerning the possible aspiration of a foreign
body, except that about two weeks earlier, while
eating a carrot, he seemed to choke and coughed
for a few minutes afterward, but subsequently
had had no cough until the onset of the present
illness.
A tonsillectomy had been performed two months
earlier because of frequent sore throats. Other-
wise, the child had always been in good health. He
had received the usual immunization and had
not had any of the usual contagious diseases.
Physical examination showed that the child
was well developed and well nourished, some-
what large for his age. He was moderately
cyanotic and respirations were rapid, labored
and grunting. He appeared acutely and severely
ill. Examination of the neck showed no rigidity
or adenopathy. The trachea was deviated
slightly to the right. The chest was somewhat
asymmetrical, with decreased costal excursion
in the right upper region and increased flare of
the right costal border. The entire lung field
was dull to percussion, both anteriorly and
posteriorly. Breath sounds were markedly de-
creased over the right upper lobe and were al-
most entirely absent over the right lower lobe.
No rales were detected and the left lung fields
Submitted Feb. 14, 1950.
were clear. The heart and mediastinum were
both shifted to the right, and the heart rate
was accelerated. The abdomen was not dis-
tended and showed no abnormal findings.
Roentgenographic examination of the chest
showed the right hemithorax entirely opaque
and the heart and trachea markedly retracted
to the right, indicating virtually complete
atelectasis of the right lung. The left lung
was entirely clear. The findings suggested ob-
struction of the right main stem bronchus by
a non-opaque foreign body.
Routine laboratory tests showed nothing signif-
icant, except for a slightly elevated leucocyte
count of 11,450. The differential count showed
2 per cent eosinophils.
In view of these findings, bronchoscopy was
performed immediately. A Jesberg bronchoscope
(4 mm. 26 cm.) was used. When the carina
was reached, the left main stem bronchus ap-
peared clear. The right main stem bronchus
contained some mucopurulent material which
was aspirated. Then some whitish, heavier mate-
rial appeared in the bronchus and was removed
with a forceps. It was large and appeared to
be fibrinous, somewhat resembling a piece of
white cotton string. Then the aspirator was
used and much heavy material passed through
the tube into the wash bottle. The material
sucked into the wash bottle appeared to be
casts of the bronchial tree, formed of heavy,
fibrinous material (figure 1).
Immediately after this heavy fibrinous plug
had been removed, the child’s breathing im-
proved. Breath sounds came through in the
lower lobe, and the mediastinum shifted to
normal position, as did the heart.
The pathologist reported that the gross speci-
men (of the material removed from the bronchus)
consisted of a number of pale gray masses
with a root-like formation. They measured as
much as 2.5 centimeters in over-all length, with
the individual branches varying considerably.
The maximal thickness was 1.5 millimeters. The
tissue was moderately friable. Microscopic ex-
amination revealed irregular masses of fibrin,
containing unusually large numbers of eosin-
for November , 1950
1079
ophils, with numerous neutrophils and round
cells. The pathologic diagnosis was fibrinous
bronchial casts.
The child’s recovery was rapid. Two days
after the bronchoscopy, the respiratory rate was
still slightly increased, but there was no cyanosis,
his color was good and both sides of the chest
were moving equally. There was no dullness on
.Figure 1. Gross specimen (fragmented) of fibrinous bron-
chial cast removed through the bronchoscope.
the right side of the thorax and breath sounds
were clear and normal over the entire chest,
with no rales. On March 1, 1948, nine days
after admission, he was happy, eating well and
his respiratory rate Was normal; he was then
dismissed from the hospital.
OTHER REPORTED CASES
In the case reported by Perlstein1 the patient
was a man, aged 54 years, whose diagnosis on
admission was far-advanced tuberculosis. He
had been feeling weak and losing weight for
about a year. An exploratory laparotomy had
been performed but nothing abnormal had been
found. He began to have a paroxysmal cough,
but brought up no sputum; a little later dyspnea,
chills and cyanosis appeared. On admission,
thefe were clinical signs of massive atelectasis.
While a chest roentgenogram was being taken,
the patient coughed up some blood-streaked
sputum in which a bronchial cast was found,
rolled up in a large ball of mucus. He felt
better almost immediately, his temperature re-
ceded and he was up and about within a few
days. For a few days after this episode, sputum
expectorated showed fragments of casts consist-
ing of strands of fibrin, containing no cells and
no bacilli. The atelectasis disappeared com-
pletely. All sputum was negative for tubercle
bacilli, though later roentgenograms of the chest
showed suspicious markings in the upper lobes
which pointed to a diagnosis of probable inactive
tuberculosis.
Seiler3 reported the case of a woman, aged
41 years, whom he treated with collapse ther-
apy, after failure of medical treatment. About
ten years earlier, she had had an illness which
began with an apparently light cold and a
questionable dry pleurisy, though there were
no significant lung findings. Cough persisted
for several weeks, and then the patient coughed
up blood-streaked mucus plugs, containing
■“little branches” and her symptoms disappeared
almost immediately. Later she had had several
recurrences of this type of illness, always with
improvement after coughing up plugs in the
form of bronchial casts. When she consulted
Seiler, at the age of 41, the manifestations had
become more severe, and she complained of
weakness and loss of weight, frequent paroxysms
of coughing and dyspnea. In this case, material
from the bronchus showed that it consisted prin-
cipally of fibrin, with gram-positive cocci and
leucocytes. There were no tubercle bacilli, no
eosinophils or Charcot-Leyden crystals.
Rakower’s4 patient was a woman, aged 36
years, who had had three attacks of “grippe”
during the past year with persistent dry, non-
productive coughing. On one occasion, when she
was ill while visiting in the country, and had
a severe pain in the chest which had been
diagnosed by the local physician as left-sided
pneumonia, she coughed up a large mucus plug
which she described as being 10 to 12 centi-
meters long. After this episode, her condi-
tion improved, the pain in the chest disappeared,
the cough subsided and the patient returned
to her home. After the last attack of grippe,
she had had a slight elevation of temperature
and became increasingly dyspneic, with persist-
ent coughing. After clinical and roentgen-
ographic examinations which showed atelectasis,
bronchoscopy was decided upon before making
a definite diagnosis. While the patient was
being prepared for bronchoscopy, she had a
paroxysm of coughing and brought up a bron-
chial cast which measured 6 to 8 centimeters
and was blood-streaked. The patient felt better
almost immediately and recovered steadily.
After two months, the lungs were almost en-
tirely clear. The expectorated plug contained
Charcot-Leyden crystals, a large number of
eosinophils, leucocytes and epithelial cells. There
were heterogeneous bacteria with a preponder-
ance of gram-positive cocci.
Roth5 reported the case of a woman, aged 56
years, who had had a persistent, non-productive
cough for more than six months, with severe
dyspnea. She was treated with torantil,® an
antihistamine substance, and expectorated fibrin-
ous plugs which relieved her symptoms.
Meyer’s8 patient was also a woman, aged 29
years, whose symptoms began during an attack
of influenza. Her temperature never exceeded
38 °C and she was not severely ill. She had a
persistent cough, however, and during the third
week began to cough up fibrinous material. The
thickest specimen was about 2 millimeters and
the longest about 4 centimeters. A culture of
the material showed hemolytic streptococci and
some white and yellow staphylococci. This pa-
tient’s lung sounds were normal to percussion
and auscultation throughout her illness. After
getting rid of the fibrinous material, the patient
improved and was up and about within a week.
The sputum became like mucus instead of fibrin-
ous.
Malamud and Lisman7 observed a woman, aged
50 years, who, thirteen years previously, had
had an acute pulmonary infection accompanied
by profuse coughing and had expectorated long
strings of mucus, with branches. She had re-
covered from that illness in about three weeks.
When the authors observed her, she had been
ill for four weeks, with cough, dyspnea, weak-
ness, and malaise which had not responded to
usual treatment. After two weeks, she had
coughed up a large mucus plug, about 5 centi-
meters long, with branches, which had produced
transitory improvement. Afterwards, the
dyspnea and cough became more severe, with
deterioration in her general condition, and she
was admitted to the hospital. Examination
showed a bronchitis which was apparently not
1080
The Ohio State Medical Journal
severe and atelectasis of the left pulmonary
lobe. The patient coughed up abundant muco-
purulent material, whose appearance did not
attract attention, and then began to improve
with complete recovery within a few weeks.
DISCUSSION
As already noted, the information on fibrin-
ous bronchitis is extremely scanty, since the
condition is of such rare occurrence, although
the indications are that it is somewhat more fre-
quent in Europe than in the United States. Such
information as there is consists of individual
case reports, scattered throughout the world
literature. Perlstein1 estimated in 1930 that
about 175 cases had been reported and Seiler3
estimated that there are only about a hundred.
The cause remains obscure, but allergy,
diphtheria, tuberculosis, and influenzal infections
are most frequently indicated. Perlstein re-
ported that Shroder (1920) had found five cases
among 4716 cases of pulmonary tuberculosis.
In commenting on the possible etiology, Perl-
stein stated: “It is a matter of speculative im-
portance whether fibrinous bronchitis is a
metabolic disturbance of the bronchi, as sug-
gested by Engel, or whether it is a response
to infection or even to an altered, that is to say,
increased coagulability of the blood serum. In
any case, the association of the condition with
tuberculosis, pneumonia and the broncho-
asthmatic group, all of which are among our
commonest fibrin-producing diseases, seems to
be more than a fortuitous circumstance.”
Rakower concluded that two conditions contri-
bute to the production of pseudomembranous
bronchitis: (1) a constitutional diathesis and
(2) some infectious, mechanical or physico-
chemical agent. In the case he reported, the
patient had a familial history of allergy and he
considered a neurovegetative diathesis the pri-
mary cause but the precipitating agent was in-
fectious (three attacks of grippe).
In my own case, the only finding which would
suggest an allergic factor was an increased
eosinophil count. There was no history of
allergic symptoms and no clinical signs to sug-
gest this. Since the case was of acute onset,
it seems likely that it was produced by in-
fection. The patient received penicillin and
sulfadiazine during his stay in the hospital,
and the febrile symptoms subsided promptly.
All authors recognize two forms of this condi-
tion, the acute and the chronic. The acute type
is more serious; in this condition the mortality
is estimated by different authors as 25 to 50
per cent. Some patients with the chronic type
have had recurrent symptoms for years, even
as long as 25 years.
It would appear from the literature that the
condition is usually recognized after spontan-
eous expectoration of large bronchial plugs of
fibrinous material. With the more widespread
use of bronchoscopy, it may be that more of
these cases will be recognized and relieved by
aspiration of the fibrinous material through the
bronchoscope.
Alth®ugh atelectasis is a rare complication of
this condition, especially in the more chronic
cases, it was a feature in the clinical picture
of four of the eight cases of other authors
cited. Maxwell8 also reported atelectasis in a
case which was not fibrinous bronchitis but the
bronchi were occluded by large mucous plugs.
Despite the extreme rarity of fibrinous bron-
chitis or of atelectasis resulting from bronchitis,
the fact that it can occur should be kept in
mind in any bizarre case of acute respiratory
difficulty, especially in those with signs and
symptoms of atelectasis. Consistent use of
bronchoscopy in such instances might bring a
few more of these cases to light.
SUMMARY
A case is reported of acute fibrinous bronchitis
complicated by massive atelectasis of the right
lung in an infant boy, aged 20 months. Cough
had been present for five days, but the child had
been acutely ill only for 24 hours before ad-
mission with severe dyspnea and cyanosis and
signs of massive collapse of the lung. Removal
through the bronchoscope of an occluding bron-
chial cast of fibrinous material brought im-
mediate relief and led to an uneventful recovery.
Note: I am indebted to Dr. H. R. Hathaway of Lake-
wood, Ohio, for having diagnosed and referred this case.
REFERENCES
1. Perlstein, R. N. : Case of Fibrinous Bronchitis Com-
plicated by Massive Atelectasis. Am. Rev. Tuberc. 22 :82-86,
July, 1930.
2. Jackson, C., and Jackson, C. L. : Bronchoscopy,
Esophagoscopy and Gastroscopy, Philadelphia, W. B. Saun-
ders Co., 1934 (3rd edition).
3. Seiler, S. : tlber Bronchitis Plastica (Mit Mitteilung
Eines Durch Kollapstherapie Geheilten Falles), Schweiz.
Med. Wchnschr. 72 :86-90, January 24, 1942.
4. Rakower, J. : Atelectasie Massive au cours de la
Bronchite Pseudo-Membraneuse Primitive. Press Med.
46:1116-1118, July 16, 1938.
5. Roth, O. : Zur Pthogenese und Behandlung der
Bronchitis Fibrinosa, Klin. Wchnschr. 17 :1798-1800, Decem-
ber 17, 1938.
6. Meyer, A. : Uber Bronchitis Fibrinosa Acuta, Klin.
Wchnschr. 16:1126-1127, August 7, 1937.
7. Malamud, T., and Lisman, A. : Atelectasia Aguda de
un Lobulo Pulmonar en Una Bronquitis Pseudomembranosa
Frusta, Prensa Med. Argent. 33 :2362-2365, November 22,
1946.
8. Maxwell, J. : Massive Collapse of Lung Occurring in
Bronchitis, St. Barth. Hosp. Rep. 70:183-189, 1937.
The Gallbladder and Common
Duct Problem
The findings which we have regarded as
criteria for opening the common duct are as
follows: (1) A palpable stone in the duct. (2)
Jaundice or a history of jaundice. (3) Abnormal
dilatation of the duct. (4) A contracted gall-
bladder containing stones. (5) Multiple small
stones in the gallbladder with an enlarged, pa-
tent cystic duct. (6) Flocculent bile in the duct,
as shown by aspiration. (7) Gallstones asso-
ciated with chills and fever. — Robert L. Sanders,
M. D., J. Iowa State M. S., 40:437, 1950.
for November, 1959
1081
The Physician and Privileged Communications as
They Relate To Mental State
E. H. CRAWFIS, M. D., LL. B.
INTRODUCTORY
THE average psychiatrist is averse to testi-
fying in court, and avoids it as much as
possible. In fact, many physicians, in-
cluding psychiatrists, fear such an experience.
However, at one time or another, situations will
arise in which the psychiatrist is forced to ap-
pear and testify. Paranoid patients, those with
postraumatic neuroses, or senile deteriorations,
for example, may appear in any psychiatrist’s
office, be examined without any indication of
possible litigation, and then within a period of
several years the psychiatrist be called upon to
testify as to the patient’s mental condition, the
cause of his illness, etc. Thus, in spite of
aversion to court appearance, the chances of
escaping completely are almost nil. For this
reason, the psychiatrist needs to know something
of his rights and privileges in court.
One of the important factors governing the
physician’s testimony is that of privileged or
confidential communications. To most physicians,
privileged communication is a vague phrase, and
they have little understanding of this impor-
tant property right, which belongs to the pa-
tient, and of the responsibilities of the phy-
sician, who is charged with the duty of observ-
ing the privilege. For this reason, I think that
a discussion of the privilege as it applies to
the physician, and to psychiatrists in particular,
will prove valuable.
DUTY TO GIVE TESTIMONY
One of the fundamental maxims of the Anglo-
American judicial system is that the public has
a right to everyone’s evidence. Our starting
point is that there is a general duty to give
whatever testimony one is capable of giving.
Exemptions are exceptional and are limitations
to the general rule. The privileged communica-
tions rule as applied to physician and patient
is one of these exceptions to the general liability
of every person to give testimony in court.1
BASIC PRINCIPLES
There are four fundamental conditions upon
which the privilege is based.1
1. Communications must originate in the
belief and confidence that they will not be
disclosed.2 3 4 Many diseases are not socially
accepted, and the patient will go in for treat-
Read before the Cleveland Society of Neurology & Psy-
chiatry, Feb. 15, 1950.
The Author
• Dr. Crawfis, Cleveland, Ohio, is a grad-
uate of Ohio State University School of Medi-
cine, 1935; fellow, Amer. Med. Assn.; member,
Cleveland Soc. of Neurology & Psychiatry;
Amer. Psychiatric Assn.; Cleveland Academy
of Medicine; Medical Correctional Assn. For-
merly, asst. supt. Lima State Hospital, Lima,
Ohio; at present, supt., Cleveland State Hosp.,
Cleveland ; clinical instructor in Psychiatry,
School of Medicine, Western Reserve Univ.;
demonstrator in nervous and mental diseases,
Western Reserve Univ.
Dr. Crawfis, who also holds a degree in Law,
is a member of the Cuyahoga County Bar Assn. ;
Cleveland Bar Assn.; Ohio State Bar Assn.;
and the American Bar Assn.
ment only if he is sure that the doctor will
not disclose his illness. This is especially
true in psychiatry, where the community
is not yet sufficiently enlightened as to
mental illness.
2. The element of confidence must be
essential to the maintenance of the rela-
tionship.
3. The relationship must be one in which
the community is interested, and which it
supports.
4. The injury to the relationship by the
disclosure of communications must be greater
than the benefit thereby gained for the
correct disposal of litigation. Although in-
dividual injury may occur by reason of the
withholding of information, the general bene-
fit to most patients and to the Courts justi-
fies the relationship.
HISTORY OF THE PRIVILEGE
In examining the history of privileged com-
munication, we find the one of attorney and
client to be the oldest. Under the English
Common-Law Rules, no privilege was recognized
as to communications between physician and
patient. The privilege was established by statute
in New York in 1828, and has been adopted by
at least half of the states. We must be clear,
therefore, that the privilege as applied to phy-
sician and patient is statutory, and we must ex-
amine the statutes in the particular state, in
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The Ohio State Medical Journal
each individual case, to know whether the priv-
ilege exists or not.
ARGUMENTS AS TO THE PRIVILEGE
There are arguments as to the privilege.
Some feel that it is unnecessary and should be
eliminated. In some states where it applies,
there have been efforts to abolish it.
The principal objection to the privilege is in
personal injury cases and in cases involving in-
dustrial accidents. The claim is made that the
privilege is used only to suppress the truth.
In such cases the medical testimony is very
important, and frequently the deciding factor.
It is in this field that the greatest efforts are
made to introduce testimony on the ground of
waiver; that is, when the patient has impliedly
relinquished the privilege, and those efforts are
stoutly resisted. There are numerous conflict-
ing decisions. The patient may waive his
privilege and the Court can force the physician
to testify. However, it is important to know
that the physician does not have the power to
waive the privilege.
It should be pointed out also that the priv-
ilege has been modified as to reporting of
venereal disease, and also as to industrial ac-
cidents and illnesses. Here the privilege has been
modified either by the exercise of police power,
or by express waiver. The physician is required
by health regulations to report certain infectious
diseases. For example, reports are required
by law or by official bodies. In the case of
industrial illnesses and insurance policies, the
privilege is expressly waived by the patient at
the beginning of the relationship.
GENERAL STATEMENTS ABOUT
PRIVILEGED COMMUNICATION
It is necessary that the relationship of phy-
sician and patient exist — a professional relation-
ship, where the patient seeks treatment. The
relationship may arise without the patient’s per-
mission, if unconscious and an emergency exists.
The physician must be acting in his professional
capacity, and information acquired when not
employed as a physician is not privileged. The
patient may waive the privilege. From the
standpoint of the attorney, this is probably the
most interesting phase of privilege. The waiver
may be expressly stated as in insurance policies,
and may arise because the patient sues the phy-
sician for malpractice, or merely calls the phy-
sician as a witness in a case involving the pa-
tient’s illness.
PRIVILEGE AS APPLIED TO MENTAL STATE
To the psychiatrist, the question of privilege
presents some special problems. One of these
is that of testifying as to mental condition.
This stems from the fact that, in earlier cases,
sanity or insanity was not regarded as a medical
problem. There are cases in which the family
physician has been called to testify as to his
patient’s medical condition, although other in-
formation known by the physician was considered
privileged. Other cases reach the opposite con-
clusion. The same applies to psychiatrists.
However, in reading the more recent cases, I
believe that the trend is definitely toward accept-
ing the viewpoint that as to his patient’s mental
condition the privilege applies to the psychia-
trist. If you are called to testify as to infor-
mation received from your patient, or his mental
condition, you should regard this as a privileged
communication, and should not testify unless the
privilege is waived, or you have been instructed
to testify by the Court.
PRIVILEGE DOES NOT APPLY IF
EXAMINATION ORDERED
Where the examination of the patient has been
ordered by the Court, or for the opponent in
civil litigation, since no professional relation-
ship applies, the privilege does not apply. Also,
in expert testimony, the hypothetical question
does not involve the privilege.
PRIVILEGE AS APPLIED TO HOSPITAL RECORDS
Apparently there is no question that the
privilege includes medical records, and hospital
records.2 However, in the case of a public hos-
pital, we are not so clear. In Ohio, for example,
we have conflicting decisions as to whether the
privilege attaches to public health institutions.
The most recent decision states that the hold-
ing is for the privilige in the majority of juris-
dictions. The New York Courts have reached
a directly opposite decision, and hold that the
physician-patient relationship does not apply in
State Hospitals. I think that it is important for
us to know that this rule would not be applied
in Ohio, and that the physician-patient relation-
ship is the same in our State Hospitals as in
general hospitals or private practice.
It should be made clear that the privilege
applies to the communication itself, and not to
the fact that a communication was made. The
date of an examination, number of office visits,
etc., are not privileged.
In applying these rules to hospital records
then, we see that ordinary facts as observed
by lay persons are admissible. Date of ad-
mission, discharge, and other statistical data
clearly are not controversial. Others, such as
observation of “odor of alcohol on breath”; “pa-
tient was delirious 4 hours before accident”;
“patient’s vomitus had odor of whiskey”; rec-
ord showing unruly behavior of patient and dis-
obedience of orders of surgeons and nurses —
— all have been held admissible, that is, not
within the privilege.
However, the history and examination or
progress notes as recorded by intern, resident,
for November, 1950
1083
or medical officer, are privileged, and the Court
should be consulted before testifying on such
matters. In State Hospitals, where the diag-
nosis and condition of the patient are reported
to the committing court, they are public record
and cannot be considered privileged.
PRIVILEGE MAY OR MAY NOT APPLY
IN CRIMINAL CASES
The privilege has been held to apply in
criminal as well as civil cases. However, the
Courts do not like its effects, feeling that
justice will not be done in many instances, and
have taken various methods to circumvent its
application. In California, the statute expressly
limits it to civil cases.
INVOLVING TESTATOR’S MENTAL CAPACITY
PRIVILEGE USUALLY DOES NOT APPLY
There are a considerable number of cases in-
volving will contests, and the testator’s mental
capacity. However, in referring to the phy-
sician’s testimony it is apparent that usually
the family physician, and not a psychiatrist,
was involved. In some cases the question of
waiver of privilege was argued. Generally,
however, the decision has been reached that the
physician could testify on testator’s mental con-
dition because this was not a part of the medical
situation; that is, he was not under treatment
for mental illness.
It should be pointed out that the requirements
for mental capacity to make a will are not the
same as those used in judging either competency
or insanity in the legal sense. It is possible for
a person to be legally insane or incompetent
and still be considered as able to make a
valid will. In almost all cases, one can as-
sume that questions involving mental capac-
ity to make a will do not come within the
area of privileged communications. I think
that it is important for the psychiatrist to re-
member that insanity in the legal sense is not
synonymous with psychosis. The Courts are in-
terested only in competency or responsibility.
Generally speaking, the Court considers the
terms insanity and psychosis as synonymous, and
yet they are not. In civil cases the test pri-
marily is competency, that is, the ability to
manage one’s own financial affairs. On the
criminal side the measurement primarily is the
ability to form the intent to commit crime. I
am sure that all psychiatrists know many psy-
chotic patients, who are competent and able to
manage their own affairs.
POSSIBILITY OF PHYSICIANS BEING SUED
FOR BREACH OF PRIVILEGE
There are a number of cases in which phy-
sicians have been sued for libel or slander,
based upon the disclosure of information covered
by the privilege.3 Such disclosure, either oral or
written, must expose the person to contempt or
ridicule and injure him in his occupation. Usually
such cases have been based upon disclosures
of venereal disease, but all physicians should
remember such a possibility in discussing then-
cases before groups. In presenting case his-
tories, photographs, etc., care must be used in
concealing the identity of patients.
Testimony given by a physician in court on
confidential information is not a breach of the
privilege, and no liability is incurred for this
reason. Also, filing of various official reports
required by law does not make the physician
liable.
BREACH OF PRIVILEGE AS TO RECORDS
AND RELEASE OF INFORMATION
Liability for breach of the privilege must also
be considered when requests for information come
to the physician, or requests to the hospital for
examination of records, or copies of records.
Most hospital administrators are aware of the
necessity of a signed release by the patient, his
guardian, widow, heir, etc. Such release must
be kept on file with the record. In the situation
where residents or medical staff members wish
to use records for research or preparation of
papers, authorization for use of records is
obtained from the hospital rather than the pa-
tient. No privilege or waiver is involved if the
identity of the patient is not disclosed.
Abstracts, summaries, etc., supplied to hospi-
tals and attending physicians, are usually a
matter of courtesy, and release or authoriza-
tion is not required.
A frequent problem encountered in hospitals
is a request to examine records by insurance
men, or attorneys, with a signed release by the
patient. In many instances, it is customary for
the hospital to permit this. We do not agree
with this practice. It should be pointed out
that the record is the property of the hospital,
not the patient, and that a signed authorization
is only a waiver of privileged communication.
It is much better practice to answer questions
from the record than to allow free examination.
There are several objections to such examina-
tion: First, there is the possibility of altera-
tion; Second, the names of residents or interns
are frequently obtained, and they are sub-
sequently subpoenaed; Third, lay persons may
misinterpret statements in the record, giving
rise to needless litigation; Finally, in State
Hospitals or in private sanitariums, the com-
petency of the patient may be questionable.
Certainly in the case of State Hospitals, where
patients are committed by the Court and thereby
automatically declared incompetent, a waiver by
such a patient would be invalid. For this rea-
son, I strongly advise that a more careful check
be kept on the access to hospital records.
Finally, the psychiatrist should be reminded
that even though he is not paid, the privilege
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The Ohio State Medical Journal
is not waived.4 Just as in malpractice cases,
the basic principle is protection of the patient,
and those patients treated without charge are
protected as well as those who pay.
SUMMARY
1. There is considerable variation in the ap-
plication of the rule of privileged communica-
tions; in Ohio it is established by statute. There
are arguments as to whether it is justified but
as long as it is in the statutes we must accept
it.
2. When the psychiatrist testifies as to his
patient’s mental condition, the privileged com-
munications rule applies.
3. The rule applies to hospital records, and in
Ohio to State Hospital records.
4. The rule probably does not apply in testify-
ing as to mental capacity to make a will.
5. Knowledge of the rule is important to
prevent suits against the physician either on the
basis of his private records, or those in the
hospital.
6. In permitting examination of the patient’s
record, the rule of privileged communications
should be considered.
And in conclusion, some general knowledge
of his legal rights and liabilities is a neces-
sary part of every psychiatrist’s equipment.
Much as he would like, he cannot completely
avoid legal complications in the present day
practice of psychiatry.
BIBLIOGRAPHY
1. Wigmore on Evidence. Sec. 2285, Sections 2380-2391.
2. Law of Hospital, Physician and Patient — Hayt and
Hayt.
3. Medical Malpractice — Regan.
4. The Business Side of Medical Practice — Wiprud.
Citation of cases is omitted.
Bronchiectasis
Bronchiectasis is a common disease which has
been overlooked, wrongly diagnosed and poorly
treated by a majority of medical men for many
years. Too often children with typical pictures
of bronchiectasis have been diagnosed as chronic
bronchitis or their parents have been told that
the child’s cough was habitual and that he or
she would eventually outgrow it . . . Bronchiectasis
is a common disease which usually develops after
pertussis, pneumonia or measles, or a combina-
tion of these diseases ... If it should develop,
the patient should be studied with the thought of
elimination of the disease by surgery. Surgery
is urgent since a high percentage of patients who
develop bronchiectasis before the age of 10 years
are dead of the disease or its complications before
the age of 40 years. The risk of lobectomy
(even bilateral) or pneumonectomy is slight
compared to the risk of the patient keeping his
diseased lung tissue. — Ralph A. Dorner, M. D.,
J. Iowa S. M. A., 40:290, 1950.
Nephritis
As the acute nephritis becomes better and the
urinary and other findings begin to disappear,
the proteins are graually increased up to a
normal intake of 1 Gm. or more per kilogram
per day . . . Salt should be restored gradually
when edema disappears, to avoid recurrence of
edema. We usually increase their intake by 2
Gm. for two to three days. If there is no in-
crease in edema or weight and no decrease in
urinary output or rise in blood pressure, the salt
is increased to 5 Gm. a day and eventually a
normal quantity is permissible.
As glomerulonephritis progresses and the pa-
tient passes into the nephrotic phase, one is
confronted with a problem which is quite dif-
ferent from that of the acute phase. For in
this stage of the disease the patient may not
have hypertension, or hematuria, or nitrogen
retention, but does have marked edema, hyper-
cholesterolemia, albumin globulin reversal, and
large quantities of albumin in the urine, at
times as high as 20 to 40 Gm. per 24 hours.
Nephrosis is one of the stages through which
glomerulonephritis may progress and is also
regularly encountered in amyloid degeneration
of the kidneys. Its effect on water and salt
metabolism is essentially the same, regardless of
its origin. In the treatment we attempt, first, to
promote diuresis and, secondly, to correct the
hypoalbuminemia. Salt restriction is preeminent
and this has to be rigid. The extensive edema in
these patients is on the basis of a depletion of
the serum albumin, and we try to improve this
factor by dietary management. These patients
are given diets high in protein up to 3 Gm. per
kilogram. It is difficult to raise the protein level
in the blood if excretion is 10 Gm. of protein or
greater; if 15 Gm. or over, it is impossible to
build the serum albumin content by diet. Never-
theless, depletion of serum albumin means deple-
tion of all protein stores in the body, and protein
feeding is the only way we can keep up the pa-
tient’s nutrition until nature comes to his rescue.
Nature then may heal the glomeruli through
which this large quantity of protein is leaking,
or a fibrosis of these glomeruli may result and the
protein loss is stopped. But in reality the kid-
ney has been more extensively damaged. In-
travenous protein hydrolysate or amino acids
are of no value in attempting to build up the
protein depletion. These are of value only in
correcting the nitrogen crises which result from
depletion of plasma nitrogen, as demonstrated by
Fahr. Some may wunder about the use of con-
centrated salt-free serum albumin at this stage.
We feel this is not advisable, as it is excreted as
quickly as it is administered and is too closely
to be eliminated in the urine. — B. J. Peters, M. D.,
Wisconsin M. J., 49:791, 1950.
for November, 1950
1085
Development of Dermatology in Ohio
Part II
LEON GOLDMAN, M. D.
(Concluded from the October Issue)
THEN in these three medical centers in Ohio
the burden of undergraduate and later post-
graduate dermatologic teaching was under-
taken by these part-time teachers and always busy
practitioners. They were the type of clinicians
that Bechet mentioned and they were not only
important in their local scene, but they in-
fluenced American Dermatology. Ravogli helped
to found the Section of Dermatology and Syph-
ilology of the American Medical Association
in 1887 and was its host in Cincinnati and in
its first meeting on May 8, 1888, when Corlett
was its first secretary. Later Ravogli became
its chairman in 1897. Ravogli was also presi-
dent of the American Dermatological Associa-
tion in 1916. In addition to the national im-
portance of his services in developing postgrad-
uate training in Cleveland, Harold Cole was
and is a foremost syphilologist in this country
and his work with Sollmann was responsible for
the clinical implications of the pharmacology of
the heavy metals available for the therapy of
syphilis in those days. Even today, the main-
tained close associations of syphilology with der-
matology in Cleveland and Cincinnati is unfor-
tunately not held as a united front on the rest
of the American scene.
IN CINCINNATI AND CLEVELAND
The result of such teaching centers was the
development of men interested in dermatology,
specializing in dermatology and even serving as
teachers. The rise of such centers in the United
States made it unnecessary to go to Europe for
training in diseases of the skin. The dermatolo-
gists in those centers, especially in Cleveland
From the Department of Dermatology and Syphilology
of the College of Medicine of the University of Cincinnati
and the Cincinnati General Hospital. Presented at Ohio
State Archeological and Historical Society Annual Meeting,
Columbus, April 14, 1950.
The Author
• Dr. Goldman, Cincinnati, is a graduate of
University of Cincinnati College of Medicine,
1929; diplomate, American Board of Derma-
tology and Syphilology; fellow, Royal Society
Tropical Medicine and Hygiene; member,
American Academy of Dermatology and
Syphilology, American Society of Tropical
Medicine, and Society for Investigative Derma-
tology; director dermatology, Cincinnati Gen-
eral and Children’s Hospitals; and prof.,
dermatology and syphilology, University of
Cincinnati College of Medicine.
and Cincinnati, assisted in the development of
their respective groups. Without such assist-
ance, the directors could have never maintained
such teaching and research activities. The men
in Cleveland consisted of John Rauschkolb, John
Gammel, Hagobe Miskjian, George Binkley,
Herbert Johnson and others. In Cincinnati the
succession of outstanding men included Edward
Shields, Charles Tabb Pearce, Meyer L. Heidings-
feld who later became professor of dermatology
and died September 3, 1918, and then was suc-
ceeded by Elmore Tauber who developed the
service at the Cincinnati General Hospital, and
then by Harry Claassen, respectively, as profes-
sor of dermatology in the College of Medicine
of the University of Cincinnati and as director
of the service at the Cincinnati General Hos-
pital.
In Cincinnati, the two medical colleges,
Miami and Ohio Medical College were combined
in 1909. Cleveland Medical Department of Ohio
Wesleyan University was later taken over by
1086
The Ohio State Medical Journal
Western Reserve University in 1910. The pro-
fessor of dermatology there before the merger
was Dr. Harry B. Kurtz. Some dermatologic
teaching was done also in the homeopathic
medical schools both in Cleveland and in Cin-
cinnati. Later as part of the development on
the national scene, Ohio participated in the
founding of the large clinic type of practice
and the Cleveland Clinic in 1923 soon after its
inception, had a Department of Dermatology and
Syphilology and Earl W. Netherton was placed
in charge. Later George M. Curtis came as
his assistant.
DEPARTMENTS DEVELOPED
Now with the increasing age of specialism,
we find that large active hospitals developed
departments of dermatology. These were im-
portant for the teaching, not only of the resident
staff of the particular hospital, but for those
who w’ere associated with medical college for
undergraduate teaching. They were instru-
mental in the development of postgraduate teach-
ing for the specialists in training and for the
practicing dermatologists in their respective
staffs. The interest and value of such a spe-
cialty service was dependent upon such factors
as the interest of the hospital in developing
such services, the allocation of in-patient beds,
the interest (as opposed to ‘‘inertia”) of the
visiting dermatologists. In Cleveland, some of
these hospital services may be mentioned be-
cause they were actually active training centers.
In 1917 Mt. Sinai Hospital had a night clinic
for urology, syphilis, and venereal diseases
under Dr. Philip Jacobs. In 1919 Dr. Benj amine
Levine organized a day clinic and included der-
matology. Later he was joined by Dr. J. E.
Fisher and Dr. Sidney Littman. In St. Vin-
cent’s Charity Hospital, the service origi-
nally developed by Dr. Heithaus was later con-
tinued by Dr. Cummer and Dr. LaRocco. The
St. Luke’s Hospital service developed by Dr.
Robert E. Binkley, who was later succeeded by
Dr. Herbert Johnson. St. Alexis Hospital had
Dr. Clyde Cummer as visiting dermatologist
about 1925. Later John Rauschkolb developed
an outpatient dispensary there. Claude Nor-
ris in Youngstown and Howard Parkhurst in
Toledo are prominent in the national scene.
SPECIALTY SOCIETIES
One other factor in the development of der-
matology in Ohio was the development of the
specialty medical society. Strange at times may be
some of the uses to which this type of society may
be bent, yet its primary function was and con-
tinues to be that of postgraduate teaching. For
those of us who are not familiar with the me-
chanics of such a society, it may be well to add
'that ordinarily its program includes the exhibi-
tion of clinical cases whose diagnosis is to be
established or special treatment procedures to
be demonstrated. The cases are discussed then
in detail. In any postgraduate program this is
a very important part of practice. In 1948 the
Cleveland Dermatological Society celebrated its
Twenty-Fifth Anniversary. The names of doctors
who were charter members follow: C. L. Baskin,
W. T. Corlett, H. N. Cole, J. R. Driver, J. E.
Fisher, W. C. Gill, A. H. Heithaus, H. B. Kurtz,
C. G. LaRocco, B. Levine, S. Littman, H. J.
Parkhurst, L. W. Potts, C. J. Shepard, E. I.
Steinberg, K. G. Zwick.
In 1950 the Cincinnati Dermatological Society
had its Twenty-Fifth Anniversary. Its charter
members were: Doctors Charles J. Broeman,
Harry L. Claassen, Ralph R. DuCasse, George
Holt, H. Jerry Lavender, James Miller, Abe W.
Nelson, C. Tabb Pearce, Augustus Ravogli, El-
more B. Tauber, Karl G. Zwick. In this con-
nection one may point out that Zwick was a
charter member of both dermatological societies.
These specialty societies were instrumental in
the development of more extensive specialty so-
ciety groupings on a national scale. In 1927
Cincinnati joined with Cleveland, Pittsburgh and
Detroit to form the Four Cities Dermatological
Association, now the greatly enlarged and active
Central States Dermatological Association. Cin-
cinnati later was part of the Mississippi Valley
Dermatological Association. In spite of the rise
of other national specialty societies and the
consequent increases in meeting periods and
increase in programs, the Central States Der-
matological Association has become an im-
portant group in the Midwestern dermatology.
The specialist depends on these societies for his
own continued teaching and professional contacts.
During World War II, accelerated undergrad-
uate teaching programs combined with severely
reduced teaching departments and increased
burdens of private practice produced a complex
and fatiguing mixture scarcely encouraging any
scientific advances in dermatology. In addition,
research towards the war effort was carried out
at the various dermatologic centers. In Cin-
cinnati, the Department of Dermatology, to-
gether with the Kettering Laboratory of Applied
Physiology of the College of Medicine, gave
instructional courses on a national scale on
civilian defense against chemical warfare.
Now the teaching centers in Cleveland, Cin-
cinnati and Columbus continued to expand under
the pressure of the increasing numbers of
physicians interested in training in dermatology.
Some of these had started training before going
into the Armed Services, others became en-
amored of this specialty (or specialism in gen-
eral) while in service. Dr. Eldred Heisel be-
came head of the Department of Dermatology
at Ohio State University.
The 1948 Book of the American Board of
Dermatology and Syphilology listed Cleveland
for November, 1950
1087
City Hospital and the University Hospitals of
that city and the Cincinnati General Hospital
as accredited institutions for three year training
and the Cleveland Clinic Foundation Hospital
for a two-year training program.
DISTRIBUTION BROADENS
The current picture in dermatology in Ohio,
as in the national scene, is the gradual move-
ment of well trained and capable specialists
to smaller communities. So, in addition to
Cleveland and Cincinnati, the American Board
diplomates of dermatology are found in many
of the cities of Ohio. In the last issue of the
American Board of Dermatology, graduates were
listed for Akron, Canton, Cincinnati, Cleveland,
Columbus, Dayton, Lima, Middletown, Toledo
and Youngstown.
Important now in postgraduate training in
dermatology in the United States is the Ameri-
can Academy of Dermatology. Clyde Cummer
of Cleveland was honored as president in 1948
and now John E. Rauschkolb of Cleveland is
serving as assistant secretary-treasurer.
Now dermatologists in Ohio are part of the
turmoil of the national scene. One of the
currents is the rewakening of the social respon-
sibility of the physician. Perhaps an illustra-
tion of this was the almost complete neglect
previously of the public health aspects of syph-
ilis by the practitioner, including the der-
matologists. By his interest and his work,
Harold Cole was the exception here, but the
disinterest of the rank and file led the Public
Health Service, of necessity, to its great role in
the field of venereal disease control. Perhaps
this will be a lesson for us in practice. Now,
the dermatologist in Ohio is active in the cancer
control program. We must assume the initiative
where needed. This is the age truly of preven-
tive medicine and dermatology has much to offer
for this, for preventive and dynamic dermatology
are the basis of training for the young der-
matologist now in Ohio. Thus we hope to make
him of tough fiber to understand and to strive
and to succeed in this period of the tempting
theory of easier security by rules rather than
security by hard work. There is always much
to be done.
In the eighteenth century, Percival Pott wrote
the first detailed description of an occupational
cancer. So doing, he interpreted to the medical
world a class of neoplasms which, in later times,
was destined to have an ever-increasing signifi-
cance. For with the rise of industry there has
been a corresponding rise in the incidence of in-
dustrial cancers. This fact, of course, is im-
portant. But it is not nearly so important as
the fact that industrial cancers can be prevented.
They need never exist. — The Cancer Bulletin
2:27, 1950.
KEEPING UP WITH MEDICINE
• Case-finding surveys of adult groups indicate
that examination of adults is much more profit-
able than examination of preadolescent and
adolescent children.
% :js %
• Today we hear less of gluttony and of drink-
ing to excess as being the inevitable precursor
of an attack of gout and more charitable views
include trauma, fatigue, stress, allergic and
psychic factors, among the precipitating causes
of an attack.
* *
• They are now saying that it is unwise to at-
tempt treatment in cases of azoospermia and
oligospermia without first performing a testic-
ular biopsy, which after all is a minor opera-
tion.
% 5*C
• Anoxia produces an increase in lymph flow
and excessive bronchial secretions.
5iS Sjl jfc
• Medicine cannot in the long run increase the
population of the world. The consequence of
the diminished death rate which our medical mis-
sionaries have accomplished in India and China
is that persons whose lives have thus been
saved must die of starvation a few years later.
*!* y ¥
• It has been reported that the toxicity of
ephedrine is nearly tripled by the concomitant
action of moderate doses of theophylline
ethylenediamine and that conversely the toxicity
of aminophylline is nearly doubled by the con-
comitant action of moderate doses of ephedrine.
* * *
• Posture plays a leading role in preventive
medicine; its effects are far reaching. We phy-
sicians should pay more attention to it.
• In a recent survey of the dietaries of 402
pregnant women in a typical southern rural area
only 6 per cent were receiving the recommended
allowances of specific nutrient for pregnancy.
5^ 5|C
• The average length of life of white women
in the United States is now at the new high
of 71 years; the average of white males is 65.5
years.
❖ ❖ ❖
• In our society eating has become a condition
reflex independent of the body needs. The reduc-
tion program for the obese patient therefore be-
comes one of reconditioning the reflex.
* * *
• One hundred forty-six cases of methemo-
globinemia with 14 deaths, due to nitrates in
the drinking water have been reported from
rural Minnesota. — J. F.
1088
The Ohio State Ale di cal Journal
• • •
Proceedings of The Council
Civilian-Military Coordination of Doctor Supply Is Only One of Many
Matters of Importance to Profession Taken Up at Two-Day Conference
FOLLOWING is an abstract of the minutes
of meetings of The Council of the Ohio State
Medical Association held at the Granville
Inn, Granville, Ohio, Saturday and Sunday, Sep-
tember 16 and 17, 1950.
All members of The Council were present ex-
cept Dr. J. Craig Bowman, Upper Sandusky,
councilor of the Third District. Others attend-
ing included A. M. A. delegates and the chair-
men of a number of Association committees.
After the meeting had been called to order
by Dr. Swartz, President, The Council adopted
a resolution of sympathy regarding the death of
the mother of Dr. A. A. Brindley, Toledo, a past-
president and A. M. A. delegate, and instructed
the executive secretary to convey to Dr. Brindley
a message of sympathy and condolence.
The executive secretary reported as follows
on membership: Total membership as of Sep-
tember 15, 1950, 7,463, compared to a total
membership of 7,479 as of December 31, 1949.
WAIVER OF DUES
The question of waiving dues for members en-
tering military service as a result of the na-
tional emergency was discussed. On motion
duly made, seconded and unanimously carried.
The Council adopted the following policy:
1. State Association dues for the balance
of 1950 shall be waived for new members
who have entered active military service on
a temporary basis because of the national
emergency.
2. State Association dues for 1951 shall
be waived for members who entered active
military service on a temporary basis in
1950 because of the national emergency.
3. State Association dues for 1951 shall
be waived for physicians who were members
of the Association in 1950 and who enter
active military service on a temporary basis
because of the national emergency prior to
the payment of 1951 State Association dues.
4. The Secretary-Treasurer of each County
Medical Society shall be requested to co-
operate with the Columbus Office of the
Association in assembling the names of
physicians entitled to waiver of dues under
the foregoing provisions.
A. M. A. DUES
The executive secretary was instructed to col-
lect 1951 A. M. A. dues in the manner used for
the collection of 1950 A. M. A. dues; namely, by
billing members direct at the time a State
Association membership card is mailed to them.
Correspondence from a number of members,
asking about eligibility for associate fellowship
in the A. M. A., was reviewed. The executive
secretary was instructed to advise members re-
garding the provisions for associate fellowship
in the A. M. A.; and that those who considered
themselves eligible for such type of membership
should file applications with the Columbus of-
fice for review by The Council.
The finances of the Association and The
Journal were reviewed. The executive secretary
advised The Council that due to an increase in
costs of producing The Joui'nal and because of
the purchase of additional office equipment, it
would be necessary for the State Association to
provide increased funds for The Journal. On
motion duly made, seconded and unanimously
carried, an additional amount of $10,000 was
appropriated for The Journal account and the
equipment purchases made during the year were
approved.
Mr. Nelson and Mr. Saville reported on the
pre-election conferences held to date and on those
scheduled to be held prior to October 1.
MEDICAL SERVICE PLAN
Dr. Mundy presented and discussed a report
from the Committee on Medical Service Plans,
based on the minutes of a meeting of that com-
mittee held on August 13, 1950.
During the discussion Dr. Heusinkveld filed
with The Council a letter tansmitted to him under
date of September 12, 1950, by Mr. James E.
Stuart, executive director, Hospital Care Cor-
poration, Cincinnati.
After an extended discussion of the recom-
mendations of the Committee on Medical Service
Plans, The Council adopted by unanimous vote
the following resolution:
“Resolved, That The Council approve in
principle the issuance by Ohio Medical In-
demnity, Inc., of a service contract for
families whose income does not exceed $4,000
per year, and for unmarried persons whose
income does not exceed $2400 a year.”
A motion recommending that obstetrical services
be provided on an indemnity basis for sub-
scribers to the family or individual service con-
tracts was carried by a vote of 11 to 3.
By unanimous vote The Council adopted the
following motion:
“That the service contracts provide that
the amount paid for tonsillectomies shall be
either $40 for subscribers under 12 years of
for November, 1950
1089
age and $50 for subscribers over 12 years
of age, or $45 regardless of age, whichever
provision is found to be acceptable from an
actuarial and sales point of view.
By a unanimous vote The Council adopted a
motion referring the foregoing recommendations
to the Board of Directors of Ohio Medical In-
demnity, Inc., with a request that a service con-
tract be prepared on the basis of the principles
set forth in these actions, together with a fee
schedule for professional services and a schedule
of premiums, and that the recommendations of
the Board of Directors of 0. M. I. be considered
by The Council at its next meeting.
The Council then adopted a motion accepting
the report of the Committee on Medical Service
Plans, ordering it filed, and expressing apprecia-
tion to the committee for its excellent work.
Acting on behalf of the Ohio State Medical
Association, a shareholder of Ohio Medical In-
demnity, Inc., The Council approved the action
of the Board of Directors of O. M. I., authorizing
an additional subscription not to exceed $15,000
to Blue Shield Medical Care Plans to be used in
effecting early incorporation of a Blue Shield
National Service Agency.
THE NATIONAL EMERGENCY
Lengthy consideration was given to the na-
tional emergency and the mobilization of medi-
cal personnel for the armed forces. In order to
establish machinery whereby the Association
could play an important part in coordinating the
needs of the military forces for medical officers
and the health needs of all communities of the
state, including the needs of hospitals, medical
schools and other institutions for adequate
civilian medical service, The Council took the
following action:
Authorized the reorganization of the Com-
mittee on National Emergency Medical Service
as follows:
1. Designated Dr. Robert Conard, Wil-
mington, and Dr. C. C. Sherburne, Colum-
bus, as co-chairmen of the Committee on
National Emergency Medical Service.
2. Designated Dr. Conard as chairman of
a newly created section of that committee
to be known as the Military Advisory Com-
mittee.
3. Designated Dr. Sherburne to continue
as chairman of the civil defense section of
the committee, the personnel of that section
to consist of the following physicians who
are at present members of the Committee on
National Emergency Medical Service: Dr.
Fred Berlin, Lima; Dr. Morris G. Carmody,
Painesville; Dr. Carl R. Damron, Mans-
field; Dr. Drew L. Davies, Columbus; Dr.
William J. Graf, Cincinnati; Dr. Harry R.
Huston, Dayton; Dr. Maurice M. Kane, Green-
ville; Dr. E. A. Ockuly, Toledo; Dr. Claude
S. Perry, Columbus; Dr. W. O. Ramey, Cin-
cinnati; Dr. George L. Sackett, Cleveland;
Dr. Robert E. Tschantz, Canton; Dr. Cyrus
R. Wood, Port Clinton; Dr. Herbert B.
Wright, Cleveland; Dr. Robert M. Zollinger,
Columbus.
Authorized the president to appoint 11 phy-
sicians as members of the Military Advisory
Committee under the chairmanship of Dr. Conard,
each to represent one of the eleven Councilor
Districts of the Association.
Authorized the employment of Dr. Conard on
a full-time basis, with offices in the Columbus
office of the Association, to handle all administra-
tive details for the Military Advisory Committee
and to assist on administrative details in con-
nection with the work of the Civil Defense Com-
mittee.
Instructed the president to issue a request
to all county medical societies to designate a new
committee or an existing committee as a Military
Advisory Committee to work with the State
Association Military Advisory Committee on all
matters wherein the State Association Committee
would need factual material and advice regarding
the availability or essentiality of local phy-
sicians for military service or for civilian service.
CIVIL DEFENSE
A report on civil defense activities in Ohio
to date was made by Dr. Sherburne, Dr. Conard,
Dr. Swartz and the executive secretary. Details
of the Ohio Civil Defense program were reviewed
and plans for placing the program into operation
were discussed.
Dr. Swartz and Dr. Conard reported on tem-
porary procedures which had been followed in
consultations with the Army on the matter of
recalling medical reserve officers for active duty.
It was pointed out that these responsibilities
would now be handled by Dr. Conard and the
newly created Military Advisory Committee.
PUBLIC HEALTH REPORT
The Council then reviewed, paragraph by par-
agraph, the second report issued recently by the
Ohio Committee on Public Health relating to
local health departments. The following actions
were taken on the principal recommendations
of the Ohio Committee on Public Health:
On the matter of reducing the number of local
health districts, The Council expressed itself as
favoring the recommendations in the following
order:
1. That the county be made the basic health
unit with a permissive clause for cooperative
plans between counties.
2. That the Council would favor us an altern-
ative, the proposal that the county be made the
1090
The Ohio State Medical Journal
basic health unit with all municipalities included
except those over 100,000 population.
On the matter of revising the procedure for
the selection of members of a local board of
health, The Council expressed itself as believing
that the most desirable method would be to
provide for the appointment of the board of
health by the county commissioners. It ex-
pressed itself as believing it would be more de-
sirable to leave the present procedure unchanged
than to provide for election of members of the
board of health by voters of the county.
With respect to proposals which would pro-
vide more local funds for public health activities,
The Council expressed itself as believing that a
method to provide for an appropriation from the
county general funds wrould be desirable. How-
ever, The Council felt that it could not take
too definite a stand on the financial recommenda-
tions because of a lack of adequate informa-
tion and advice. It suggested that further study
be given to the question of finances.
With respect to the recommendations on the
distribution of the state subsidy to local health
departments, The Council approved all of the
recommendations set forth in the committee’s
report.
COMMITTEE REPORTS
Mr. Page, secretary of the Committee on Rural
Health, reported for that committee, which re-
port was approved and ordered filed. The Council
expressed itself as believing that the proposed
conference with interns, residents and medical
students in the Cincinnati area should be held
as planned by the committee.
Dr. Wilzbach reported on the activities of the
Committee on Education, of which he is chair-
man. There was a general discussion in which
some members of The Council stated that they
felt there is a need in Ohio for more post-
graduate programs, primarily programs which
would provide resident training at the medical
schools for physicians in private practice who are
desirous of taking refresher work.
Mr. Saville, director of the Department of
Public Relations, presented a lengthy report on
the newspaper advertising and radio programs
which will be carried on in October as a part of
the National educational program of the Ameri-
can Medical Association. Several motion pictures
were shown for review by The Council. By official
action, The Council decided that the Association
should not at this time sponsor films for showing
in public theaters.
Dr. Diethelm, chairman of the Committee on
Scientific Work, discussed with The Council the
question of the program for the 1951 Annual
Meeting. The Council suggested that the com-
mittee work out a program which would be
along the same lines as the program presented
at the 1950 Annual Meeting in Cleveland.
HOSPITAL PROBLEM
Dr. Worstell, chairman of the Committee on
Industrial Health and Workmen’s Compensation,
reported on conferences which had been held with
representatives of the Ohio Society of Anesthe-
siologists and the Ohio Hospital Association re-
lating to a new section of the hospital contract
issued by The State Industrial Commission,
under which a hospital may elect to provide
anesthesia services as a part of the hospital’s
services covered by the per diem rate paid by
the Commission for hospitalization of Work-
men’s Compensation cases. He advised The
Council that suggested changes in the contract
which had been agreed to informally at these
conferences had been rejected by the Board of
Trustees of the Ohio Hospital Association. On
motion duly made, seconded and unanimously
carried, this question was referred back to the
Committee on Industrial Health and Workmen’s
Compensation for further conferences with rep-
resentatives of the Ohio Society of Anesthe-
siologists, and that the principles set forth in
the recent action of the House of Delegates of
the American Medical Association pertaining
to the practice of medicine by hospitals should
be taken into consideration by the committee in
its future deliberations.
Dr. Worstell also reported on conferences he
had attended as official representative of the
Association on the matter of compulsory dis-
ability insurance.
Dr. Dixon and the executive secretary re-
ported to The Council on plans to date for the
clinical session of the American Medical Associa-
tion to be held in Cleveland, December 5-8, 1950.
V. A. CASE REVIEWED
The Council then considered a dispute between
a member of the Association and the Veterans
Administration on the handling of the case of a
veteran suffering from multiple sclerosis and
which had been submitted to The Council for
arbitration. Statements submitted by the phy-
sician and the Veterans Administration, together
with statements submitted by several physicians
who had been selected by The Council to review
the file, were studied and discussed.
By unanimous vote The Council adopted the
following statement:
“There is no known cure for multiple
sclerosis. These patients are seriously ill
and can have intervening illnesses of other
types — perhaps they are even more likely
to have such intervening illnesses than a
healthy individual. Therefore, such patients
should be under medical supervision. Inas-
much as there is a difference of opinion be-
tween medical authorities in the case sub-
for November, 1950
1091
mitted to The Council for arbitration, The
Council recommends that the patient in-
volved be referred to a hospital for further
study and consultation and that after such
study and consultation the recommended
therapy should be approved by the Veterans
Administration and the patient permitted to
select a physician qualified to provide the
treatment suggested.”
MISCELLANEOUS BUSINESS
A communication from a local medical society
on the matter of autopsies was discussed and
referred to Committee on Public Relations and
Economics for study and recommendations.
A communication from a member, regarding a
chest x-ray program carried on under contract
by a hospital, was considered. The file was
referred to Dr. Hudson, councilor of the Fifth
District for investigation and a report back to
The Council.
”A letter from a member protesting the regu-
lation of the Veterans Administration regarding
the ceiling of $6,000 per annum on fees paid to
physicians was discussed. Attention was called
to the fact that The Council is already on record
as believing that this rule is undesirable, that
a protest had been filed with the Veterans Ad-
ministration, and that the Veterans Administra-
tion did not act favorably on the suggestion that
the rule be rescinded.
A communication from a county medical so-
ciety, stating that a motion had been adopted
by that society to create a class of members
to be known as junior members, was discussed.
The Council instructed the executive secretary to
write the society and advise it that the only
way this matter could be handled by the society
would be through an amendment to the con-
stitution and by-laws of that society.
On motion duly made, seconded and unani-
mously carried. The Council authorized a contri-
bution of $100 to the National Society for
Medical Research.
A request from the Practical Nurses’ Asso-
ciation that the Ohio State Medical Association
name a representative to sit on its advisory com-
mittee was disposed of through the adoption of
a motion authorizing the president to name such
a representative.
A request from the Ohio State Radiological So-
ciety, that the Association name a special com-
mittee to consider questions arising between
hospitals and physicians, was considered. The
Council reaffirmed its previous action to the
effect that such matters could be handled by
either the Committee on Public Relations and
Economics or the Judicial and Professional Rela-
tions Committee.
The Council was advised that Dr. John D.
Porterfield, State Director of Health, had re-
quested the Association to name a representative
on an Advisory Committee on Poliomyelitis,
which is being created by the department. The
president was authorized to appoint a represen-
tative of the Association to serve on that com-
mittee.
APPROVE STATE CONFERENCE
At the suggestion of Dr. Paul I. Hoxworth,
Cincinnati, president of the American Association
of Blood Banks, The Council considered the idea
of the Ohio State Medical Association sponsoring
a state-wide conference of all individuals, groups
and agencies interested in blood banks and blood
donor programs for the purpose of working with
cooperative and coordinated activities, especially
activities which will play an important part in
the national emergency. By official action, The
Council approved the idea and instructed the ex-
ecutive secretary to work out the details with
Dr. Hoxworth and others.
A number of letters from citizens in various
parts of the state, expressing dissatisfaction with
services received from physicians or fees charged
by physicians were discussed. The executive
secretary was instructed to refer these com-
munications to the councilor of the areas in-
volved so that a thorough investigation could
be made by him in conjunction with the county
medical societies and the physicians involved,
and that the executive secretary follow this pro-
cedure in handling future cases of this kind.
Mr. Saville presented a number of sample
cartoons on the general question of socialized
medicine for the purpose of getting the reactions
of members of The Council as to their desirability
for distribution. The Council approved the gen-
eral idea and instructed the Department of Pub-
lic Relations to proceed with further planning for
their production and distribution.
DR. BOWMAN RESIGNS
Dr. Swartz read to The Council a letter from
Dr. J. Craig Bowman in which Dr. Bowman
tendered his resignation as councilor of the
Third District. On motion duly made, seconded
and unanimously carried, The Council accepted
the resignation with regret and expressed ap-
preciation to Dr. Bowman for his conscientious
and active work over a period of many years.
By unanimous vote, The Council elected Dr.
Fred P. Berlin, Lima, to fill the vacancy on The
Council created through the resignation of Dr.
Bowman. Under this action Dr. Berlin will serve
as Councilor of the Third District until the time
of the 1951 Annual Meeting, April 24-26, when
under the provisions of the Constitution and
By-Laws, the House of Delegates will elect a
successor to Dr. Bowman for his unexpired term,
ending in the Spring of 1952.
There being no further business, The Council
adjourned.
Attest: Charles S. Nelson,
Executive Secretary.
1092
The Ohio State Medical Journal
Ohio’s Public Health Needs . . .
Committee on Public Health, Representing Twelve State-Wide Groups,
Recommends Possible Improvements Throughout State in Final Report
NUMEROUS suggestions for improving the
operation and services of local health de-
partments in Ohio are set forth in a re-
port issued in October by the Ohio Committee
on Public Health and transmitted to the Ohio
Director of Health, with a recommendation that
follow-up action be taken by groups and or-
ganizations interested in strengthening the
state’s public health program.
The Ohio Committee on Public Health rep-
resents 12 state-wide organizations banded to-
gether for the purpose of evaluating tax sup-
ported public health services in the state,
making recommendations for the improve-
ment of these health services, and planning
a program of action for the accomplishment of
recommendations.
COMPOSITION OF COMMITTEE
These organizations are: The Ohio State Medi-
cal Association, The Ohio Farm Bureau Feder-
ation, The Ohio State Grange, The Ohio Con-
gress of Industrial Organizations, The Ohio
Federation of Labor, The Ohio Tuberculosis and
Health Association, The Ohio Congress of Par-
ents and Teachers, The Ohio State Veterinary
Medical Association, The Ohio State Nurses As-
sociation, The Ohio Hospital Association, The
Ohio Federation of Women’s Clubs, and The
Ohio Association of Township Clerks and Trus-
tees.
The committee during 1948 completed a study
of the Ohio Department of Health. The report
of that study was presented in the pamphlet
Ohio Can Have Better Public Health Service.
The report, just completed, concerns itself
with the problems of local public health depart-
ments, their administration, their finances, their
personnel and the services rendered by these de-
partments to the people.
METHOD OF STUDY
Specifically, the committee:
Analyzed the organization of Ohio’s local
health departments and looked into the relation-
ships of local units of government to the Ohio De-
partment of Health.
Compared the various departments with recog-
nized standards established by the American
Public Health Association and the United States
Public Health Service for the size of the district
in terms of population and area.
Studied local health department finances — the
sources of funds, the amount of money spent,
the amount of money needed.
Investigated the service rendered by local
health departments to see how they compare
with accepted program standards promulgated
by the American Public Health Association.
Inquired into the type training, and quality of
present personnel, as well as the personnel
needed by local health units to render the serv-
ices expected by the citizens of the community.
FOLLOW-UP ACTION PROPOSED
In transmitting the report to State Director
of Health J. D. Porterfield, the committee made
the following comments:
“Although the committee as a whole believes
that local public health services in Ohio can,
and should, be improved, opinions of committee
members differ as to exact method, or methods,
for improving such services. Therefore, the com-
mittee has not attempted to set forth a single,
arbitrary solution to the problem. Instead, it
has set forth numerous suggestions, believing
that some of them individually, or in some com-
bination, might well be the basis for improved
public health services in all areas of the state.
“With the issuance of this report, the Com-
mittee feels that it has accomplished the two
objectives for which it was established: first, a
study of the Ohio Department of Health, includ-
ing recommendations for improving its efficiency
and effectiveness and, second, a study of local
public health services with suggestions for im-
proving and strengthening such services.
“This committee is not, and was not intended
to be, an action group. If follow-up action
on any of the committee’s suggestions is in-
dicated, sucL action must come from indi-
viduals and permanent organizations through-
out the state interested in this question.
“Therefore, the committee, prior to its dis-
solution, is transmitting to you copies of both
reports for whatever use your department and
the people of Ohio generally may care to make
of them.”
SUMMARY OF FINDINGS
Following is a summary of the committee’s
findings on local health units:
I. Organization —
A. There are too many separate health
departments in Ohio. At the present time
Ohio has 159 separate health departments.
Many of the areas served by these depart-
jor November, 1950
1093
ments are too small to maintain efficient
adequate public health services. Of the 159
departments, 130 serve a population of less
than 50,000 each. The area should have
enough people and enough money to support
a complete public health program.
B. Public Health programs need full time
administration. Eighty-seven departments
in the state employ part time health commis-
sioners. It is essential to good service that
all health commissioners be full time em-
ployees, spending their entire effort in plan-
ning and directing public health programs.
C. Competent, alert and interested boards
of health are essential. A local health de-
partment cannot carry on its work effectively
unless it has the backing and support of
such a board. In some areas of the state,
the board of health is composed of persons
who are not qualified for such an important
position. Some who have studied ways and
means of correcting this situation believe
that the procedure for selecting members
of the board should be improved. They
have offered suggestions as to how the pro-
cedure might be changed. There are others
who believe that the present procedures are
satisfactory. They suggest that efforts
should be directed toward encouraging
present appointing authorities to select
better qualified and more interested persons
for the boards of health. The arguments
pro and con on this question are set forth
in some detail in this report.
II. Finances —
A. Not enough money is appropriated for
local public health in Ohio. The median per
capita expenditure for local health service
in Ohio is 48c a year. The minimum per
capita annual expenditure recommended by
the American Public Health Association
and National Health Council is $1.50. A
method of appropriating money locally should
be devised which will make available suf-
ficient funds for the operation of adequate
local public health programs.
B. The method of distributing state sub-
sidies does not encourage better public
health services. State subsidy is paid to local
health departments on a straight matching
basis of 50c on the dollar spent for health
commissioner, nurse and clerk to a maximum
of two thousand dollars per year. Any sub-
sidy should be based on needs and services.
III. Personnel —
Many local health departments have found
it difficult to attract and hold minimum
standard personnel.
A. Twenty health commissioners do not
have medical degrees. There are 148 who
have not had post graduate training in
public health.
B. While all nurses are registered, only
46 per cent have had postgraduate train-
ing in public health.
C. Only 45 per cent of the public health
sanitarians and sanitary engineers in local
health departments have the basic quali-
fications established by the American Pub-
lic Health Association.
D. Only three departments have health
educators.
Better salaries, greater security, higher
qualifications, and more intensive train-
ing programs are needed.
IV. Services —
This study does not attempt to evaluate serv-
ices. It merely lists the minimum services re-
quired.
The report states that at present the average
health department serves a population much
smaller than is recommended and lists the fol-
lowing alternative suggestions for solving this
problem :
The establishment of local health districts
and the procedures of unification are provided in
the Ohio General Code. Any reorganization
must be made by the Legislature. The follow-
ing are the possible changes which could be
made to revise the basic public health law of
Ohio as it relates to local health districts:
A. The county could be made the basic health
unit with permissive clause for cooperative plans
between counties as is now possible in Ohio Gen-
eral Code. The advantages of this system of
organization for health districts are as follows:
1. Municipalities would be combined into
single health departments with their subur-
ban areas. This would result in uniform
regulations and administrative policy be
much less confusing, more economical and
make possible more effective attack on the
over-all health problems of the area served.
2. Populations of health districts would
more nearly conform to accepted standards
of size. The number of districts would be
immediately reduced from 203 to 88. There
would be only 55 districts with a population
of less than 50,000 instead of the 130
presently existing. Whereas there are now
77 districts with a population of 10,000 or
less, under this proposal no districts would
be that small.
3. A broader taxing base would be avail-
able upon which the fiscal needs of the health
department could be founded. At the present
time each small district must finance its own
health department personnel. With a larger
district these individual resources could be
1094
The Ohio State Aledical journal
pooled to the over-all advantage of the en-
tire unit.
The disadvantages of this plan are:
1. There would probably be strong op-
position from some groups, possibly espe-
cially the larger municipalities and their
suburban areas. Whether such opposition
would endanger the passage of this type of
legislation needs serious study.
B. Make the county the health district with
all municipalities included except those over
100.000 in population. This plan would have the
same general effect as the first but might solve
the problem of political opposition. There are
two disadvantages:
1. From the standpoint of public health
administration, this method continues to
divorce the city and its health problems from
its suburban district and continues to foster
the conflicts which result from such a pro-
gram.
2. The main problem in preparing such
a piece of legislation lies in the fact that in
order to establish these cities as health dis-
tricts and to finance health departments
within them, it would be necessary to rewrite
by amendment a larger number of sections
of Ohio General Code dealing with munic-
ipalities.
C. The law which establishes health districts
might not be changed at all. There would be no
problem of securing a change in legislation. Al-
though the present organization of local health
districts is especially complex, these sections
have been clarified by court action and legal
opinion. Such a period of legal testing would
be required should new legislation be adopted.
If this program is adopted, there would have to
be a very intensive educational program to secure
voluntary combination of health districts into
local health units large enough to support a
complete health service. Although the educa-
tional process is of great value, the present per-
missive legislation for combination of local health
departments has been on the statutes for some
thirty years. During this time the number
of health units has been reduced only from 203
to 159.
On the matter of improving the personnel
of local boards of health and possible new meth-
ods for the selection of board members, the re-
port offers the following alternative suggestions:
City Health Districts: The mayor is the ex-
officio president of the board of health. He
appoints its five members with the confirmation
of city council. Each member is appointed for
a five-year term of office and appointments are
made so that one expires each year.
This method has met with varying success.
In many instances we find a highly competent,
alert and interested board. On the other hand,
there are many city boards of health so sluggish
in their service that it is practically impossible
to secure a quorum for board meetings.
The main objections to this system of securing
members of a board of health are that it is
often open to political pressures and is not
cushioned against partisan political battles.
Also, the appointing authority is so highly cen-
tralized that it does not appear to be a dem-
ocratic method for the selection of a board hav-
ing such broad authority under the law.
General Health Districts: This district is made
up of townships and villages in each county ex-
clusive of the municipalities of 5,000 and over.
The mayor of each village and the chairman of
the trustees from each township form a district
advisory council which appoints the board of
health and hears its reports. This plan has
the following advantages:
A. The board is chosen by representatives
from every part of the district.
B. The members of the advisory council
are elected officials and therefore represent
the people in the appointment of the board
of health.
C. This procedure protects the board from
partisan political pressures.
The objections to this procedure are as fol-
lows :
A. The appointing authority is invested
in such a large group so widely distributed
throughout the county, that it is difficult for
public to make its wishes known in order to
effect changes in the board of health.
B. So little responsibility is placed on the
advisory council with respect to health de-
partment, that there is apparent indiffer-
ence to the appointment of members of the
board of health. This has resulted in sev-
eral unsatisfactory situations.
1. The board of health may be made up of
people uninterested in public health programs.
2. The same individuals may be appointed
again and again. Often they know little
about public health when first appointed and
do not grow in knowledge with service
through the years.
3. The appointees to the board of health
may think their chief responsibility is to
ask for as little money for the health de-
partment as possible. This is often a re-
flection of the attitude of township trustees
who think the health department consumes
tax monies which might otherwise be under
their control in the general fund of the
township.
Recommendations: The procedure for appoint-
ing local boards of health has been set down in
for November, 1950
1095
the Ohio General Code, therefore, any reorgan-
ization must be made by a change in legislation.
The following are posible methods for appoint-
ing local boards of health:
A. Appointment by the county commision-
ers. This method has three good features:
1. It centralizes the appointing authority
into a small number of persons. When the
group is small, responsibility is more con-
centrated.
2. Appointment by county commissioners
buffers the board to some extent against
partisan politics.
3. There is a precedent for appointment
by county commisisoners. This procedure
is now followed for appointing other boards
who render services to the entire county.
This method of appointing local boards of
health has two drawbacks.
1. The appointing authority is in the hands
of a very few people. From the stand-
point of concentrated effort, this is good.
But it is easier for a small group to abuse
its power.
2. Indigent medical care and welfare are
under the commissioners. There might be
pressure to bring the health department into
these programs.
B. The board of health might be elected at
a general election the same as is now done for
a board of education. This method has two
main features in its favor. First, it brings
the board of health, its membership, respon-
sibilities and duties, to the direct attention of
the entire population. Here is an opportunity
for public education which could not be secured
in any other way. Second, the public choice
of members of the board of health is a demo-
cratic procedure. The bad feature is this:
boards of health are immediately opened to the
partisan political pressures of a general election.
C. The present method of choosing the board
of health may be left unchanged. The good
and bad features of this method have been
pointed out. In addition the present method
does away with the need for a legislative battle
that would follow a change in method.
Recommendations of the committee on the
question of improved financing for local health
departments are as follows:
Not enough money is spent for public health
in Ohio. The median per capita expenditure for
local health service in Ohio is 48 cents. The
minimum per capita expenditure recommended
by the American Public Health Association is
$1.50. Local appropriations are restricted by the
ten mill limitation on taxes. A method of appro-
priating money locally should be devised which
will bring sufficient funds for the operation of
local health programs. Recommendations are
as follows:
A. Special millage. A special tax over and
above the ten mill limit might be set aside for
health purposes only. These funds would be
granted directly to the health department and
would be free from any political maneuvering in
the budget commission which would divert the
funds for any other use. This plan has an added
advantage of providing a secure income so that
each year the board could base its program on
a fairly stable budget.
Inflexibility is the disadvantage. From the
point of view of the board of health the millage
might not increase with the need for expanded
services and an expanded budget. From the
point of view of the people, a special millage
removes the necessity for the health board to
justify its need for funds each year.
There is a danger that with a stable and in-
dependent budget, a department will tend to be
lax in the service it provides. A modification
of this plan might lessen this shortcoming to
a certain extent. Under this plan the health
department would submit its budget to the
governing body, which would approve the total
and have authority to levy within the special
tax granted for health purposes. This is a
more complex way of securing a budget and
would require budgeting for health purposes a
year in advance. Planning of long range pro-
grams is a good administrative technique. How-
ever, specific line-item budgets for a fiscal
year, which is one year hence, poses extreme
problems in sound budgeting and programming.
B. Appropriation from the county general
fund. There are two advantages here:
1. Precedent has already been set to
secure health funds from this source since
tuberculosis care is already lodged with the
county commissioners. Also the broader
taxing base would have the general effect
of making more money available for budget-
ing to health purposes and coordinate more
closely tuberculosis central programs.
2. Securing funds from this source, in
addition to making more money available
for health work, also would require the
board of health and its administration to
justify its budget before responsible of-
ficials at the end of each fiscal period.
The disadvantages are:
1. Under existing laws health appropria-
tion from the general fund is now allowed.
2. County commissioners are now charged
with the care of welfare cases in terms of
medical care. The county commissioners may
tend to combine the public health program
with medical care programs. This would
create the very real danger of making a
1096
The Ohio State Medical Journal
local health department responsible for indi-
gent medical care and other welfare pro-
grams.
C. Increase in the ten mill limit. This would
be a specialized millage over and above the
constitutional limit. The advantage is this:
1. Such a program would make possible
an increase in the amount of money available
for public health.
The disadvantage is this:
1. A general increase in the ten mill
limitation on funds would certainly meet
very strong opposition since it might lead to
increased governmental costs from all de-
partments.
D. Leave financing as it is now done. Ad-
vantage is it requires no legislative change.
State subsidies are too low and are not
distributed according to local needs, the report
points out. It presents the following recom-
mendations for distribution of the state subsidy
to local health departments:
RECOMMENDATIONS
State subsidy should possess these general
qualities :
A. The method of distribution should be
simple so that every person can understand
its operation.
B. It should be elastic enough to apply
to all health districts in the state.
C. It should be designed to equalize
health services so that poorer areas are
given greater assistance.
A formula for state subsidy might contain
these provisions:
A. The department must meet minimum
standards of eligibility in order to receive
the subsidy.
B. State funds should not be substituted
for local money in developing the program.
C. A sliding scale of distribution, depend-
ing upon population and wealth, should be
developed according to local resources to
equalize the amounts given.
D. Minimum standards of service should
be met for a district to continue to be eligi-
ble for the grant.
With respect to personnel problems confront-
ing local health units, the committee com-
mented as follows:
Not enough personnel is employed by local
health departments to carry out a well or-
ganized health program. Too few employees
have had the opportunity to secure postgraduate
training in their field. Salaries are not in
keeping with the responsibility placed on em-
ployees nor equal to average paid to employees
occupying similar positions in other states.
Cancer Meeting Sponsored in
Columbus, November 19
The Committee on Cancer of the Ohio State
Medical Association and the Ohio Division of the
American Cancer Society are sponsoring a meet-
ing to be held at the Neil House in Columbus,
on Sunday, November 19, beginning at 10 a. m.
Special invitations are directed to District
Councilors of the Ohio State Medical Association,
members of medical advisory committees ap-
pointed by County Medical Societies, medical
trustees of the Ohio Division, officers of County
Medical Societies and any other interested phy-
sicians.
Principal scientific speakers for the occasion
will be Dr. Charles S. Cameron, head of the
Medical and Scientific Department of the Ameri-
can Cancer Society, who recently returned from
the Fifth International Cancer Congress in Paris,
France; and Dr. Alton Ochsner, president of the
American Cancer Society, dean of the Medical
School of Tulane University and head of Ochsner
Clinic of New Orleans.
Officials of the Society announced that the
American Cancer Society would underwrite ex-
penses of those who attend. The meeting is
scheduled to adjourn following luncheon.
Fellowships in Industrial Health
Offered at Cincinnati
The Institute of Industrial Health of the Uni-
versity of Cincinnati will accept applications for
a limited number of Fellowships which are being
offered to qualified candidates who wish to
pursue a graduate course of instruction which
will qualify them for the practice of Industrial
Medicine.
Candidates who complete satisfactorily the
course of study will be awarded the degree
Doctor of Industrial Medicine. Any registered
physician, who is a graduate of a Class A
medical school and who has completed satis-
factorily two years of residency (including intern-
ship) in a hospital accredited by the American
Medical Association may apply for a Fellowship
in the Institute of Industrial Health.
The course of instruction consists of a two-
year period of intense preliminary training in-
the basic phases of Industrial Medicine followed
by one year of practical experience under ade-
quate supervision in industry. During the first
two years, the stipends for the Fellowships vary
from $2,100 to $3,000. In the third year the
candidate will be compensated for his service
by the industry in which he is completing his
training.
Requests for additional information should be
addressed to the Institute of Industrial Medicine,
College of Medicine, Cincinnati 19, Ohio.
for November, 1950
1097
St. Luke’s Hospital, Cleveland,
Continues Weekly Symposia
Saint Luke’s Hospital, 11311 Shaker Blvd.,
Cleveland, announced continuation of its weekly
symposia as follows:
Wednesday, November 1 — Sequelae of Subdural
Hematoma.
“Clinical Aspect,” Dr. J. H. Nichols, St.
Luke’s and Western Reserve University School
of Medicine.
“Pathological Aspect,” Dr. Rafael Dominguez,
St. Luke’s and Western Reserve.
“Rehabilitation of Hemiplegia,” Dr. Clark
Randt, Crile General Hospital and Western Re-
serve.
“Convulsive Disorders and Treatment,” Dr. C.
J. Centa, St. Luke’s.
Wednesday, November 8 — Backache.
“An Outline of the Types and Causes of
Backache,” Dr. W. S. Duncan, St. Luke’s.
“An Examination of the Back with Diag-
nostic Signs and Symptoms,” Dr. W. H. McGaw,
St. Luke’s and Western Reserve.
“The Gynecological and Obstetrical As-
pects of Backache,” Dr. G. B. Hurd, St. Luke’s.
“The Neurosurgical Aspects of Tumor or Rup-
tured Intervertebral Disc,” Dr. Spencer Braden,
St. Luke’s.
“The Conservative Treatment” — Demonstration
of Strapping, Braces, etc., Dr. J. E. Brown;
Demonstration of Exercises and Manipulations,
Dr. S. G. Stubbins; The Choice of Various Types
of Heat, Dr. W. M. Solomon.
“The Indications for Surgical Orthopedic
Treatment of the Painful Back,” Dr. T. A. Willis,
St. Luke’s.
Wednesday, November 15 — The Kidney.
“Biochemical Tests of Renal Insufficiency as a
Guide to Therapy,” Dr. Frank S. Houser, St.
Luke’s.
“The Recovery Phase of Acute Renal Block,”
Dr. Rafael Dominguez, St. Luke’s and Western
Reserve.
“Urinary Obstruction in Infancy,” Dr. D. W.
McIntyre, St. Luke’s.
“Management of Urinary Infection,” Dr. D. A.
_ Chambers, St. Luke’s and Western Reserve.
Wednesday, November 29 — Allergy in Children.
“Technique of Testing Methods,” Dr. McKinley
London, St. Luke’s.
“Asthma and Hayfever,” Dr. A. J. Horesh,
Western Reserve.
“Effect of Allergies on the Whole Child,”
Dr. Ralph I. Fried, St. Luke’s.
“Pathological Aspects of Allergy,” Dr. Rafael
Dominguez, St. Luke’s and Western Reserve.
“Dermatologic Allergy; Gastrointestinal Al-
lergy,” Dr. Fred Rittinger, Head of the Depart-
ment of Pediatrics, Saint Luke’s Hospital.
Wednesday, December 6 — Occupational Hazards.
“Various Hazards with Particular Reference
to Toxic Solvents and Lead,” Dr. Allen J.
Fleming, assistant medical director, E. I. duPont
de Nemours & Co., and formerly assistant di-
rector, Haskell Laboratory of Industrial Toxi-
cology.
“Silicosis,” Dr. R. C. McKay, Western Reserve
and Cleveland City Hospital.
“Toxicity of Beryllium,” Dr. A. D. Nichol, St.
Luke’s.
Many County Fairs Covered by
Association’s Exhibits
Nearly every week of the 1950 county fair
season found exhibits from the Ohio State Medi-
cal Association on display in one or more loca-
tions in the state.
See Photos on Facing Page
'During the season there were two exhibits
available for use by the county societies or their
auxiliaries who sponsored booths at their county
fairs or other community celebrations. They
covered, in simple, understandable language
brucellosis and the progress in medical science
made during the past century.
At the Miami county fair, the Auxiliary to
the Miami County Medical Society sponsored
the Progress-In-Medicine exhibit, which was
displayed in a building set aside for health ex-
hibits. Various members of the auxiliary
stalled the exhibit and handed out thousands
of pieces of literature covering the exhibit and
other health-interest subjects. The Brucellosis
display was a high-light of the Vinton County
Centennial Celebration held this summer at Mc-
Arthur. Dr. Herbert Chamberlain, who was one
of the guiding lights of the celebration, super-
vised the medical display.
In Trumbull County the County Medical So-
ciety sponsored a booth which included among
other displays, the Progress exhibit. In a booth
located under the grandstand, thousands of
northeast Ohioans studied the exhibits and re-
ceived informative literature.
In Columbiana County and Knox County the
fairs were held at St. Clairsville and Mt. Vernon
respectively, and both exhibits were sponsored
by the Auxiliaries.
In Preble County the ladies staffed their
booth, which featured the Progress display as
well as a display boosting Today's Health.
The Clinton County Medical Society presented
the Brucellosis exhibit at their county fair at
Wilmington.
Instrumental in installing and helping to man
the exhibits, were Mr. Hart F. Page and Mr.
Russell C. Mock, of the Association’s Public
Relations Department.
1098
The Ohio State Medical Journal
Association Promotes Health at County Fairs
COMSMBtftBtf WS!
O. S. M. A. Staff Photos
These are candid shots of some of the exhibits sponsored by the Public Relations Department of the Ohio State Medi-
cal Association at county fairs this season
(1) Dr. George Woodhouse explains points of the Progress-In-Medicine display at the Miami County Fair while
Mrs. Woodhouse and Mrs. William Trostel look on.
<2 ) Visitors to the Vinton County Centennial Celebration look over the Brucellosis exhibit.
(3) Three youngsters looking over the many posters depicting the last 100 years’ progress in medical science on
display at Warren in Trumbull County during the county fair.
(4) Mrs. John L. Baube explains the exhibit to a visitor to the Knox County Auxiliary’s display at the county fair.
(5) A group of three high-schoolers study the display sponsored by the Auxiliary to the Columbiana County Medical
Society at the Columbiana Fair, St. Clairsville.
(6) Dr. Edmond K. Yantes, of Wilmington, is shown with a Clinton County man looking at the Brucellosis exhibit.
(7) Mrs. Birna R. Smith and Mrs. E. P. Trittschuh of Preble County, hand out literature to young visitors during
the first day of the Preble County Fair.
(See article on facing page.)
for November, 1950
1099
• • •
A.M.A. Cleveland Meeting
Elaborate Plans Are Laid by Local Committees for Mid-Year Session,
December 5-8; Diversified Program Is Arranged for All Practitioners
ELABORATE planning, especially by a large
Cleveland Committee, is shaping up a pro-
gram that promises one of the most thor-
ough Interim Sessions of the American Medical
Association in Cleveland, December 5-8.
The Council on Scientific Assembly of the
A. M. A. headed by Dr. Henry R. Viets, of
Boston, met with state and local representatives
in Cleveland on September 20 and laid final plans.
A complete program of the scientific meeting
will appear in a forthcoming issue of The Jour-
nal of the A. M. A. Here is just a resume of
topics to be discussed:
Hemorrhagic Diseases, Cancer, Cardiovascular
Diseases, Diabetes, Obstetrics, Pediatrics, Der-
matology and Syphilology, Gastrointestinal Dis-
eases, Traumatic Surgery, ACTH and Cortisone,
Anesthesia, Medical Therapy, Neurology and
Psychiatry, Ectopic Pregnancy, Poliomyelitis,
Fluid Balance, Parenteral Protein Feeding, Frac-
tures in the Age of Antibiotics.
On most of the foregoing subjects, several
sessions have been arranged to permit doctors
a wide schedule of choice.
An elaborate program of television sessions
has been arranged with surgery lectures from
Western Reserve University School of Medicine.
All scientific sessions have been arranged pri-
marily with the general practitioner in mind.
LOCAL COMMITTEES
Dr. Fay A. LeFevre, of Cleveland, is chairman
of the local Administrative Committee, with the
following other members, all of Cleveland: Dr.
Fred W. Dixon, President-Elect of the Ohio
State Medical Association; Dr. A. Carlton Ern-
stene, Dr. Farrell T. Gallagher, Dr. Donald
M. Glover, Dr. Charles L. Hudson, Councilor of
the Fifth District, Dr. Edward F. Kieger and
Dr. Herbert B. Wright.
Chairman of other committees are: Subcom-
mittee on General Meeting, Dr. Howard Diettrick,
Subcommittee on Information and Registration,
Dr. Leonard L. Lovshin; Subcommittee on Ex-
hibits, Dr. David Kirk Spitler; Subcommittee
on Housing, Dr. Irdell M. Hinnant; Subcom-
mittee on Television Program, Dr. William D.
Holden.
Chairman of Scientific Program Subcommittees
are the following: Anesthesia, Dr. R. J. Whit-
acre; Cancer, Dr. William F. Boukalik; Cardio-
vascular Diseases, Dr. A. Carlton Ernstene;
Dermatology and Syphilology, Dr. George W.
Binkley; Diabetes, Dr. Edmund E. Beard; Fluid
Balance, Dr. Chester R. Lulenski; Gastrointes-
tinal Diseases, Dr. E. N. Collins; Medical Ther-
apy, Dr. Stanley M. Goldhamer; Neurology and
Psychiatry, Dr. Douglas Bond; Obstetrics, Dr.
Clifford J. Vogt; Pediatrics, Dr. Charles F. Mc-
Khann; Poliomyelitis, Dr. Walter M. Solomon;
Traumatic Surgery, Dr. Donald M. Glover.
Attending the September meeting also were
Dr. George F. Lull, Secretary and Manager of
the A. M. A.; Dr. Austin Smith, Editor of the
Journal of the A.M.A.; Dr. E. O. Swartz, Cin-
cinnati, President of the Ohio State Medical
Association, and Mr. Charles S. Nelson, Execu-
tive Secretary of the 0. S. M. A.
Blanks for making hotel reservations may
be found in current issues of the Journal of the
A. M. A.
Features of the Session will be meetings of
the House of Delegates.
Ohio Radiologists To Meet in
Columbus, May 26-27
The annual meeting of the Ohio State Radi-
ological Society will be held at the Fort Hayes
Hotel, Columbus, on Saturday and Sunday, May
26 and 27, 1951.
Scientific sessions as well as business sessions
will be held on both Saturday and Sunday. Golf
will be played on Friday afternoon preceding
the meeting, with the ladies participating if they
wish. Following golf, dinner will be served.
On Saturday evening, May 26, a gala affair
is planned with dinner, entertainment and danc-
ing.
One of the main purposes of the meeting
will be to take advantage of the accomplish-
ments of Ohio radiologists, officers announced.
The meeting also will afford opportunity for
Ohio radiologists to become better acquainted,
they said.
A program has been arranged for the ladies.
President of the Society is Dr. Arnold D. Piatt,
of Newark.
The American Dermatological Association is
offering a prize of $300 for the best essay sub-
mitted of original work relative to some fun-
damental aspect of dermatology or syphilology.
The deadline is February 1, 1950. Further in-
formation may be obtained from Dr. Louis A.
Brunsting, Secretary, 102-110 Second Ave., SW.,
Rochester, Minn.
1100
The Ohio State Medical Journal
When there is a tendency toward hemorrhoids, when hemorrhoids
are present or after hemorrhoidectomy — when avoidance of strain-
ing is desired — Metamucil’s smooth, demulcent action conforms to
accepted bowel management.
Metamucil softens the fecal content, stimulates peristalsis by
supplying plastic, bland bulk and encourages easy, gentle, reg-
ular evacuation without irritation or straining.
Metamucil is the highly refined mucilloid of Plantago ovata
(50%), a seed of the psyllium group, combined with dextrose
(50%) as a dispersing agent.
G. D. Searle & Co., Chicago 80, Illinois.
SEARLE RESEARCH IN THE SERVICE OF MEDICINE
METAMUCIL5*
for November, 1950
1101
Doctors and the War . . .
Rules on Classification of Physicians Registered Oct. 16; Dr. Conard
Named to Head Advisory Committee; Needs of Armed Forces Analyzed
NEW developments on the matter of pro-
viding medical officers for the armed
forces as a part of the national prepared-
ness program were as follows as this issue of
The Journal went to press:
1. The Department of Defense has requested
Selective Service to furnish a total of 922
doctors of medicine, 500 dentists and 100 veter-
inarians for the Army Medical Corps which
needs approximately 1,325 medical officers to
meet its immediate requirements.
2. First registration of male physicians under
the Doctor Draft Act (Public Law 779) was
held on October 16.
3. Local Selective Service Boards are in the
process of classifying physicians who registered
on Oct. 16; schedules for physical examination
of those classified as available for induction
will be announced soon.
4. No date set as yet by National Selective
Service Headquarters for the registration of
other male physicians under 50 years of age but
who were not required to register on October 16.
5. Dr. Robert Conard, chairman, Military
Advisory Committee of Ohio State Medical As-
sociation, has been appointed chairman of Ohio
Advisory Committee to Selective Service by the
Medical Advisory Committee of National Security
Resources Board which is serving as advisor
to National Selective Service.
6. Secretary of Defense Marshall directed
the Navy to call V-12 medical reserve officers
without prior service to active duty for assign-
ment to the Army Medical Corps.
ARMY ASKS FOR INDUCTEES
In its memorandum asking Selective Service
for physicians, dentists and veterinarians for
the Army, the Department of Defense specified
induction quotas as follows: 300 doctors of medi-
cine by November 15; 300 doctors of medicine,
300 doctors of dental surgery or doctors of
medical dentistry, and 50 doctors of veterinary
medicine by December 15; 322 medical doctors,
200 doctors of dental surgery or medical den-
tistry, and 50 doctors of veterinary medicine by
January 15.
The Department of the Navy and the De-
partment of the Air Force have indicated that
present plans do not call for submission of
requisitions in these categories.
REGISTRATION ON OCT. 16
Male physicians who were required to register
on October 16 were those comprising the first
two priority groups specified in the Doctors’
Draft Act (Public Law 779) namely: A. S. T. P.
and V-12 students and those deferred from
active military duty in World War II to con-
tinue their professional education who had less
than 2d months of active service in the armed
forces or U. S. Public Health Service after
completing their professional education and who
are not at present in a reserve component of
the armed forces. Physicians in these categories
with more than 21 months of active service with
the armed forces or U. S. Public Health Service
and who are in good standing in some armed
force reserve unit did not have to register on
October 16.
Memoranda issued by Selective Service cov-
ered the following special situations:
SPECIAL INSTRUCTIONS
Male persons who on or after October 17,
1950, receive degrees in medicine, dentistry, etc.,
will be required to register within five days of
receipt of degree.
Physicians between the ages of 18 and 26 who
had registered in the general draft were re-
quired to register again under this special draft.
His original local board will have jurisdiction
over him.
Men were held individually responsible for
locating the “duly designated registration of-
ficial of Selective Service local board having
jurisdiction in the area in which he has his
permanent home or in which he may happen to
be on that day.” Anyone prevented from regis-
tering on the appropriate date because of cir-
cumstances beyond his control must register as
soon as possible after cause of such inability
ceases to exist.
Men absent from the country on their regis-
tration date are required to register within five
days after their return.
Volunteers among physicians classified avail-
able by Selective Service but who enter the
armed forces prior to induction will be counted
against the Selective Service quotas.
Physicians who registered on October 16 were
required to give only a minimum amount of
information. Forms for detailed information
were given to each with instructions to fill out
the forms and return them to the local board
within five days. A registration certificate
(SSS Form No. 2) will be mailed by the board
to the registrant after the completed forms are
received.
CLASSIFICATION STARTED
Local Selective Service Boards began the
classification of physician registrants on Octo-
1102
The Ohio State Medical Journal
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for November, 1950
1103
ber 23. Classification is to be completed before
November 15 if possible.
On November 15 local boards are expected
to begin scheduling physicians classified as
available for active duty for physical examina-
tions so that all examinations for those put
into Class I-A can be completed by Dec. 15.
CLASSIFICATION REGULATIONS
Following are classification regulations estab-
lished by Selective Service governing physicians
subject to the Doctors’ Draft Act, not only those
who registered on October 16 but others 50
years of age or under who will be required to
register at some future date before January 16
— the date has not been set:
Each special registrant who has not attained
the fifty-first anniversary of the day of his
birth shall be considered by the local board as
available for military service and eligible for
classification in Class I-A until his eligibility
for a deferred or exempt classification is clearly
established to the satisfaction of the local board.
(Editor’s Note: Although only those under
50 will be required to register, a registrant is
liable for induction until he reaches 51.)
The delivery to a special registrant of a
Classification Questionnaire (SSS Form No. 100)
and an Initial Data For Classification and Com-
missioning in Medical Services For Medical,
Dental and Veterinary Corps (DD Form No. 390)
shall be notice to the registrant that unless
information is presented to the local board,
within the time specified for the return of the
questionnaire and initial data form, which will
justify a deferred or exempt classification, the
registrant will be classified in Class I-A.
DEFERMENT CATEGORIES
Every special registrant shall be placed in
Class I-A except that when grounds are estab-
lished to place such registrant in one or more
of the classes in the following table, the spe-
cial registrant shall be classified in the lowest
class for which he is determined to be eligible,
with Class I-A-0 considered the highest class
and Class I-C considered the lowest class ac-
cording to the following table:
Class: I-A-0
IV-E
I- D
II- A
III- A
IV- A
IV- F
V- A
I-C
A special registrant shall be placed in Class
I-A-0 if he is a conscientious objector but with
no objection to non-combatant duty only.
A special registrant shall be placed in Class
I-C if (1) he is on, or enters upon, active duty
Registration Date for Other Doctors
Under 50 Has Not Been Set
Only a part of Ohio physicians who will
be subject to the Doctors’ Draft Act were
required to register on Oct. 16.
Between now and Jan. 16, the Selective
Service Director will set a Registration
Day for those who were not in priorities
Nos. 1 and 2 — those who registered on
Oct. 16.
At the time of the next registration ail
other male physicians who are under 50
years of age at that time will be expected
to register.
These physicians comprise priority
groups Nos. 3 and 4. Group 3 consists
of those who did not have active service
in the armed forces or U. S. Public Health
Service after September 16, 1940. Group 4
consists of all other physicians under 50
years of age regardless of the amount of
service after September 16, 1940.
in the armed forces, or (2) he has entered upon
active duty in the armed forces after the date
fixed for his registration in any special regis-
tration and has been separated therefrom by
honorable discharge or discharge under honorable
conditions or by an equivalent type of release
from service.
A special registrant shall be placed in Class
I- D if he is or becomes a member of a reserve
component of the armed forces.
ESSENTIAL TO COMMUNITY
A special registrant shall be placed in Class
II- A only if it is determined that (1) the medical,
dental, or allied specialist service being per-
formed by such registrant in his community is
necessary to the maintenance of the national
health, safety or interest, (2) the service per-
formed by him cannot be performed by other
medical, dental, or allied specialists who are in
the community, and (3) the registrant cannot
be replaced in the community by another person
who can perform such medical, dental or allied
specialist service. It is the intent of these
criteria that a special registrant shall be placed
in Class II-A when his induction would cause
the availability of essential health services to
fall below reasonable minimum standards. In
making such determination, the local board shall
give consideration to but shall not be bound by
any advice offered by the state and county ad-
visory committees established by medical so-
cieties.
A special registrant shall be placed in
Class III-A only if (1) it is determined that
his induction into the armed forces would result
in extreme hardship and privation to a wife,
1104
The Ohio State Medical Journal
Jlu^ierS fyine GaSmeticS and PerlumeS,
ai advertised In fiublicatio-nS al the
American Medical A SSaciatianr
ale distributed in Ohio- hu:
CARL G. and DOROTHY SMITHSON, Divisional Distributors
252 S. CHESTERFIELD ROAD
PHONE: DOUGLAS 1240 COLUMBUS 9, OHIO
DISTRICT DISTRIBUTORS
DOLORES ADAMS
18 1 Twelfth Ave.
Columbus 1, Ohio
Phone WAlnut 1654
ESTHER MESSERSMITH
Arbaugh Building
Salem, Ohio
Phone 7290
ELVAH R. HUNT
519 Oak Street
Ironton. Ohio
Phone 927-R
ALICE SENSENBRENNEP
313 E. Mound Street
Circleville. Ohio
Phone: 780 L .
KSTA REESE
22 Portsmouth Road
Gallipolis. Ohio
Phone: 986 W
RUTH STIFF
240 N. Cherry St.
Lancaster, Ohio
Phone: 1914 W
VIRGINIA M. DAVIDSON
General Delivery
Logan, Ohio
Phone: 5-2327
MAE THOMPSON
332 Eastern Ave.
Washington C.H., Ohio
Phone: 31921
ANNABELLE O. RICHARDS
1341 Ridge Ave.
Steubenville. Ohio
Phone: 2-7643
IRMA TODD
559 Harding Road
Zanesville. Ohio
Phone 3895
BEULAH A. GARDNER
301 Spring Street
Marietta, Ohio
Phone: 336 R
LILLIE CARR
P. O. Box 415
Steubenville, Ohio
Phone 24826
ASSISTANT DISTRICT DISTRIBUTORS
LOUISE S. DAVIS
379 W. 8th Ave.
Columbus 1, Ohio
Phone UNiversity 1741
MABEL M. LAMP
89 Riverview Dr.
Newark, Ohio
Phone: 41633
LEONA McARTOR
1807 Lexington Ave.
Springfield, Ohio
Phone: 22050
LANA POLSTER
80 Brunson Ave.
Columbus 3, Ohio
Phone FAirfax 1632
VIRGINIA THOMPSON
265 E. 11th Ave.
Columbus 1. Ohio
Phone: UNiversity 6277
OPAL DUNCAN
2749 Elliott Ave.
Columbus 4. Ohio
Phone RAndolph 6669
HELEN E. SMITLISON, Divisional Distributor
Post Office Box 125, CHAGRIN FALLS, OHIO
DISTRICT DISTRIBUTORS
ANNE McVICKER
517 C.A.C. Bldg.
Cleveland 15. Ohio
Phone: MAin 9237
LAVERNE CARR POWELL
1759 S. Union St,
Alliance, Ohio
Phone: 7038
MARIE HAZEN
Hotel Portage, Rm. 115
' kron. Ohio
Phone: EIEmlock 0515
RUTH M. BEATTY
53 South St. Clair
Painesville, Ohio
Phone: 4939
RUTH KIRCHNER
285 Circular St.
Tiffin, Ohio
Phone: 3817
ANNE WISFMAN
233 Superior St.
Youngstown 10, Ohio
Phone: 32938
LIELEN A. REIFE
5 Park Ave. West
Mansfield, Ohio
Phone: 46706
LOUISE WYNNE
822 West 14th
Lorain, Ohio
Phone: 6192 4
DONALD R. DAY
Hale Rd.
Painesville, Ohio
Phone: 9036
WILMA PINKLLY
232 East 10th
Ashland, Ohio
Phone: 578 Red
GEORGE YOCUM, Divisional Distributor
ROOMS 101, 102 & 103, 1028 SOUTH BARR STREET, FORT WAYNE 2, INDIANA
MAILING ADDRESS: POST OFFICE BOX 1017, FORT WAYNE 1, INDIANA
PHONE: ANTHONY 5360
DISTRIBUTORS
GLADYS SEWARD
424 Irving Street
Toledo. Ohio
Phone GArfield 3613
E. J. & AGNES CURTIS, Divisional Distributors
5921 OAKWOOD AVENUE
Phone: Mulberry 5382 CINCINNATI 24, OHIO
DISTRICT DISTRIBUTORS
MINNETTA THOMAS
815 Keith Bldg.
Cincinnati 2, Ohio
Phone: MAin 0360
RUTH MOSELEY
1627 Warevliet Ave.
Dayton, Ohio
Phone: KEnmore 2744
BELLE QUICK
Rt. 1, Greenlawn Rd.
Hamilton, Ohio
Phone: Hamilton 23076
for November , llJ50
1105
child, or parent, with whom he maintains a
bona fide family relationship in their home, re-
gardless of the date on which such bona fide
family relationship was established, and (2) by
reason of such determination it is considered
advisable that he be deferred. The term “child”
as used in this paragraph means a legitimate
or an illegitimate child from the date of its con-
ception, a child legally adopted, a stepchild, a
foster child, and a person who is supported in
good faith by the registrant in a relationship
similar to that of parent and child, but shall
not include any person 18 years of age or over
unless he is physically or mentally handicapped.
OTHER REASONS
A special registrant shall be placed in Class
IV-A only if he is the sole surviving son of a
family of which one or more sons or daughters
were killed in action or died in line of duty
while serving in the armed forces of the United
States, or subsequently died as a result of in-
juries received or disease incurred during such
service.
A special registrant shall be placed in Class
IV-E if he is a conscientious objector with
objection to any duty with the armed forces.
A special registrant shall be placed in Class
IV- F if he is found physically, mentally or
morally unfit for military service.
A special registrant shall be placed in Class
V- A if he has attained the fifty-first anniver-
sary of the day of his birth after registering
unless he is on active military service in the
armed forces and is in Class I-C.
SPECIAL SITUATIONS
In classifying physicians local Selective Serv-
ice Boards are directed to consider them in the
sequence of their dates of birth with the
youngest being considered first within each of
the established categories.
Physicians classified in I-A will be called up
for induction pursuant to special calls or req-
uisitions filed with the National Director of
Selective Service by the Department of Defense.
These calls will be filled by states and by local
boards on a quota basis. All such special calls
must be made at least 60 days prior to the
proposed date of induction. At least 21-days
notice must be given to each physician scheduled
for induction.
Any physician classified as I-A who obtains a
commission voluntarily in the medical corps of
one of the branches of the armed services prior
to being notified to report for induction will
not be inducted.
Physicians who are inducted will be inducted
as privates and will in all probability be re-
quired to take a certain amount of basic train-
ing pending transfer to and commissioning in
Questionnaires To Obtain Vital
Data Being Sent Out
In order to obtain very important data
for its responsibility in advising the mili-
tary and Selective Service on the medical
needs of local communities, hospitals, medi-
cal schools, etc., and at the same time
advise on the availabihty of physicians
for service with the armed forces, the
Military Advisory Committee of the Ohio
State Medical Association is sending out
three sets of questionnaires.
A questionnaire has been sent to Ohio
hospitals asking them for information re-
garding their interns and residents.
The deans of Ohio’s three medical schools
have been requested to supply information
regarding their faculties.
A third questionnaire is now being pre-
pared to obtain biographical and profes-
sional data on every doctor of medicine
in Ohio. It will be mailed out in the near
future.
These data will bring the records of the
Columbus Office up to date. It will be
indispensable to the Military Advisory
Committee in deciding situations in all
areas and in various institutions.
The committee urges the fullest coopera-
tion on the part of the hospitals, medical
schools and individual physicians in getting
the data to the Columbus office promptly.
the medical corps of one of the branches of
the armed forces.
ADVISORY COMMITTEES
Shortly after President Truman issued his
proclamation setting October 16 as registration
day for priority groups No. 1 and No. 2, he
issued an executive order establishing a Na-
tional Advisory Committee on the Selection of
Doctors, Dentists and Allied Specialists.
This national advisory committee, although
the members were named individually, is the
same as the formerly-established Health Re-
sources Advisory Committee of the National
Security Resources Board.
Personnel of the national advisory committee
is: Dr. Howard A. Rusk, New York City, chair-
man; Dr. James C. Sargent and Dr. Harold S.
Diehl, of the A. M. A. Committee on Emergency
Medical Services; Dr. Leo J. Schoeny, American
Dental Association; Dr. William P. Shepard,
professor of public health, Stanford University;
Dr. John Pastore, New York hospital executive;
and Mrs. Ruth Kuehn, dean of nursing, Univer-
sity of Pittsburgh.
Dr. Rusk, chairman of the national committee,
1106
The Ohio State Medical Journal
e’In general, symptomatic improvement
[of menopausal symptoms] was striking within
7 to 14 days after treatment... ’’with
"Premarin.”
Gray, L.: J. Clin. Endocrinol. 3:92 (Feb.) 1943.
Many clinicians have found that “Premarin” therapy usually brings about
prompt relief of distressing menopausal symptoms. Furthermore, sympto-
matic improvement is followed by a gratifying sense of well-being in a
majority of cases. This is the “plus” in “Premarin” therapy which tends
to quickly restore the patient’s normal mental outlook.
Four potencies of “Premarin” permit flexibility of dosage: 2.5 mg.,
1.25 mg., 0.625 mg., and 0.3 mg. tablets; also in liquid form, 0.625 mg.
in each 4 cc. (1 teaspoonful).
While sodium estrone sulfate is the principal estrogen in “Premarin”
other equine estrogens... estradiol, equilin, equilenin, hippulin . . . are
probably also present in varying amounts as water-soluble conjugates.
m
Estrogenic Substances ( water-soluble) also known as
Conjugated Estrogens (equine)
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, N. Y.
for November, 1950
1107
immediately appointed a chairman for a volun-
teer advisory committee in each state and cer-
tain others to serve with him.
DR. CONARD OHIO CHAIRMAN
Dr. Robert Conard, chairman of the Military
Advisory Committee of the Ohio State Medical
Association, was appointed chairman of the
Ohio advisory committee. Those named to
serve with him temporarily were: Dr. John D.
Porterfield, Ohio director of Health, and Dr. J.
C. Longfellow, Bellefontaine, dentist.
Dr. Conard, Ohio chairman, may appoint, sub-
ject to confirmation by the national committee,
such additional members of the state committee
as may be necessary to carry out its functions.
This is now under consideration by Dr. Conard.
The state advisory committee may appoint
at state and local levels such separate sub-
committees of physicians, dentists and veter-
inarians as may be deemed necessary to give
appropriate consideration to the respective needs
of the armed forces and of the civilian popula-
tion.
WILL USE OSMA COMMITTEE
As a sub-committee on physicians Dr. Conard
will use the Military Advisory Committee of
the Ohio State Medical Association of which
he is chairman. As local committees, Dr.
Conard plans to use the Military Advisory Com-
mittees being established by the state’s 88
county medical societies.
The Ohio Veterinary Medical Association has
a committee similar to that of the Ohio State
Medical Association and that committee un-
doubtedly will be designated as a sub-committee
on veterinarians for the State Advisory Com-
mittee.
Plans for setting up sub-committees for den-
tists and for public health personnel are under
consideration.
Personnel of the Military Advisory Committee
of the Ohio State Medical Association, which
will serve for the Association in cooperation
with County Medical Society military advisory
committees and assist Dr. Conard on his other
assignment as well, is as follows:
First District: Dr. David A. Tucker, Jr., Cin-
cinnati; Second District: Dr. Homer D. Cassel,
Dayton; Third District: Dr. Lester C. Thomas,
Lima; Fourth District: Dr. A. A. Brindley,
Toledo; Fifth District: Dr. Donald M. Glover,
Cleveland; Sixth District: Dr. Ralph L. Rutledge,
Alliance; Seventh District: Dr. Albert E. Win-
ston, Steubenville; Eighth District: Dr. Walter
L. Cruise, Zanesville; Ninth District: Dr. C. L.
Pitcher, Portsmouth; Tenth District: Dr. E. L,
Montgomery, Circleville; Eleventh District: Dr.
Charles R. Keller, Mansfield.
FUNCTIONS OF ADVISORY GROUPS
In performance of their duties the National,
state and local advisory committees are to give
Must Have Advisory Committee
In Each County Immediately
In a statement released to The Journal,
Dr. Robert Conard, chairman of the Mili-
tary Advisory Committee of the Ohio
State Medical Association and who is on
full-time duty in the Columbus Office of
the Association, urged all County Medical
Societies to immediately set up local Mili-
tary Advisory Committees if they have not
already done so and to send the names
of committee personnel to the Columbus
Office.
“It is vital that we have a strong Military
Advisory Committee in each county,” Dr.
Conard said. “These local committees will
be expected to establish a close working
relationship with local Selective Service
Boards. If this is done, an equitable dis-
tribution of physicians between civilian
needs and military demands can be worked
out.
“Local boards and local committees may
not always agree on the classification of
physicians, or they may agree too readily
on an unsound solution. When such situa-
tions arise, the member of the State
Military Committee representing the area
will be alerted. He will be expected to
evaluate the situation, obtain facts, etc.,
and bring the matter to the attention of
the state committee for study and recom-
mendation. The state committee can then
present the arguments to the State Di-
rector of Selective Service and even to
the National Advisory Committee to
Selective Service.”
Dr. Conard pointed out that the state
committee must depend on local committees
to secure basic facts and data and to enter
into initial discussions with Selective
Service through the local board or boards.
The state committee will be expected to
act as an appellate body and to intervene
only in cases where no agreement on a
local basis can be reached, he said.
appropriate consideration to the needs of the
armed forces and of the civilian population
for the services of medical, dental and allied
professional personnel. The state and local ad-
visory committees are expected to establish
and maintain liaison with the State Selective
Service Director and with local Selective Service
Boards for the purpose of advising them on
the classification of physicians, dentists, etc.
National Selective Service Director Lewis B.
Hershey in a directive dated October 13 pointed
out that the state and local committees are not
1108
The Ohio State Medical Journal
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Tolerance: Extremely well tolerated; “no evidence
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Toxicity Studies:
In recent pharmacologic investigations,
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reactions in any of the animals treated.
In contrast, 3 mg./Kg. of a “ concentrate ”
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Merck — first to isolate and produce vita-
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for November, 1950
‘ 1109
a part of the Selective Service System but
volunteer advisory committees. He emphasized
however that State Directors of Selective Service
and local Selective Service boards are to “effect
full cooperation with the volunteer advisory
committees.”
ARMY SHORTAGE ACUTE
Here are developments leading to the Army’s
request to Selective Service:
Secretary of Defense Marshall on Septem-
ber 29 directed the Navy to immediately order
to active duty enough V-12 reserves without
prior service to meet requirements of all three
military departments — Army and Air Force as
well as the Navy. An announcement from the
Department of Defense stated that the Army
had requested the Navy to assign 570 of these
reserves to it — the first increment of 235 to re-
port to duty by October 15.
The announcement further stated that of the
1,429 Navy reserve medical officers in priority
group one, some 1,350 were at that time avail-
able for immediate call to active duty. The re-
mainder were members of Organized Reserve
units not subject to call at this time. The
Army, according to the same release, was
calling to active duty some Army medical re-
serve officers in certain grades and specialties.
NEED SOME RESERVE OFFICERS
The Army has an immediate shortage of
1,325 physicians. To meet this a limited num-
ber of World War II physicians are being called
involuntarily from the reserves. Reserve medi-
cal officers assigned to Organized Reserve Corps
units will be called to duty as their units are
brought into active service. The professional
complements of the larger medical units will not
be called for initial training phases.
The 570 V-12 physicians requested of the
Navy will be detailed to the Army to meet
current critical requirements.
As soon as there are additional volunteers or
Selective Service starts meeting Army require-
ments, Navy personnel will be returned to that
service and involuntarily recalled Reserve of-
ficers will be released, except those in the higher
grades being utilized as specialists and in senior
command assignments. “Specialists cannot be
released unless Public Law 779 (Doctor-Draft
Law) provides replacements for them,” the
Army release states.
Army requirements will be 3,200 physicians to
meet current expansion plans, it is said.
REASONS FOR VOLUNTEERING
The Army newsletter enumerated these rea-
sons why it is to the advantage of registrants to
volunteer rather than be drafted:
First, volunteers will receive an additional
$100 per month professional pay;
Second, those who volunteer and are commis-
1110
Quick Way To Obtain Commission
Announced By the Army
Physicians who registered with Selective
Service on October 16 and who are classi-
fied as 1-A (available for military service)
will be given an opportunity to secure a
commission in the Army Medical Corps
Reserve without delay and red tape under
a speed-up procedure for commissioning
medical officers just announced by the De-
partment of the Army.
If a physician 1-A registrant is found
physically and professionally acceptable to
the Army (which is the only branch of
the armed forces that has asked Selective
Service for medical officers to date) and
he has indicated on his registration blank
that he desires a commission, the Army
will offer him a commission and will notify
him to appear before a notary public to
execute the oath of office. He will be
asked at a later date to complete necessary
papers for the Army records.
Once the oath is administered, the
physician becomes a member of the Army
Medical Corps Reserve and is no longer
subject to induction by Selective Service.
When the physician notifies his local
Selective Service Board that he has taken
the oath of office and is therefore com-
missioned, the board removes his name from
its roster. It credits his name against the
quota of physicians that Ohio is expected
to furnish to the Army.
Physicians commissioned in this manner
will be called to active duty by the Army
after consultation with the Military Ad-
visory Committee of the Ohio State Medical
Association.
Physicians who are classified by Selective
Association who are classified by Selective
Service as 1-A and found acceptable for
military service but do not obtain a com-
mission in the manner described above, or
through regular channels, will be subject to
induction as privates. If inducted they un-
doubtedly would have to serve some basic
training before being commissioned. Phy-
sicians commissioned from the ranks after
induction will not be entitled to the extra
$100-per-month pay allowed physicians who
enter the service as commissioned officers.
sioned need not register. (The letter was issued
before the October 16 registration.)
Third, professional skills can be utilized bet-
ter than under Selective Service, which makes
only bulk numbers of physicians available
without classification.
The Ohio State Medical Journal
• • •
Eligibility for Local Health Aid
Statement of Policy Is Issued by Health Director Outlining Minimum
Standards for Maximum Services; List of Qualified Units Is Given
TO clarify existing policy which governs
distribution of field services to local health
units, Dr. John D. Porterfield, director of
the Ohio Department of Health, has issued a
statement to all Ohio health commissioners.
The explanation came as the Ohio Department
of Health is consolidating its field consulting per-
sonnel into district offices, as previously an-
nounced. The five district field offices are as
follows: Southeast District, Athens; Northeast
District, Cuyahoga Falls; Northwest District,
Bowling Green; Central District, Delaware;
Southwest District, Dayton.
If a local health department meets certain
specified standards it is eligible for the maximum
services and aids offered by and through the
State Department. If it does not meet those
standards, it is still eligible for certain services.
MINIMUM STANDARDS
If the local health department meets these
minimum standards — (a) full-time health com-
missioner, nurse, sanitarian and clerk, paid from
local funds; (b) an office open during the normal
work week prevailing in the community; and
(c) a program which offers the seven basic serv-
ices of local health to the community — it is
eligible for the following services:
1. All legal responsibilities placed on the Ohio
Department of Health by state statute such as
public and semi-public water and sewage supply
supervision.
2. All emergency services in either epidemic
or community disaster.
3. All ancillary and specialized service pro-
grams such as tuberculosis and dental trailers,
etc.
4. All consultative and advisory services which
assist nursing, sanitation and clerical personnel
in their local program.
5. Eligibility to participate in grants-in-aid
program.
If a local department does not meet the fore-
going minimum standards, it is eligible for the
following services:
1. All legal responsibilities as indicated in
the foregoing services.
2. All emergency services in either epidemic
or community disaster.
3. Health education and community organiza-
tion programs for the purpose of gaining local
support for and development of local health de-
partments meeting minimum standards.
“Within the limits of available funds, the
Ohio Department of Health is intent upon pro-
viding desired assistance in the furtherance of
local health programs/ ” Dr. Porterfield declared.
QUALIFIED DEPARTMENTS
Dr. Porterfield issued a list of local depart-
ments that meet the minimum standards, (as of
July 1, 1950):
City Alone — Akron, Canton, Cincinnati, Cleve-
land, Cleveland Heights, Columbus, Dayton, East
Cleveland, Findlay, Hamilton, Lancaster, Lorain,
Martins Ferry, Massillon, Middletown, Spring-
field, Steubenville and Toledo.
County Alone — Ashtabula, Butler, Clermont,
Columbiana, Fairfield, Fulton, Geauga, Hancock,
Jefferson, Lorain, Lucas, Mahoning, Marion,
Meigs, Morrow, Muskingum, Portage, Preble,
Seneca, Stark, Trumbull and Washington.
Combined Departments — Adams County, Brown
County;
Ashland County — Ashland City;
Athens County — Hocking County — Vinton
County — Athens City — Logan City — Nelsonville
City;
Clinton County — Wilmington City;
Crawford County — Wyandot County;
Cuyahoga County — Bedford City — Berea City —
Euclid City — Garfield Heights — Maple Heights —
Parma City — Rocky River City — South Euclid
City — University Heights;
Drake County — Greenville City;
Defiance County — Defiance City;
Delaware County — Madison County — Union
County — Delaware City;
Erie County — Sandusky City;
Fayette County — Greene County — Washington
Court House City — Xenia City;
Guernsey County — Cambridge City;
Hamilton County — Cheviot City — North College
Hill City;
Huron County — Norwalk City;
Lawrence County — Ironton City;
Logan County — Shelby County — Bellefontaine
City — Sidney City;
Medina County — Wadsworth City;
Miami County — Troy City;
Montgomery County — Miamisburg City;
Richland County — Mansfield City;
Sandusky County — Wood County — Bowling
Green City;
Summit County — Cuyahoga Falls City;
Tuscarawas County — Dover City;
Wayne County — Wooster City.
for November, 1950
1111
Ohio Civil Defense Program . . .
Organization Meetings Are Held Throughout State; Medical-Health
Division of Governor’s Board Coordinating Action With Other Units
THE Ohio civil defense program is quickly
taking shape, with a number of sessions
already out of the way and others planned
for the next few weeks.
The Ohio civil defense program is admin-
istered by the Ohio Civil Defense Board named
two months ago by Governor Frank J. Lausche
shortly after the onset of the Korean situation.
Dr. John D. Porterfield, State Director of
Public Health, was named to the Governor’s
advisory board to head the multi-faceted medi-
cal and health division. Dr. Porterfield, in turn,
named a 15-man board to advise him in the vari-
ous and diversified phases of the health problem.
The pattern followed in setting up the Ohio
program was one based on a plan laid down by
the Federal government. Regional and munici-
pal plans follow the state and Federal plan.
This aids in the coordinating of assistance be-
tween towns, areas, and the state in the event of
emergency.
Under the direction of Dr. A. B. Garrett of
Ohio State University, several meetings covering
radiological warfare and treatment have been
held at the University. Dr. Garrett attended a
special school at Oak Ridge preparatory to con-
ducting the discussions and class sessions.
The first series of comprehensive meetings
on the over-all plan for civil defense was sched-
uled for the last few days of October and the
first week of November in each of the five civil
defense areas of the state. Meetings were sched-
uled for Columbus, Canton, Toledo, Cleveland
and Cincinnati starting on October 30 and run-
ning through November 8.
At these meetings mayors, county commis-
sioners, fire chiefs and, if there had been one
appointed, the civil defense director for each
municipality in the area would be briefed by
various civil defense officials. General Leo
Kreber was to talk on the nature of the over-all
program; Col. William E. Warner, State Direc-
tor of Civil Defense, would report on activities
to date within the state; General Kenneth Cooper,
General Kreber’s assistant, was to talk about
ways and means of developing civil defense units
in municipal areas; Colonel George Mingle of
the State Highway Patrol was to speak on plan
protection and police measures. Charles R. Scott
was to speak on fire prevention and services and
Ralph E. Dwork, who is chief of the profes-
sional training branch of civil defense for Ohio,
was to speak for Dr. John Porterfield on health
services.
It was pointed out by Dr. Porterfield that the
main purpose of these meetings was to instill
in the minds of those city and county officials
attending them the importance of establishing
civil defense units.
To be published by December 1, is a booklet
outlining procedure for organizing for civil
defense at the local level.
This manual will carry detailed information
on proposed medical-health activities of a local
civil defense program as a guide for local
committees. Dr. Porterfield suggests that local
medical-health committees proceed somewhat
slowly in setting up their programs, pending
receipt of this manual. He points out that it
would be advisable to have the activities in all
counties as uniform as possible.
During the last week in September, more
than 70 health commissioners, meeting in Co-
lumbus for their 31st annual conference at-
tended a special pre-convention session covering
civil defense and their important part in its
operation.
They were addressed by Governor Lausche as
well as members of Dr. Porterfield’s advisory
board. At the close of sessions official Army
sound films on the atomic bombing of Japan were
shown. These films, incidently, were scheduled
for use at the five regional meetings mentioned.
Clinics on Epilepsy To
Continue in 1951
A series of 40 special clinics on epilepsy will
be conducted in Ohio during 1950-1951 under
the auspices of the Ohio Society for Crippled
Children. The Society’s project on epilepsy was
initiated in 1946 to circulate information about
the disorder and to increase public understand-
ing of it.
Family physicians are invited to refer pa-
tients with epilepsy symptoms to the clinics
for diagnosis and recommendations. The Society
announced that because of increased demand for
the medical services of special clinics, three
additional physicians have been appointed as
consultants. They are Dr. Max T. Schnitker,
Toledo; Dr. John D. O’Brien, Canton; and Dr.
Nathaniel R. Hollister, Dayton. Dr. Milton M.
Parker, Columbus, continues as general con-
sultant.
Headquarters for the Ohio Society for Crippled
Children are at 5 W. Broad St., Columbus.
1112
The Ohio State Medical Journal
Nasal engorgement and hypersecretion
accompanying the common cold and sinusitis are
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Normal appearing nasal epithelium.
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Supplied in !4% solution (plain and aromatic),
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for November, 1950
1113
Wyandot Memorial Hospital Is Dedicated at Upper Sandusky
This is the architect’s sketch (McLaughlin and Keil of L
and now open for community use.
Another milestone in the hospital building
program in Ohio under the Hill-Burton Act was
marked when the Wyandot Memorial Hospital
at Upper Sandusky was formally dedicated on
September 10 — and opened to receive patients
a short time later.
The Wyandot Memorial was one of the smaller
hospital projects in much-needed hospital areas
which started from scratch under the Hill-
Burton plan.
A one-floor plan which accommodates 31 beds
and 10 bassinets, the hospital was built at a cost
of $411,000, approximately $137,000 of which
was furnished by Federal grant-in-aid funds.
Fred J. Milligan, Columbus attorney and na-
tive of Upper Sandusky, was principal speaker
for the gala occasion which brought an esti-
mated 3,000 persons out. Taking an active part
in the celebration were the Wyandot County Band
and the American Legion Drum and Bugle
Corps. The dedication ceremonies were broad-
cast over Radio Station WMRN, Marion.
Active in the program was Dr. J. Craig
Bowman, of Upper Sandusky, recently Coun-
cilor of the Third District of the Ohio State
Medical Association, who was one of the guiding
factors in realization of the hospital from the
early planning stages. Dr. Bowman has been
appointed a member of the Board of Governors
of the hospital.
Also active in the program were Anthony J.
Borowski, Dr. P. H., chief of the Office of
Hospital Facilities of the Ohio Department of
Health, Columbus, and Mr. George Fishback,
also of the Hospital Facilities Office.
Named chief of the new hospital staff is Dr.
Bernard A. Maloney, of Upper Sandusky.
Preliminary results of the census indicate
a population in the Nation of 151,000,000, an
increase of 19,000,000 over that of 1940.
) of the Wyandot Memorial Hospital, recently dedicated
Tax Roundup Article To Appear
In December Issue %
Important changes have been made in
the Federal Income Tax structure. These
changes will be .incorporated in a gen-
eral explanation of Federal and State taxes,
especially as they pertain to physicians,
which will appear in the December issue of
The Journal. Look for this summary of
all-important tax obligations.
A. A. A. S. To Meet in Cleveland
The American Association for the Advance-
ment of Science will hold its meeting in Cleve-
land, December 26-30. Programs of particular
interest to physicians and researchers in the
medical sciences include those of the following
sections and affiliated organizations:
Section on Physics; Section on Chemistry;
Section on Zoology; Subsection on Medicine;
Subsection on Denistry; Subsection on Pharmacy;
Oak Ridge Institute of Nuclear Studies; Ameri-
can Society of Parasitologists; American So-
ciety of Zoologists; American Microscopical So-
ciety; Biometric Society, Eastern North Ameri-
can Region; American Dietetic Association; Alpha
Epsilon Delta, Premedical Honor Society; Society
of the Sigma Xi; United Chapters, Phi Beta
Kappa.
The 150-Booth annual science exposition will
be featured in the Cleveland Public Auditorium.
State Welfare Director John H. Lamneck re-
cently announced that the Ohio Department of
Public Welfare had purchased the General Prot-
estant Orphans’ Home property at Cincinnati
and will proceed to convert it into a receiving
hospital as soon as possible.
1114
The Ohio State Medical Journal
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for November, 1950
1115
In Our Opinion:
BASIC CIVIL DEFENSE PLANS
NOW BEING PREPARED
This is a word of advice to the Emergency
Medical Service Committees (Civil Defense Com-
mittees) of all County Medical Societies:
Don’t get the jitters; don’t get over-anxious
to get going.
Sounds like strange advice, doesn’t it? Usually
the plea is to get going immediately.
We’re not trying to discourage interest nor
are we criticizing work already done by some
of the local committees. The point is simply
this:
Planning for the medical phases of civil de-
fense should be more or less uniform. Recom-
mendations for such planning are now being
compiled at national and state levels. This
material should be available within the next few
weeks. It will be sent to local medical emer-
gency committees as soon as available, to be
used as a basis for local planning and local
set-ups.
Obviously, conditions in areas differ. A plan
used in one spot may have to be revised to fit
conditions in another. Nevertheless, much of the
basic planning should be uniform. Plans put
together too quickly or before uniform policies
and procedures are worked out and presented for
local guidance may have to be scrapped.
The idea behind this advice is not to minimize
the importance of civil defense planning and
action, but merely to throw out a caution sign
against premature or too hasty action.
MR. RAYBURN COMMENTS
ON LOBBIES
You’ve heard a lot lately about the labor
lobby, farm lobby, business lobby, medical lobby,
and what-have-you. Those who want the pub-
lic to think you’re a scoundrel, try to identify
you with some so-called “lobby.” What about
these lobbies?
A recent issue of the United States News
published an interview with Sam Rayburn,
speaker of the House of Representatives and
who was elected to Congress 38 years ago. Mr.
Rayburn knows Congress, knows politics, knows
people and knows lobbies. Here are some in-
teresting quotations from the interview:
<i»
Q How much influence do lobbyists have?
A Well, now, it depends upon what you mean
by lobbyists. People are called lobbyists, and,
of course, the word “lobbyist” has a bad sound.
Some so-called lobbyists are men of outstanding
ability, honest men who would tell you the truth
Comments on Current Economic and Social
Questions and Professional Problems;
Suggestions Regarding Organized Activities
and are helpful to committees. Now that kind
of lobbyist is very helpful because he has
studied one question for many years and maybe
some of the members of the committee hadn’t
studied it at all. Members generally want to
learn about it in order to have both sides
honestly put forward so they can make a sane,
sensible judgment. Also there are lobbyists
of the sort usually talked about, but they don’t
come to see me.
Q You feel that different groups should get
the chance to put their views to Congress?
A Of course. And that will always be true.
Some people who hire people to come here to
Washington to represent them make mistakes
in the type and character of man they get. But,
as far as any of this so-called lobbyist influence
in any pernicious way influencing members of
Congress, that just doesn’t exist, in my opinion.
Q What about the social lobby? Do they
pull much weight in Congress?
A No. I’ll tell you a story about that. There
was a very popular man who represented rivers
and harbors groups. He knew a lot about the
subject. When he went before a committee he
was helpful. He built up wonderful friendships
among the membership. When he would invite
people out to dinner, they wanted to go because
they didn’t feel he was going to talk business.
Another fellow, probably with as much ability
but not the personality, came here. He wanted
to know how he could get to be the same kind
of man the other fellow was, because he would
like to give dinners and make friends, etc. But
I said, “You make your friends first and then,
if they want to dine with you, that will be
fine, but you are not going to buy any friend-
ship or influence around here with a dinner.”
Q Is a member of Coyigress influenced much
by the mail he gets?
A I would think so, but I’ll tell you a remark-
able thing about congressional mail. You’ll find,
if you’ll look over your correspondence for
about six months, that in all probability from 5
to 10 per cent of the people have written 90
per cent of the letters. The fellow that’s back
there and satisfied and things are going all right
so far as he’s concerned, you don’t hear from
him. It’s the fellow that’s discontented or un-
happy about something.
Q Do you think that the members of Congress
are influenced a good deal by the leading con-
stituents in their districts who may write to
them from time to time?
A Yes. And the correspondence of members
of Congress has increased manyfold since I
became a member of Congress.
Q Do you think members are impressed by
letters that are obviously individual and not a
part of propaganda?
A That’s correct. To an individual who is a
friend they certainly pay a lot of heed.
Q Or some individual whose opinion in the
community counts for something?
A That’s right.
Q We’ve heard from time to time that some
1116
The Ohio State Medical Journal
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To achieve the greatest accuracy in dosage and at
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Clinical investigation has proved that Digilanid is
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for November, 1950
1117
members of Congress maintain lists of what they
call leaders in their community — is that so?
A Practically all of them do.
Q In other words , these are people whose
opinions they respect or whose opinions they
regard as influential?
A And that they seek advice from some of
the time.
Now what did Mr. Rayburn say? Well, a
so-called lobby is not necessarily bad — many
of them serve a useful purpose and are sincere
in their motives. Congressmen like to hear from
the folks back home and respect the letters they
get from their constituents, especially letters
written by responsible citizens.
The November 7 election is now history. Ohio
voters elected Congressmen to serve for the
next two years. How about getting in touch
with YOUR CONGRESSMAN? Congratulate
him and offer your cooperation. You’ll want to
write to him many times in the future. Now
would be a good time for an icebreaker
OREGON DOCTORS WIN FIRST
ROUND OF BOUT WITH U. S.
The Oregon medical profession won the first
round in its bout with the Federal Government
which has charged it with violating the Sherman
Anti-Trust Act.
On September 28, Federal Court Judge Claude
McColloch ruled that Oregon’s ‘‘organized medi-
cine” had not violated the Sherman Anti-Trust
Act in its prepaid medical service plan.
The government charged that the Oregon
State Medical Society, a number of county so-
cieties and several physicians, sought to monop-
olize the field of prepaid medical care by re-
fusing to deal with private agencies and by dis-
ciplining physicians who did deal with them.
Judge McColloch wrote: “I hold that the Oregon
Physicians Service is not a conspiracy, but rather
an entirely legal and legitimate effort by the
profession to meet the demands of the times for
broadened medical and hospital service, eliminat-
ing the evils of privately owned concerns as well
as the element of private profit.”
The government has announced its intention
of appealing the McColloch decision.
WHAT DO YOU MEAN
“FREE CHOICE”?
Those who contend that any system of com-
pulsory health insurance — England’s or the one
proposed by Mr. Truman and Mr. Ewing — pro-
vides “free choice” of physician have another
guess coming. There just isn’t free choice
as revealed by the following article published on
Page 1 of the September 17 issue of The Lon-
don (Eng.) Times:
“The Ministry of Health announces that after
October 1 it will no longer be possible for a
patient under the National Health Service auto-
matically to change to another doctor except on
removal to a different address.
“If a patient wishes to change while remain-
ing at the same address, he must either obtain
the consent of his present doctor or send his
medical card to the executive council with a let-
ter telling them of his intention. If he applies
to his executive council, the patient will be
entitled to choose a new doctor normally 14
days after the council have received his letter
and medical card.”
WHAT DO YOU
PROFESS?
John Schoff Millis, Ph. D., LL. D., president of
Western Reserve University, speaking before
the Medical Alumni Association of that Univer-
sity, directed some thought-provoking consider-
ation on the question of what is a profession.
After he had called attention to several defi-
nitions of the word, Dr. Millis concluded: “It
seems to me that the true meaning of the
word ‘profession’ can be obtained only from
the verb from which the word is formed, namely
‘profess.’ I shall therefore change my question
to ‘What do you profess?’ That is, what do
you believe? What is your faith? What do
you hold to be the supreme truth?”
Continuing his discussion, Dr. Millis had this
to say: “We in America accept as demonstrated
that man, unlike any other occupant in the
known universe, has mind, spirit and free will.
The possession of these three attributes, at
least in potential form, so distinguishes man
that he is entitled to special privileges — those
we describe as Life, Liberty and the Pursuit
of Happiness. Because he can understand by
intellectual mastery, because he can appreciate
by spiritual insight, and because he can act
rationally through the operation of his will,
man is the unique part of the universe and
must be provided with unique rights and respon-
sibilities. This is, in my opinion, what you
profess. This is your fundamental belief, this
is your guiding faith which makes the practice
of medicine a true profession.
“If you will accept my definition of your
profession, then certain conclusions about your
practice follow. If your profession is that the
individual man counts, and never men in the
mass, then the practice of medicine must be
built around the individual patient and not around
a collective society. The profession of medicine
must be individualized, not collectivized. If
we believe as I think we do we will reject all
mass plans, all so-called socialized plans. . . .
Though we must reject any plan which concerns
men in the mass, we must be interested in and
sympathetic to the needs of every man.”
What do you profess?
1118
The Ohio State Medical Journal
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RADIOLOGY
A comprehensive review of the physics and higher mathe-
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and doses of radiation therapy, both X-ray and radium,
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of dermatological lesions and tumors susceptible to
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PHYSICAL MEDICINE
Didactic lectures and active clinical application of all
present-day methods of physical therapy in internal
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therapy, light therapy.
For the GENERAL PRACTITIONER
Intensive full time instruction covering those subjects
which are of particular interest to the physician in
general practice. Fundamentals of the various medical
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of established procedures and recent advances in medi-
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giving fundamental instruction in their specialties.
Pathology and radiology are included. The class is ex-
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for November, 1950
1119-
Hospital Approval Program . . .
American Hospital Association Proposes Taking Over a Traditional
Function of the American College of Surgeons; A. M. A. Takes Issue
CHANGE in the method which has been in
operation for many years pertaining to
standardization of hospitals and the ap-
proval of hospital activities will be made in the
near future if action taken by the American
Hospital Association at its recent convention in
Atlantic City is carried out.
The nationwide hospital approval program has
been conducted by the American College of Sur-
geons for the past 25 years. This would be dis-
continued by the College of Surgeons under the
action taken by the hospital association and the
activity would be taken over by the hospital as-
sociation.
Following is an editorial published in the Sep-
tember 30 issue of The Journal of the A. M. A.
reviewing the action of the House of Delegates
of the American Hospital Association and
presenting some pertinent comments on that
action:
* * *
The proposal is said to call for the establish-
ment of a commission which would include 13
hospital trustees, six hospital administrators and
six physicians and surgeons, three to be ap-
pointed by the American College of Surgeons
and three by the American College of Physi-
cians.
This change of procedure in standardizing hos-
pitals has been under consideration by the Ameri-
can College of Surgeons and the American
Hospital Association for several months. The
American Medical Association was not invited
to participate in the early discussions, although
the Association for many years has been in
inspection and approval programs. In fact, it
was quite by accident that an official of the
American Medical Association learned what was
contemplated. Immediately he requested further
consideration, but little progress was made in de-
veloping a satisfactory joint program. There
seemed to be little doubt that at least some
voices in the American Hospital Association
wanted their Association to be “plaintiff, judge
and jury” in any standardization program.
In the September issue of Hospitals appears
a report by John N. Hatfield, then president of
the American Hospital Association. This report
was published before the hospital group met in
Atlantic City. After claiming credit for the
American Hospital Association for various ac-
complishments, Mr. Hatfield presented a plea
for taking over the hospital standardization
program of the American College of Surgeons.
He revealed that November had been discussed
as the date for transfer. The Board of Trustees
of the American Hospital Association on Aug. 5,
1950, adopted the following resolution :
Whereas, The American College of Surgeons, through
its hospital standardization program, has made a most
significant contribution to improving the quality of
hospital care for the American people ; and
Whereas, It is the understanding of the American
Hospital Association that the American College of
Surgeons is withdrawing from the hospital standardiza-
tion field ; and
Whereas, The American Hospital Association believes
that a hospital standardization program is vital to the
continued improvement of hospital care ; and
Whereas, The membership of the American Hospital
Association for many years has expressed interest in
having the American Hospital Association conduct a
hospital standardization program ; and
Whereas, It is traditional in American life that
organized groups shall assume responsibility for
improving quality through standardization of the pro-
grams conducted by the members of such groups ; and
Whereas, The members of hospital governing boards
and the organization which represents them are the
logical group for furthering the improvement of
hospital care through national standardization, now
therefore be it
Resolved, That the American Hospital Association
establish a hospital standardization program ; and be
it further
Resolved, That the American Hospital Association
invite interested organizations of the medical profes-
sion to cooperate in the development of standards re-
lating to the practice of medicine in hospitals ; and
be it further
Resolved, That other professional organizations con-
cerned with the problems of hospital standards be
invited to cooperate with the American Hospital As-
sociation in a hospital standardization program.
When the Board of Trustees of the American
Medical Association learned of the pending ac-
tion of the Hospital Association, it sent a tele-
gram to the hospital convention requesting delay
of action “until the principles involved could be
thoroughly discussed by those most concerned,
namely, the American Medical Association, the
American Hospital Association and the American
College of Surgeons.” Until then no represen-
tative of the American Medical Association had
been invited to discuss the standardization pro-
gram at the Atlantic City convention. After
dispatch of the telegram, Dr. Elmer Henderson,
President of the American Medical Association,
and two members of the Board of Trustees went
to Atlantic City to discuss the problem with of-
ficials of the Hospital Association. In spite of
this, however, the delegates of the American
Hospital Association adopted a resolution au-
thorizing their board of trustees to establish a
standardization program.
For some years groups of medical specialists
have denounced a practice in some hospitals
which results in these physicians’ being em-
1120
The Ohio State Medical Journal
ployed by the hospitals, which in turn submit
bills to the patients for the services rendered by
the specialists. Radiologists, anesthesiologists and
pathologists have been particularly concerned by
the trend. The House of Delegates of the
American Medical Association has given careful
consideration to this growing trend and at the
1950 annual meeting adopted a resolution pro-
testing the practice and urging physicians and
medical societies to recognize their respon-
sibilities and medical ethics.
Now the hospitals apparently want to extend
further their control over medical practices
and superimpose lay judgment on professional
knowledge and ability. By their decision to
authorize the American Hospital Association to
undertake an inspection program for hospitals,
the delegates to the convention of the Hospital
Association indicated an obvious willingness to
encourage further inroads on professional free-
dom.
We hope that the Board of Trustees of the
American Hospital Association will interpret
broadly the directive from the delegates to
establish a standardization program “after con-
sultation with other organizations.” The medical
profession will not allow professional staffs of
hospitals to fall under the complete control and
domination of hospital trustees and administra-
tors. In any hospital each participating group
has certain responsibilities to the hospital, the
patients, the community and to each other.
Physicians have as one of their responsibilities
the welfare of their patients, and they cannot
and will not compromise in this respect. Phy-
sicians know better than lay groups the medical
needs of patients. They are spending their lives
determining these needs and their solution. If
the American Hospital Association proceeds to
usurp the rights of professional groups to deter-
mine the best medical standards, it can expect,
to say the least, some very interesting develop-
ments. One thing is certain: The American
Medical Association will not step quietly aside
if the medical profession is convinced the wel-
fare of its patients is jeopardized. It has under
discussion its own hospital standardization pro-
gram in preparation for such an eventuality.
“The United States is, at present, the place
of choice for the study of venereal disease prob-
lems and control methods, and this should be
borne in mind in directing the training of per-
sonnel for combating venereal disease through-
out the world,” a World Health Organization
report states.
The University of Michigan School of Public
Health, Ann Arbor, is offering its third inservice
training course in waterworks problems on
February 15 and 16, 1951.
proof of performance
shown by
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Medical Association, Sealy’s Orthopedic is now the most
widely used mattress of its type in the world. Since it is
correctly firm it insures proper sleeping posture, gives natural
support and complete comfort, too. For patients bothered
by “low” morning backache, possibly caused by sleeping on
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for November, 1950
1121
Buckeye News Notes . .
Canal Winchester — Dr. Roger M. Gove, super-
intendent of Columbus State School, discussed
the value of mental health at a meeting of or-
ganizations sponsored by the Mental Health
Committee of the Madison Grange.
Cincinnati — Dr. David H. Blankenhorn has
been assigned to a station in Vienna with the
U. S. Army Medical Corps. Dr. Blankenhorn
announced that Mrs. Blankenhorn was sched-
uled to accompany him to Europe.
Cincinnati — The Southwestern Ohio Society of
General Physicians held an all-day seminar at
the Hotel Gibson on October 1. The subject of
the seminar was arthritis and the guest speaker
Dr. Edward F. Rosenberg, of Chicago.
Cincinnati — Dr. K. W. Ascher, assistant profes-
sor of ophthalmology, University of Cincinnati
College of Medicine, gave two courses at the
Annual Meeting of the Academy of Ophthal-
mology, held in Chicago, October 9-13.
Cincinnati — Marion A. Blankenhorn conducted
a three-day medical institute at the Holston
Valley Community Hospital, Kingsport, Tenn.
Cincinnati — Dr. David W. Heusinkveld, Coun-
cilor of the First District of the Ohio State
Medical Association, addressed the Cincinnati
Dental Society on the subject of “Socialized
Medicine.” Dr. L. Howard Schriver, a Past-
President of the Association, also spoke briefly,
denouncing compulsory health insurance pro-
posals.
Cleveland — Dr. F. Mason Sones, formerly of
the Department of Pediatric Cardiology, Henry
Ford Hospital, Detroit, has joined the medical
staff of the Cleveland Clinic. Dr. Sones will
have charge of the cardiac catheterization lab-
oratory.
Lorain — Dr. Oscar B. Markey, Cleveland, was
guest speaker at the annual meeting of the
Lorain County Mental Hygiene Association.
Martins Ferry — Dr. R. H. Wilson was honored
at a banquet sponsored by the Junior Order
of United American Mechanics. Among honors
awarded Dr. Wilson was a certificate of mem-
bership in the International Fellowship of Sur-
geons.
Sparta — Dr. Robert A. Vogel, for the past year
health commissioner for the combined district
comprising Delaware-Union-Madison counties,
now has Morrow County added to his respon-
sibilities. Dr. Frank M. Hartsook of Carding-
ton, recently resigned as Morrow County health
commissioner.
Toledo — Dr. Howard Holmes was honored by
the Toledo Public Health Association with the
presentation of a plaque for his direction of
the tuberculosis clinic and registry at the
Toledo Health Department for the past 10 years.
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1122
The Ohio State Medical Journal
Do You Know? . . .
Dr. Claude S. Perry, Columbus, and Dr.
Charles E. Holzer, Sr., Gallipolis, served on
the 31-member Ohio Governor’s Committee for
National Employ the Physically Handicapped
Week. The committee furnished the leader-
ship for the fifth annual state-wide campaign
conducted early in October.
^ rj?
Among those who took part in the annual
meeting of the Ohio Society for Crippled Chil-
dren in Columbus, October 14-15, were: Dr.
Max T. Schnitker, Toledo, consultant for the
epilepsy project; Dr. Lillian Marks, medical di-
rector of services for crippled children of the
State Department of Public Welfare, Columbus;
and Dr. Ralph W. Holmes, Chillicothe, a direc-
tor of the Society.
❖ ❖ ❖
Dr. Thomas H. Sutherland, Marion, secre-
tary of the Aero Medical Association, has been
instrumental in arranging a conference of rep-
resentatives of Latin American nations interested
in study and research in aviation medicine to
be held in Mexico City next year.
❖ ❖ ❖
The National Heart Institute in its two years
of operation has awarded 167 heart research
fellowships to outstanding students in the medi-
cal and allied fields, Dr. Leonard A. Scheele,
Surgeon General of the Public Health Service ,
announced. Grants to September 30 totaled
$521,702.
* * *
Secretary of Defense George C. Marshall on
October 4 named Ohio’s Dr. Richard L. Meiling,
director of medical services for the Department
of Defense, as chairman of the Department’s
Blood Donor Campaign. Dr. Meiling will act
as liaison with the American National Red Cross,
and will direct and coordinate the program
with the Department of Defense.
^ i*c
Dr. Gordon E. Savage, formerly health com-
missioner for Greene and Fayette Counties
and the City of Xenia, has been named health
officer for the Southwest District of the Ohio
Department of Health with headquarters in
Dayton, Dr. John D. Porterfield, state health di-
rector, announced. Dr. Savage is the first of
five district health commissioners to be ap-
pointed for the newly created Health Districts.
^5 sj:
Dr. Frederick T. Merchant, president-elect of
the Marion County Academy of Medicine, has
been called to active duty, as Assistant Chief,
Surgical Consultant’s Division, Office of the
Surgeon General of the Army, Washington, D. C.
Veterans Administration
Nearly three-fourths of all disabled veterans
on Veterans Administration disability compen-
sation rolls are drawing their monthly checks
because of general medical and surgical dis-
abilities.
This fact was disclosed in a V. A. analysis of
the nearly 2,000,000 disabled veterans on rolls
as of June, 1950.
In addition to the 73 per cent with general
medical disabilities, the analysis revealed an-
other 23 per cent of the veterans with neuropsy-
chiatric conditions and the remaining four per
cent with tuberculosis.
Forty-two per cent of the veterans in the
general medical and surgical category, the study
showed, had disabilities involving joints, muscles
and tendons.
The analysis compared the degree of disability
of veterans of World War II, World War I and
the regular establishment — all of whom are
entitled to compensation for service-connected
disabilities.
About six out of every ten World War II
veterans on the rolls had disabilities rated at
20 per cent or less; five out of ten World War I
veterans were in the 20-per cent-or-under class,
and only four out of ten members of the regular
establishment were in that category.
>;: * *
Veterans of the Spanish-American War, Boxer
Rebellion and Phillipine Insurrection are now
eligible for out-patient medical care without re-
gard to service-connection, the Veterans Admin-
istration announced.
Regulations implementing their right to such
care, based on Public Law 791, 81st Congress.
To be eligible, a veteran must have served some
time between April 21, 1898, and July 4, 1902,
(or July 15, 1903, if the service was in Moro
Province, Philippine Islands), and was dis-
charged other than dishonorably.
An estimated 118,000 veterans have become
potentially eligible for full medical and dental
care in V. A. clinics, or at home by fee basis
physicians and dentists for any illness or dis-
ability.
5^ >):
About 9,000,000 persons were added to the
population at ages 25-64 between 1940 and 1949.
This age group constitutes the main source of
the industrial and agricultural manpower. —
Metropolitan Life.
* Jj: *
The Medical Society of the District of Co-
lumbia recently honored radio’s “Dr. Christian”
(Jean Hersholt) for extolling the best qualities
of the physician and impressing upon the pub-
lic the value of a close relationship between pa-
tient and family doctor.
for November, 1950
1123
PRIMARY
ATYPICAL
VIRUS
PNEUMONIA
CRYSTALLINE
“Prompt fall in temperature occurred in every patient within thirty-
six hours after the first dose of terramycin, and in no case was there
a febrile relapse.”
" ... . ... . . . ;
■ ■ . -
“Demonstrable clinical improvement was usually evident within a
• - ' -i .
M., and Kneeland , Y.:J. A. M. A. 14-3:1303 (Aug. 12) 1950
1124
The Ohio State Medical Journal
| ■ 1 1 g m •> — - * - ~ ■ - -v " pww * — -
Wi9W~SWM Vffwwl
imycin therapy was considered excellent in
were no cases in which treatment failed.”
every case.
■JS '' <\ /
Melcher, G. W.; Gibson, C. D. ; Rose, H. M. , and
Knee land, Y.:J. A. M. A. 143:1303 (Aug. 12) 1950.
Dosage: On the basis of findings obtained in over 150 leading medical
research centers, 2 Gm. daily by mouth in divided doses q. 6 h.
100 mg. capsules, bottles of 25 and 100;
50 mg. capsules, bottles of 25 and 100.
1IYDK O CHLORIDE
Terramycin may be highly effective
even when other antibiotics fail.1
Terramycin may be well tolerated
even when other antibiotics are not.2
1. Blake, F. G. ; Friou, G.J., and Wagner, R. R.; Yale J. Biol, and Med. 22:495 (July) 1950.
2. Herr ell, W. E.; Heilman, F. R. ; Wellman, W. E. .and Bartholomew, L. A.: Proc. Staff Meet.
Mayo Clin. 25:183 (Apr. 12) 1950.
2HAS. PFIZER & CO., INC., Brooklyn 6, N.Y.
for November, 1950
1125
In Memoriam
• • •
Willard P. Bowser, M. D., Berea; Western Re-
serve University School of Medicine, 1918; aged
55; died September 23; former member of the
Ohio State Medical Association and the Ameri-
can Medical Association through 1948. Dr.
Bowser had been a practicing physician in Berea
since 1919. He was on the staffs of Community
Hospital, Berea, and St. John’s and Deaconness
Hospitals in Cleveland. In addition to his medi-
cal practice, he was active in the Kiwanis Club
and had been named “Citizen of the Year”
by that body. Surviving are his widow, a daugh-
ter and a son.
Arthur C. J. Brickel, M. D., Cleveland; Western
Reserve University School of Medicine, 1921;
aged 54; died September 10; member of the
Ohio State Medical Association and a Fellow
of the American Medical Association. Dr.
Brickel had been practicing in Cleveland since
the completion of his medical education. He
was a member of the senior staff of Charity
Hospital and a clinical instructor at Western
Reserve. Writings included the medical text,
“Surgical Treatment of Hand and Forearm In-
fection.” He was a member of the Catholic
Church and the Catholic Physicians Guild. Sur-
viving are his widow, four sons and a daughter.
John W. Cogswell, M. D., Strasburg; State
University of Iowa College of Homeopathic
Medicine, 1906; aged 67; died September 9;
member of the Ohio State Medical Association
and the American Medical Association. Dr.
Cogswell resided in Strasburg about five years.
He formerly practiced in Newcomerstown and
Somerset. During World War I, he served in
the Army Medical Corps as a major. Surviving
are his widow and a daughter; also a brother,
Dr. Charles Cogswell, of California.
Samuel H. Davidow, M. D., Youngstown; Jef-
ferson Medical College of Philadelphia, 1920;
aged 54; died October 6; member of the Ohio
State Medical Association and the American
Medical Association. Dr. Davidow had practiced
in Youngstown for the past 30 years. He was
a member of Rodef Sholem Temple, Squaw
Creek Country Club, B’nai B’rith and Phi
Lambda Kappa. Surviving are his widow, two
daughters, his mother, two sisters and a brother,
Dr. Sidney L. Davidow, also of Youngstown.
Henry E. Fledderjohnn, M. D., New Knoxville;
University of Pennsylvania School of Medicine,
1886; aged 94; died October 2; former member
of the Ohio State Medical Asociation and the
American Medical Association through 1933. Dr.
Fledderjohnn retired from active practice in
1940 after completing 52 years in the same
community. However, he returned to practice
during World War II. Recently he was awarded
the 50-Year Pin and Certificate of the Ohio State
Medical Association. He was active in the
Evangelical-Reformed Church. Surviving are
two daughters, a son, and two brothers, one of
whom is Dr. F. F. Fledderjohnn of New Bremen.
Harry E. Hunt, M. D., Westerville; Cleveland-
Pulte Medical College, 1899; aged 78; died on
or about October 1; former member of the Ohio
State Medical Association and the American
Medical Association through 1938. Dr. Hunt
had practiced for many years in Westerville,
but recently had been residing at the Ohio
Soldiers’ and Sailors’ Home in Sandusky. He
was a veteran of the Spanish- American War.
He retired from practice because of illness in
1939.
Edgar M. Latham, M. D., Toledo; Toledo Medi-
cal College, 1900; aged 82; died September 28;
formerly a member of the Ohio State Medical
Association and the American Medical Associa-
tion through 1925. Dr. Latham began his prac-
tice in Holland (Ohio) in 1900 and moved to
Toledo 15 years later. Surviving are his widow,
a daughter and a brother.
John F. Lindsay, M. D., Youngstown; Western
Reserve University School of Medicine, 1902;
aged 73; died October 11; former member
of the Ohio State Medical Association and the
American Medical Association through 1936. Dr.
Lindsay established his practice in Salineville
and continued there until 1910 when he moved
to Youngstown. He retired because of ill health
in 1936. He was a member of the Presbyterian
Church and several Masonic orders. Surviving
are his widow; two sons, one of whom is Dr.
John F. Lindsay, Jr., of Cleveland; and two
brothers, one of whom is Dr. Samuel C. Lindsay,
of Cleveland; also a sister.
Robert F. Linn, M. D., Lakewood; Stritch
School of Medicine of Loyola University, Chicago,
1938; aged 40; died September 26; member of
the Ohio State Medical Association and the
American Medical Association; member of the
American College of Surgeons; diplomate of the
American Board of Obstetrics and Gynecology.
Dr. Linn began practice in 1938 in Cleveland,
where he was on the permanent staff of Lutheran
Hospital and on the consulting staff of City
Hospital. He served in the Medical Corps
during World War II. He was a member of
the Cleveland Society of Obstetricians and
Gynecologists and was affiliated with the Masonic
Lodge. Surviving are his widow and his step-
mother.
John W. McCreery, M. D., Akron; Vanderbilt
University School of Medicine, 1894; aged 80;
1 126
The Ohio State Medical Journal
died September 27 ; former member of the
Ohio State Medical Association and the Ameri-
can Medical Association through 1924. Dr. Mc-
Creery practiced in Akron from 1918 until
1926 when he retired. One brother survives.
Adonis H. Nihiser, M. D., Vaughnsville; Ohio
State University College of Medicine, 1929; aged
53; died September 20; member of the Ohio
State Medical Association and a Fellow of the
American Medical Association; secretary of the
Putnam County Medical Society in 1946, and its
president in 1947 and 1948. Dr. Nihiser had
practiced in Vaughnsville for about 20 years.
Surviving are his widow, a brother, a half-brother
and five sisters.
Elmer Samuel Oman, M. D., Columbus; Ohio
Medical University, Columbus, 1898; aged 82;
died September 13; former member of the Ohio
State Medical Association and the American
Medical Association through 1924. Dr. Oman
had practiced in Columbus for 52 years although
he was in semi-retirement for several years. He
was a member of the Methodist Church. Two
sons survive.
Jerry C. Price, M. D., Beverly Hills, Calif;
Tulane University of Louisiana School of Medi-
cine, 1928; aged 46; died September 24; Fellow
of the American Medical Association; member of
the Association for the Study of Internal Secre-
tions. Dr. Price formerly was head of the
Tiffin State Hospital and also consultant for
the Ohio Society for Crippled Children on the
epilepsy project.
Charles H. Rether, M. D., Columbus; Hahne-
mann Medical College and Hospital of Phila-
delphia, 1899; aged 84; died September 29.
Dr. Rether served virtually all of his practice
in Columbus. Surviving are two sons and four
daughters.
Charles Peter Sullivan, M. D., Dayton; North-
western University Medical School, Chicago,
1912; aged 63; died September 24; member of
the Ohio State Medical Association and a Fel-
low of the American Medical Association. Dr.
Sullivan had practiced for about 30 years in
Dayton, going there after service during World
War I in the Medical Corps. He was a member
of the Catholic Church and the Catholic Phy-
sicians Guild. Surviving are his widow, one
son and three sisters.
Walter W. Tilock, M. D., Lorain; Eclectic Medi-
cal College, Cincinnati, 1926; aged 55; died
October 14; member of the Ohio State Medical
Association and the American Medical Associa-
tion. Dr. Titlock had practiced for about 23
years in Lorain. He was a member of the
American Legion, having served during World
War I. He was a trustee of the Bethany Col-
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for November, 1950
1127
lege, Bethany, W. Va., was a member of the
Christian Temple, the Kiwanis Club and Beta
Theta Phi. Surviving are his widow, a son and
two sisters.
Clarence M. Valentine, M. D., Columbus; Ohio
State University College of Medicine, 1908; aged
67; died October 1; member of the Ohio State
Medical Association and a Fellow of the Ameri-
can Medical Association. Dr. Valentine prac-
ticed continuously in Columbus beginning in
1910 with the exception of time spent in the
Medical Corps during World War I. He was
a past-commander of the local American Legion
Post, was a member of the Methodist Church,
several Masonic Orders and the Order of the
Eastern Star. Surviving are his widow, a
daughter, a son, a brother and a sister.
David Rowland Williams, M. D., Girard; Co-
lumbus Medical School, 1891; aged 87; died
October 15; member of the Ohio State Medical
Association and the American Medical Associa-
tion; delegate of the Trumbull County Medical
Society in 1918. Dr. Williams had practiced
for approximately 58 years in Girard and re-
cently was honored by the Trumbull County
Medical Society by being presented the 50-Year
Pin and Certificate of the Ohio State Medical
Association. He had served for 30 years as the
Girard health officer and had served 27 years
on the Girard School Board. He was an elder
emeritus in the Presbyterian Church and was
past-president of the Girard Kiwanis Club. Two
daughters survive.
American Speech, Hearing, Association
To Meet in Columbus
The American Speech and Hearing Associa-
tion will meet in Columbus at the Deshler-
Wallick Hotel, November 9-11. Numerous na-
tionally recognized otologists and educators in
the speech and hearing defect field will discuss
current problems of interest to the profession.
Among authorities who will be heard are
Drs. Hallowell Davis, Edmund P. Fowler, Jr.,
Aram Glorig and Norman Canfield, as well as
outstanding educators in the field of hearing and
speech pathology. All physicians are invited to
attend.
The Columbus Eye, Ear, Nose and Throat So-
ciety has invited outstanding representatives to
address them at a dinner meeting to be held
Thursday, November 9, at 6 p. m., at the Uni-
versity Club, 40 South Third Street. All
otologists and educators are invited to attend.
Reservations at $3.50 per person must be made
by November 6 to Dr. John M. Lowery, Secre-
tary, 74 South Fifth Street, Columbus 15.
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1128
The Ohio State Medical Journal
Dr. Haden Named Medical Director of
National Red Cross Blood Program
Dr. Russell Landram Haden, medical educator
and recently head of the Department of Medi-
cine at the Cleveland Clinic, has been appointed
medical director of the Red Cross National
Blood Program, General
George C. Marshall, the
organization’s president
announced.
Dr. Haden will direct
the medical aspects of
the blood program as
it is expanded to provide
blood, plasma and other
derivatives for the na-
tion’s hospitals and for
military and civil de-
fense needs. He will
work with Dr. Ross T.
Mclntire, chairman of
the blood program’s committee on medical
policies and procedures. This committee of lead-
ing surgeons and hematologists is supervising
the planning and development of Red Cross blood
collection centers and the coordination of the
country’s private and institutional blood banks
in carrying out the responsibilities assigned
Red Cross by the military and defense author-
ities.
R. L. HADEN, M. D.
A native of Virginia, Dr. Haden graduated
from Johns Hopkins Medical School. Following
a residency at Johns Hopkins Hospital he be-
came Director of Laboratories in the Henry
Ford Hospital, Detroit. For a number of years
he was professor of experimental medicine at
the University of Kansas. He has been as-
sociated with the Cleveland Clinic since 1930.
Holder of a gold medal award from the
Radiological Society of America, Dr. Haden is
author of Clinical Laboratoi'y Methods and Prin-
ciples of Hematology and is a contributor to
numerous medical journals. He is a Fellow of
the American College of Physicians and a mem-
ber of the American Society of Clinical Investi-
gation and other professional organizations.
The Red Cross national blood progam is now
operating 35 regional blood collection centers
and is in process of adding seven more to the
network. Civil Defense centers for the pro-
curement of blood to meet the demands of
defense preparedness are also being established
in a number of metropolitan areas.
Dr. Haden succeeds Dr. Louis K. Diamond,
Boston Hematologist and a member of the
Harvard Medical School Faculty, who resigned
to return to his duties at Harvard and at Chil-
dren’s Hospital where he is director of the blood
bank and research laboratory.
MODERN
THERAPEUTIC FACILITIES
for Your
Arthritic Patients
At Battle Creek, much can be accomplished for
your arthritic patients. Complete X-ray and
other diagnostic facilities assure rapid and ac-
curate appraisal of the nature and extent of the
affliction. Thereafter, the indicated means of
drug or physical therapy can be instituted for
maximum therapeutic benefit.
Of particular value in the care of the arthritic
patient are the unusually complete facilities for
diathermy, heliotherapy, balneotherapy, and
massage. Indeed, this department at Battle
Creek is one of the finest in the country, not only
in equipment but also in personnel.
Battle Creek Sanitarium has been offering its
outstanding services continuously for 85 years;
John Harvey Kellogg, M.D., served as its super-
intendent from 1876 to 1943.
Wire or call collect for complete information
on availability of accommodations.
THE BATTLE CREEK SANITARIUM
BATTLE CREEK, MICHIGAN
for November, 1950
1129
Activities of County Societies . . .
First District
(COUNCILOR: D. W. HEUSINKVELD, M. D.,
CINCINNATI)
HAMILTON
The Annual Meeting of the Academy of Medi-
cine of Cincinnati was held on Sept. 19. Guest
speaker was Dr. Warren Hi. Cole, professor of
surgery, University of Illinois College of Medi-
cine, whose subject was, “Socialized Medicine;
It’s Implications and Prevention.”
Addresses were given by Dr. J. Stewart
Mathews, the retiring president, and Dr. Frank
H. Mayfield, incoming president. Installation
of new officers was a feature of the meeting.
At the Oct. 3 meeting, Dr. Barnes Woodhall,
professor of neurological surgery, Duke Uni-
versity Medical School, spoke on “Neurosurgical
Aspects of Acute Subarachnoid Hemorrhage.”
On Oct. 17 in a joint meeting with the Cancer
Council, Dr. J. A. del Regato, director of the
Penrose Cancer Hospital, Colorado Springs, spoke
on “The Present Status of the Treatment of
Cancer of the Cervix.”
Scheduled features of meetings for November
and December are:
Nov. 14 — Dr. DeWitt Stetten, Jr., Division of
Nutrition and Physiology of the Public Health
Research Institute of New York, “Fat and Car-
bohydrate Stores in Experimental Diabetes”;
joint meeting with the Diabetes Council.
Nov. 28 — Dr. Brian B. Blades, professor of
surgery, George Washington University School
of Medicine, “The Practical Application of Recent
Advances in Thoracic Surgery.”
Dec. 5 — Dr. Arthur C. Corcoran, Cleveland
Clinic Foundation, “Functional Patterns in Rena]
Disease: Clinical and Therapeutic Correlations.”
Second District
(COUNCILOR: M. D. PRUGH, M. D., DAYTON)
CLARK
The opening fall meeting of the Clark County
Medical Society was held at the Ker-Deen Inn
on Sept. 18 with dinner. Speaker for the oc-
casion was Dr. Max D. Graves, Springfield, whose
subject was “Psychiatric Therapy.”
DARKE
Dr. Samuel E. Flook and Dr. Nathaniel R.
Hollister, of Dayton, were guest speakers at
the Oct. 17 meeting of the Darke County Medi-
cal Society in Greenville. The subject of dis-
cussion was “Low Back Pain from the Orthopedic
and Neurological Standpoints.”
GREENE
Dr. Hans G. Schulumberger, Department of
Pathology, Ohio State University, was guest
speaker at the Oct. 12 meeting of the Greene
County Medical Society in Xenia. His subject
was, “Bone Producing Lesions Found in the
Scalp, Skull and Brain with Discussion on the
Comparative Pathology and Embryogenesis.”
MIAMI
Dr. John T. Quirk, Piqua, presented a paper
on the subject, “Paroxysmal Tachycardia (Ven-
tricular),” illustrated with lantern slides, at the
Oct. 6 meeting of the Miami County Medical
Society. The meeting was held at the Nurses’
Home of Piqua Memorial Hospital, with dinner
following. A complete report of the legislative
program of the Ohio State Medical Association
was presented by Dr. Hugh Wellmeier, legislative
committee chairman.
Third District
(COUNCILOR: FRED P. BERLIN, M. D., LIMA)
SENECA
Dr. R. F. Machamer, Tiffin, led a discussion
on the aspects of socialized medicine at a meet-
ing of the Seneca County Medical Society in
Tiffin on Sept. 19.
AUGLAIZE
At the Sept. 22 meeting of the Auglaize
County Medical Society, members went on record
to participate in the National Blood Program.
THEAnn Arbor School
For Children with Educational ,
Emotional or Speech Problems
Boys and girls are enrolled in a year round
program designed to provide opportunities
for optimal educational and emotional growth.
Excellent teaching staff. A training center in
Special Education for student teachers at the
University of Michigan.
For information and catalog, address the
Rpgistrar. 1700 Broadway. Ann Arbor. Mich.
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The Ohio State Medical Journal
The following1 committee was appointed to act
for the Society in the irrogram: Dr.. W. F.
Schmiesing, chairman,- Dr. Michael Rabe, Dr.
Elizabeth Y. Kuffner, Dr. Guy E. Noble, Dr.
Alfred W. Veit and Dr. Clyde W. Berry. Dr.
David W. Nielson, Waynesfield, was admitted
as a member at the meeting.
Fourth District
(COUNCILOR: CARLL S. MUNDY, M. D.. TOLEDO)
PUTNAM
Dr. Charles W. Bird, Continental, was honored
at the Oct. 3 meeting of the Putnam County
Medical Society by being presented the Fifty-
Year Pin and Certificate of the Ohio State
Medical Society. The presentation was made
by Dr. Fred P. Berlin, Lima, recently named
Councilor of the Third District of the Ohio
State Medical Association. The meeting was
held at Wittenberg’s Restaurant in Columbus
Grove. — H. N. Trumbull, M. D., Correspondent.
Fifth District
(COUNCILOR: CHARLES L. HUDSON, M. D.,
CLEVELAND)
CUYAHOGA
The program of the Cleveland Academy of
Medicine for October contained the following
features:
Pediatric Section, Oct. 4 — “Significance of the
Electro-Encephalogram in the Newborn,” Dr.
James G. Hughes, Memphis, Tenn.
Experimental Medicine Section of Academy
and Cleveland Section of the Society for Experi-
mental Biology and Medicine, Oct. 13 — “Effect
of Cortisone on Acute Streptococcal Tonsilitis,”
presented by a team representing the Streptococ-
cal Disease Laboratory, Warren Air Base,
Wyoming, and the Department of Preventive
Medicine, Western Reserve University.
“Concentration of the Intrinsic Factor Activity
of Desiccated Stomach,” W. H. Prusoff, Ph. D.;
Dr. G. C. Meacham, Dr. R. W. Heinle, and Dr.
A. D. Welch, Departments of Pharmacology and
Medicine, Western Reserve.
“Studies with Mutant Organism on the Mechan-
ism of Sulfonamide Inhibition,” J. 0. Lampen,
Ph. D., Department of Microbiology, Western
Reserve.
“Propanediol and Its Possible Relationship to
Acetone Metabolism,” Harry Rudney, Depart-
ment of Biochemistry.
Industrial Medicine and Orthopedic Section,
Oct. 18 — “Low Back Pain,” a discussion by the
following panel: Dr. James A. Dickson, moder-
ator, Dr. Walter A. Engel, Dr. William A.
Nosik, Dr. Rudolph S. Reich, Dr. Marvin W.
Evans and Dr. Harry Sherman.
Obstetrical and Gynecological Section, Oct. 24
CHAS. F. BOWEN, M. D.
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H. M. BRUNDAGE, M.D., Director
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Prompt Service
Telephone: MAin 2490
for November, 1950
1131
— “Clinical Diagnosis of Uterine Cancer,” Dr.
James W. Regan.
Regular Academy Meeting, Oct. 20 — “A Sym-
posium on Uterine Bleeding,” Moderator, Dr. R. L.
Faulkner; panel speakers — Dr. James W. Regan,
“Use of Cytologic Technic in Investigation of
Uterine Bleeding”; Dr. William McK. Jeffries,
“Some Hormonal Aspects of Functional Uterine
Bleeding”; Dr. Allan C. Barnes, Columbus, “Ab-
normal Uterine Bleeding on an Organic Basis.”
LAKE
Dr. John E. Williams of Cleveland addressed
the Lake County Medical Society at Lake
County Memorial Hospital on the subject, “Of-
fice Urology.” Dr. Paul Reading, Painesville,
president, presided at the meeting and Dr.
Morris G. Carmody, Painesville, gave a report
on the importance of all doctors voting in the
November general election. There was a good
attendance at this interesting session of the So-
ciety on September 12.
Dr. Herbert Clapp, spoke at the Oct. 10 meet-
ing of the Society on “Treatment of Sterility.”
Dr. C. B. Elliott, speaking for the legislative
committee, reported on views of state and local
candidates seeking election on Nov. 7, especially
in regard to medical and health matters.
Seventh District
(COUNCILOR: R. J. FOSTER, M. D., NEW
PHILADELPHIA)
BELMONT
“Diseases of the Skin” was the topic of a
discussion by Dr. John E. Rauschkolb, Cleveland,
at the Sept. 21 meeting of the Belmont County
Medical Society at the Bellaire City Hospital.
Eighth District
(COUNCILOR: CHESTER' P. SWETT, M. D„ LANCASTER)
GUERNSEY
The regular meeting of the Guernsey County
Medical Society was held on Sept. 21 with a
noon luncheon at the Berwick Hotel, with 13
members present and Dr. Reo Swan, Cambridge,
president, in the chair.
The secretary brought to the attention of mem-
bers recent communications from the Ohio State
and American Medical Associations, and was
instructed by the president to fill out and
return the blank, “Information on Component
Medical Society Activities,” as requested by
the A. M. A.
The group voted to cancel the Oct. 5 meeting
so that members could attend the Eighth Dis-
trict meeting in Newark.
Dr. Howard F. Van Noate spoke of the many
useless details and various aggravations connected
with the filing and collecting of fee bills for
With the Aid of Our
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SURGERY — Intensive Course in Surgical Technic,
two weeks, starting Nov. 27, Jan. 22. Surgical
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four weeks, starting Nov. 6, Feb. 5. Surgical
Anatomy & Clinical Surgery, two weeks, starting
Nov. 20, Feb. 19. Surgery of Colon & Rectum, one
week, starting Nov. 27. Gall-Bladder Surgery, ten
hours, starting April 23.
GYNECOLOGY — Intensive Course, two weeks, start-
ing Feb. 19. Vaginal Approach to Pelvic Surgery,
one week, starting March 5.
OBSTETRICS — Intensive Course, two weeks, starting
March 5.
RADIATION PHYSICS — Intensive Review Course,
four days, starting Nov. 29.
ROENTGENOLOGY — Diagnostic & Lecture Course
First Monday of every month. Clinical Course
Third Monday of every month. X-Ray Therapy
every two weeks.
DERMATOLOGY — Informal Clinical Course every
two weeks.
CYSTOSCOPY — Ten Day Practical Course every two
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PEDIATRICS — Informal Clinical Course every two
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General, Intensive and Special Courses in all
Branches of Medicine, Surgery and the Specialties
TEACHING FACULTY — ATTENDING
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J
1132
The Ohio State Medical journal
Aid-to-the Aged cases. This was followed by re-
marks by Drs. Reo Swan, Knapp, Wells and
George Swan regarding the manner in which they
handle this situation. All seemed to agree that
there is no simple and easy solution to this situa-
tion. Dr. George Swan also mentioned that in
cases where the $200 annual emergency fund
is inadequate, physicians must look to the
County Commissioners for the balance due.
The scientific part of the program was in
charge of Dr. Elizabeth Smith, Guernsey County
health commissioner. Dr. Smith outlined the
many functions of a public health department
and called attention to the many ways in which
she is prepared to assist physicians in public
health matters. Her talk was well received by
all members — Gordon Lawyer, M. D., Secy.-Treas.
WASHINGTON
Initial fall meeting of the Washington County
Medical Society was held at Hotel Wakefield,
Marietta, on Sept. 13. Dr. Kenneth E. Bennett,
who assumed office as president when Dr. Clar-
ence E. Ash, of Beverly, moved to Columbus in
June, presided. (Dr. Ash is now in residency
training at University Hospital.)
Mr. W. G. Ebert, who recently became di-
rector of Marietta Memorial Hospital, was in-
troduced to Society members.
The president appointed a Committee on Civil-
ian Defense consisting of the following: Drs.
E. W. Hill, C. A. S. Williams and W. D. Turner.
The following new members were voted into
the Society: Dr. Victor C. Whitacre, Beverly;
and Dr. Larry Gale, Newport.
The educational program consisted of two
films, “Streptomycin Drugs in the Treatment
of Tuberculosis,” and “Malnutrition in the Hos-
pital Patient.” — William R. Stewart, M. D.,
Secy.-Treas.
Tenth District
(COUNCILOR: H. M. CLODFELTER, M. D., COLUMBUS)
FAYETTE
Physicians pledged 100 per cent cooperation
with the Red Cross in its program at a meeting
of the Fayette County Medical Society on
Sept. 12 at the new Fayette County Memorial
Hospital. Under plans outlined by Dr. A. D.
Woodmansee, medical advisory chairman for
Fayette County, physicians agreed to be on
duty when the bloodmobile visited the county.
They agreed to work approximately one hour
each at the center. The Society also made a
public appeal through the press for donors.
FRANKLIN
The motion picture “Medical Aspects of Atomic
Energy” was shown at the Sept. 11 meeting of
the Columbus Academy of Medicine. The film
was produced by the Armed Forces Institute
of Pathology.
757 W. Washington St., Charleston 2, W. Va.
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541 W. Town Street, Columbus 8, Ohio
Wherever the Hanger Wearer may live
or travel, he can feel assured that his
Hanger Artificial Limb will be properly serviced
at the nearest Hanger office.
One or more offices in every section — North,
East, South, and West — render hanger Wearers
the same high quality service. Conveniently
located in many key cities, each offers complete
repair facilities and carries a full line of Hanger
Standard parts and supplies.
Thus the Hanger Wearer is caused a minimum of
inconvenience and discomfort. Long waits for
shipments from distant factories are eliminated.
Traveling representatives cover many areas sur-
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COLUMBUS Office: R. G. Woehr, Rep.,
2800 Indianola Ave., Tel. Lawndale 6200
iiSSl
for November, 1950
1133
The Academy had as guest speaker at its
Oct. 16 meeting, Dr. I. S. Ravdin, the John Rhea
Barton professor of surgery, University of Penn-
sylvania, director of the Harrison Department
of Medical Research, and surgeon-in-chief at the
Hospital of the University. His subject was
“Biliary Tract Disease.”
Eleventh District
(COUNCILOR: JOHN S. HATTERY, M. D., MANSFIELD)
LORAIN
The regular monthly meeting of the Lorain
County Medical Society was held at the Pueblo,
Lorain, on Oct. 10 with dinner. After a business
session, Dr. Frank L. Meaney, Cleveland, ad-
dressed the group on the subject, “Plastic Sur-
gery.”
Woman’s Auxiliary . . .
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
President — Mrs. George W. Cooperrider, 1828 Bryden Road,
Columbus
President-Elect — Mrs. Farrell Gallagher, 1527 W. Clifton
Blvd., Lakewood
Vice-President— Mrs. E. P. Greenawalt, 1707 St. Paris Road,
Springfield
Recording - Secretary — Mrs. Ross Knoble, 219 - 44th St.,
Sandusky
Corresponding Secretary — Mrs. Oscar Jepsen, Canal Win-
chester
Treasurer — Mrs. A. Paul Hancuff, 3551 Maxwell Road,
Toledo 13
Past-President — Mrs. C. W. Kirkland, 4805 Guernsey Street,
Bellaire
The annual conference of county presidents
and presidents-elect with state board members
was held on Friday, September 22, at the Fort
Hayes Hotel in Columbus. State chairmen at
that time gave an outline of their programs and
took part in an open discussion. The morn-
ing meeting was presided over by Mrs. George
W. Cooperrider, state president. At the lunch-
eon, honored guests included State Senator Ros-
coe Walcutt, Columbus, member of the Ohio
Senate, Dr. H. M. Clodfelter, Columbus, Coun-
cilor of the Tenth District, and Dr. Merrill D.
Prugh, Dayton, Councilor of the Second Dis-
trict of the Ohio State Medical Association.
Senator Walcutt addressed the group following
the luncheon on “The Business of the Other
Fellow.” The afternoon session of the pro-
gram was presided over by Mrs. Farrell Gal-
lagher, state president-elect, at which local
county reports were given and an informal
question and answer period was held. The fall
meeting of the Board of Directors was held
the preceding afternoon and evening at the
Fort Hayes Hotel.
AUGLAIZE
The Woman’s Auxiliary to the Auglaize
County Medical Society met on Sept. 20 at the
W. H. MILLER, ]
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328 East State Street
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The Ohio State Medical Journal
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home of Mrs. R. H. Schaefers in Wapakoneta.
Announcements of coming state and district
meetings were made. The year’s program was
reviewed by the president. As this was the
first business meeting since the state conven-
tion in Cleveland, Mrs. E. F. Heffner gave a
report on the convention. The evening’s pro-
gram featured a review by Mrs. T. H. Will of
the article, “Radioactive Iodine,” as published in
Today's Health. A new member, Mrs. David
Nielson, was welcomed into the group.
CLARK
The Clark County Auxiliary launched its
year’s activities when it met on Sept. 18 for a
business session and tea at the home of Mrs.
J. H. Shanklin. Mrs. E. W. Schilke, president,
presided at the business meeting at which year-
books were distributed and committees named.
Mrs. E. R. Brubaker, nurse scholarship loan
chairman, reported on the third year student the
Auxiliary is assisting at the Springfield City
Hospital School of Nursing. She announced
that a first year student at Mercy Hospital and
a second year student nurse at City Hospital
would be aided this year with scholarship loans.
Mrs. Paul Schanher gave a report for the legis-
lation committee and explained the doctors’ draft
bill which has just been passed. Mrs. H. C. Mes-
senger, director of District 2, was a guest at
the meeting and spoke briefly. The afternoon’s
program was a talk on “Hobbies” by Mrs.
Ronald Pedrick who gave a demonstration of
enamel painting of flowers on paper and textiles
and told the group of many other uses of this
medium. Mrs. Pedrick was introduced by Mrs.
C. T. Doeing, program chairman.
Mrs. T. M. Hayes was chairman of the hos-
pitality committee which arranged the tea fol-
lowing the program. Five new members were
introduced by Mrs. D. J. Parsons, membership
chairman: Mrs. Clyde Asbury, Mrs. Frederick
Bavendam, Mrs. H. L. Guyselman, Mrs. W. E.
Leeper, Mrs. R. A. McLemore.
FAIRFIELD
Doctor-husbands of the Auxiliary to the Fair-
field County Medical Society were entertained
at a dinner on Sept. 28 by the Auxiliary group.
Early autumn garden flowers and trailing ivy
decorated the dinner tables. Mrs. Chester Swett,
president, gave the address of welcome. Dr.
F. W. James and Dr. Leo Stenger presented
some outstanding films of their European trip.
Hostesses for the evening were Mrs. James,
Mrs. William Jasper, and Mrs. Stenger.
FRANKLIN
A resolution of sympathy was extended to
the family of the late Cora Helen Baxter, wife
of Dr. Earl H. Baxter, by the Woman’s Auxiliary
to the Columbus Academy of Medicine. Mrs.
Baxter “was a member of numerous civic groups,
and was given leadership responsibilities in all
of them,” the resolution states. “These were
carried o^ut by her with the greatest care and
precision. Whatever she undertook, she did well.
She was an extremely able executive . . .” Mrs.
Baxter was a charter member of the Auxiliary
and served as its president in 1946-47.
GREENE
The aims and responsibilities of organized
auxiliaries to county medical societies were out-
lined by Mrs. George W. Cooperrider, state
president, at a luncheon meeting of the Greene
County Auxiliary held at Trebein Manor on
Sept. 27. The speaker emphasized the benefits
to be derived by the local community when such
a group of organized women are working
closely together.
The luncheon marked the first fall meeting of
the Greene County Auxiliary and was preceded
by a reception honoring Mrs. Cooperrider. Mrs.
W. T. Ungard, Mrs. L. W. Sontag, and Mrs.
Donald F. Kyle, served as hostesses. Mrs
Cooperrider was introduced by Mrs. Paul D.
Espey, president of the county auxiliary. Year-
books were distributed at the business session.
Committees were announced, and chairmen
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Catalogue on Request
G. H. MARQUARDT, M. D.
Medical Director
BARCLAY J. MacGREGOR
Registrar
29 Geneva Rd., Wheaton, Illinois (near Chicago)
for November, 1950
1135
presented reports, the state president serving
as adviser.
HURON
The Woman’s Auxiliary to the Huron County
Medical Society met for luncheon at the Norwalk
Country Club on Sept. 8. At the business
session following the luncheon, reports from
committee chairmen were given and Mrs. A. H.
Kimmel, state chairman for Today's Health and
the Bulletin, discussed important information
relating to those two publications. The Aux-
iliary voted that, instead of sending flowers in
the event of death in the immediate family of
a member, each Auxiliary member be assessed
a nominal sum to be paid into the nurses’
scholarship fund, and that a sympathy card be
sent to the bereaved family, stating that a con-
tribution has been made to that fund in memory
of the deceased.
KNOX
%
Mrs. C. E. Cassaday, president, presided at
the flrst meeting of the season of the Knox
County Auxiliary held at the home of Mrs.
Raymond Lord on Sept. 27. It was voted to
establish a nurse’s scholarship fund to be given
to a girl graduate of a high school in Knox
County in June, who wishes to enter nurses’
training. An arrangement of fall flowers cen-
tered the table at which refreshments were
served by Mrs. Lord and her assistant hostesses,
Mrs. Conard and Mrs. Delbert Schmidt.
LAWRENCE
The Woman’s Auxiliary to Lawrence County
Medical Society held its first meeting of the
year at the home of Mrs. George Hunter. Mrs.
W. W. Lynd was the assisting hostess at a
covered dish luncheon which was held outdoors.
There was a business meeting following the
luncheon, conducted by Mrs. G. N. Spears, presi-
dent. Getting-acquainted games conducted by
Mrs. Vallee Blagg featured the afternoon’s en-
tertainment. A new member, Mrs. Harry Nenni,
was welcomed into the group.
MONTGOMERY
A luncheon meeting at Suttmiller on Sept. 12
with 89 members present featured the first fall
get-together of the Woman’s Auxiliary to the
Montgomery County Medical Society. The proj-
ect committee reported that a number of mem-
bers have been assisting at the Draft Board on
a volunteer service status. Members of an-
other group are taking turns in the trans-
portation of a crippled child to Barney Com-
munity Center for treatment. Mr. John Martin
was the afternoon’s guest speaker. The mate-
rial for his talk, “British Socialism — America’s
Number One Lesson,” was gathered from first
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THE RUPP & BOWMAN COMPANY
315-319 Superior Street
TOLEDO 3, OHIO
RESTHAVEN
A strictly modern convalescent hospital, specially
designed and scientifically equipped for the spe-
cialized care of the aged, convalescent, or cancer
patient.
Accredited by American Medical Association.
Complete cooperation to the attending physician.
For descriptive folder, call or write
M. YOUNG, Business Manager
Telephone FA. 2535 or FA. 4893
813 Bryden Road Columbus, Ohio
1136
The Ohio State Medical Journal
hand study as Mr. Martin saw it in action last
summer in England. The speaker, a born
Englishman, had returned to his native land
for an extended visit. Mr. Martin, speech di-
rector at the Oakwood High School for the
past 18 years, has delivered his talk before some
45 organizations.
RICHLAND
The September meeting of the Richland County
Auxiliary was held at * the Woman’s Club.
Luncheon was served to the 33 members in at-
tendance. Mrs. S. M. Wadsworth, Mrs. J. L.
Clark and Mrs. Robert Garber were the hostesses.
The business meeting following the luncheon
was presided over by Mrs. H. G. Knierim, presi-
dent, who gave a report on the national conven-
tion in San Francisco. The luncheon meeting in
October was held at Shelby Inn. Hostesses for
the afternoon were Mrs. Edward Dowds, Mrs.
Elmer Jackson, Mrs. Charles Butner and Mrs.
B. L. Hannam. The president, Mrs. Knierim,
conducted the business meeting.
STARK
A membership tea was held on Sept. 12 by the
Stark County Auxiliary at the home of Mrs.
Ian B. Hamilton, chairman of the membership
committee. The year’s program was discussed
and detailed explanations given to the 19 new
members. Stark County’s total membership is
now 225. A board meeting preceded the mem-
bership tea. The president announced with
deep regret the recent death of one of the
Stark County Auxiliary members, Mrs. Harry
Gauchot.
The meeting on Oct. 10 was held at the
Alliance Woman’s Club. The afternoon’s fea-
ture was a book review by Mrs. Guy E. Byers,
a member of the Columbiana Auxiliary. The
Stark County Auxiliary has 9 student nurses in
training.
SUMMIT
Bast-presidents of the Woman’s Auxiliary to
the Summit County Medical Society were
hostesses at a tea on Sept. 19 honoring new mem-
bers into the group. Mrs. Norman E. Wentsler
was chairman of the hostesses, with these past-
presidents assisting her: Mrs. S. B. Conger,
Mrs. J. D. Brumbaugh, Mrs. P. A. Davis, Mrs.
D. M. McDonald, Mrs. C. F. Wharton, Mrs. D.
M. Traul, Mrs. R. M. Lemmon, Mrs. J. Paul
Sauvageot, Mrs. Frank McDonald. Mrs. Edwin
W. Cauffield now heads the Summit County
Group.
TRUMBULL
The Trumbull County Medical Society and its
Woman’s Auxiliary held a joint dinner meeting
on Wednesday, Sept. 20, at the Warner Hotel.
The guest speaker for the evening was Dr.
Samuel Spector, associate professor at Western
Reserve Medical School. The business meeting
of the Auxiliary, held later, was presided over
by Mrs. Allen W. Beale, president. An emergency
trust fund for needy student nurses was set up
with Mrs. M. T. Knappenberger, Mrs. D. R.
Mathie and Mrs. John MacKay serving on the
special committee.
SIXTH DISTRICT
The Trumbull County Auxiliary was hostess
on Sept. 29 for the Sixth District luncheon meet-
ing held at the Warner Hotel. Auxiliary presi-
dents from Mahoning, Summit and Stark Counties
were present as were representatives from each
of the groups. The three visiting presidents
were Mrs. William Evans, Mrs. Edwin Cauffield
and Mrs. George Wilcoxon. Following the
luncheon, Mrs. A. W. Beale, president of the
local group, welcomed the guests and introduced
the guest speaker, Norma Adams, who gave an
interesting and informative talk on the “West-
ern Reserve Territory and Pioneers of Medi-
cine.” Miss Olive Harmon, daughter and grand-
daughter of pioneer doctors in Warren was an
honored guest. Mrs. Farrell Gallagher, state
president-elect, talked on the purposes and aims
of the Auxiliary. Mrs. Robert Lemmon of
Akron, sixth district director, presided at the
meeting and conducted a period of general dis-
cussion with questions and answers in which all
counties participated.
ELEVENTH DISTRICT
Dr. Fred W. Dixon of Cleveland, President-
Elect of the Ohio State Medical Association, de-
signated the members of the Woman’s Auxiliary
as “public relations experts” of the medical
profession. Dr. Dixon was the principal speaker
at the Eleventh District meeting held in Sep-
tember at the Elyria Country Club. Dr. Dixon
pointed out that good public relations are neces-
sary to physicians for many reasons and espe-
cially at this time because of the agitation for
socialized medicine. He urged that the doc-
tors’ wives become informed so that they are
able to explain intelligently the reasons for the
actions of the medical profession. Approximately
85 women from Huron, Erie, Richland and
Lorain counties met for the luncheon district
meeting. The Lorain County Auxiliary, Mrs.
D. A. Russell, president, served as the hostess
group.
Dr. John S. Hattery, Mansfield, Councilor of
the Eleventh District of the Ohio State Medical
Association, was presented as the man who in-
troduced the resolution originating the Woman’s
Auxiliary in Ohio, back in 1939. He traced the
background of the medical profession through
its various phases to the present day. Mrs.
Farrell Gallagher, state president-elect, spoke
on “The Why of the Auxiliary.” Mrs. George
Cooperrider, state president, reported on the
national convention in San Francisco and pointed
for November, 1950
1137
out that the goal of the National Auxiliary is
that every doctor's wife be an Auxiliary member.
Mrs. C. E. Swanbeck, director of District 11,
presided. She presented the presidents of the
four County Auxiliaries: Mrs. E. J. Meckstroth
of Erie County; Mrs. William Kauffman, Huron;
Mrs. H. G. Knierim, Richland; and Mrs. Rus-
sell, Lorain. Each gave a short report of the
work in her county. Special music which fol-
lowed the luncheon was provided by two young
pianists. The welcome address was given by
Dr. S. ©. Nielson, president of the Lorain County
Medical Society. The program closed with a
round table discussion led by Mrs. Swanbeck.
Opinions of the Attorney General
The syllabus of Opinion No. 2328, recently
rendered by Attorney General Herbert S.
Duffy is as follows: “Persons suffering from
tuberculosis and in need of care and medical
treatment, but not in need of hospital care and
treatment, and not living in a tuberculosis sani-
tarium or hospital, are entitled to poor relief
providing they have acquired legal settlement in
one of the counties of the district."
The syllabus of Opinion No. 2329 is as follows:
“(1) A nurse is not authorized to exercise the
office of acting health commissioner in a gen-
eral health district. (2) A district board of
health is authorized to appoint a public health
nurse without the recommendation of a health
commissioner for such district in a situation
where the office of health commissioner is vacant."
The syllabus of Opinion No. 2041 is as follows:
“1. A district advisory council may fill a
vacancy in the board of health of a general
health district only at its annual meeting.
“2. Meetings of the district advisory council
which are held subsequent to the annual meeting
of said council are special meetings rather than
continuations of the annual meeting."
COMING MEETINGS
Ohio State Medical Association, Annual Meet-
ing, Netherland Plaza, Cincinnati, April 24-26,
1951.
A. M. A. Clinical Session, Cleveland, December
5-8.
Radiological Society of North America, 36th
Annual Meeting, Palmer House, Chicago, Decem-
ber 10-15.
American Academy of Dermatology and Syph-
ilology. Annual Meeting, Chicago, December 2-7.
INDEX TO ADVERTISERS
Abbott Laboratories 1043
American Meat Institute 1042
Ames Company, Inc. - 1052
Ann Arbor School, The 1130
Ayerst, McKenna & Harrison, Ltd. 1107
Baker Laboratories, Inc. 1058
Battle Creek Sanitarium, The 1129
Birtcher Corporation, The J 1128
Borden Company 1057
Bowen, Charles F., M. D. — 1131
Camel Cigarettes 1050
Cincinnati Sanitarium 1047
Clinical and Pathological Laboratory 1131
Columbus Orthopaedic Appliance Co. - 1132
Cook County Graduate School of Medicine 1132
Cordelia of Hollywood 1103
Davies, Rose & Co., Ltd. 1056
Fleet, C. G., Company, Inc. 1041
Hanger, J. E., Inc 1133
Harding Sanitarium 1048
Holland Rantos Co J 1059
Ingleside Home, Inc. 1127
Lederle Laboratories, Inc. 1039
Lilly, Eli, and Company Insert between 1060
and 1061
Luzier’s, Inc 1105
McMillen Sanitarium 1047
Mead Johnson & Company Back Cover
Medical-Dental Management 1122
Medical Protective Company 1133
Mercer Sanitarium, The 1048
Merck & Company, Inc 1109
Miller, W. H., M. D 1134
M & R Dietetic Laboratories, Inc. 1060
Nestle’s Company, Inc. 1119
New York Polyclinic Medical School 1119
Num Specialty Company 1139
Oak Ridge Sanatorium 1046
Parke, Davis & Company 1140
and Inside Back Cover
Pfizer, Charles & Co., Inc 1124 and 1125
Philip Morris & Company 1055
Picker X-Ray Corp. 1053
Pogue, The Mary E., School 1135
Quincy X-Ray & Radium Laboratories 1139
Radium Emanation Corporation 1117
Resthaven 1136
Rexair Division, Martin-Parry Corp 1115
Rupp & Bowman Company 1136
Sandoz Pharmaceuticals, Inc. 1117
Sawyer Sanatorium J 1037
Schering Corporation 1051
Sealy Mattress Company 1121
Searle, G. D., & Company 1101
Squibb, E. R., & Sons 1054
Stoneman Press 1115
U. S. Vitamin Corporation Insert Between
Pages 1068 and 1069
Wendt-Bristol Company H34
Wickhaven Sanitarium. 1048
Windsor Hospital 1048
Winthrop-Stearns, Inc. 1113
Wyeth, Inc. - 1049
Zemmer Company 1139
1138
The Ohio State Medical Journal
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STATE ASSOCIATION OFFICERS AND COMMITTEEMEN
E. O. Swartz, President Fred W. Dixon, President-Elect
604 Doctors Bldg.. Cincinnati 2 1027 Rose Bldg., Cleveland 15
H. P. Worstell, Treasurer
41 S. Grant Ave., Columbus 15
Mr. Charles S. Nelson, Executive Secretary
Carl A. Dincke, Past-President
159 Second St., Carrollton
Mr. George H. Saville, Asst. Exec. Secy.
DEPARTMENT OF PUBLIC RELATIONS
Mr. George H. Saville, Director Mr. Hart F. Page, Asst. Director
Headquarters Office, 79 East State Street, Columbus 15. Telephone MA. 7715
THE COUNCIL
First District, D. W. Heusinkveld, 2700 Union Central Bldg., Cincinnati 2 : Second District, M. D. Prugh, 910
Fidelity Bldg., Dayton 2 ; Third District, Fred P. Berlin, 405 Cook Tower, Lima ; Fourth District, Carll S. Mundy,
125 Fifteenth St., Toledo 2 ; Fifth District, Charles L. Hudson, 2102 Abington Rd., Cleveland 6 ; Sixth District, Paul A. Davis,
1436 Delia Ave., Akron 2 ; Seventh District, R. J. Foster. 131 Fair, N.E.. New Philadelphia ; Eighth District, Chester P.
Swett, 132 E. Main St., Lancaster; Ninth District, J. P. McAfee, 1130 23rd St., Portsmouth; Tenth District, H. M. Clod-
felter, 40 S. Third St., Columbus 15 ; Eleventh District, John S. Hattery, 802 Farmers Bank Bldg., Mansfield.
COMMITTEES AND DELEGATES
Committee on Education — Carl A. Wilzbach, Cincinnati,
Chairman (1952) ; J. Edwin Purdy, Canton (1951) ; J. L.
Webb, Nelsonville (1955) ; Thomas E. Rardin, Columbus
(1954) ; Charles S. Higley, Cleveland (1963).
Judicial and Professional Relations Committee — John
A. Caldwell, Cincinnati, Chairman (1954) ; E. J. Wenaas,
Youngstown, (1951) ; Neil Millikan, Hamilton, (1955) ;
J. E. Tuckerman, Cleveland, (1953) ; Charles W. Pavey,
Columbus, (1952).
Committee on Public Relations and Economics — Herbert
B. Wright, Cleveland, Chairman, (1953) ; Horace B. David-
son, Columbus, (1951) ; John A. Fraser, East Liverpool,
(1955) ; George A. Woodhouse, Pleasant Hill, (1952) ;
Frederick P. Osgood, Toledo, (1954) ; the President, the
President-Elect, and the Past-President, Ex Officio.
Committee on Scientific Work — Martin W. Diethelm,
Toledo, Chairman (1951) ; Louis G. Herrmann, Cincinnati,
(1952) ; Robert M. Zollinger, Columbus, (1955) ; A. Carlton
Ernstene, Cleveland, (1954) ; Frank W. Anzinger, Springfield,
(1953).
Committee on Cancer — C. E. Hufford, Toledo, Chairman ;
John H. Lazzari, Cleveland ; Carl A. Wilzbach, Cincinnati ;
L. A. Pomeroy, Cleveland ; Robert M. Zollinger, Columbus ;
Robert T. Allison, Jr., Akron ; Edgar P. McNamee. Cleve-
land ; W. D. Nusbaum, Lancaster ; Walter Reese, Middletown.
Committee on Chronic Illness — Harry V. Paryzek, Cleve-
land, Chairman ; Frank A. Riebel, Columbus ; Joseph I.
Goodman, Cleveland Heights ; W. B. Lacock, Columbus ;
Stanley D. Simon, Cincinnati ; Herman J. Nimitz, Cincinnati ;
Jonathan Forman, Columbus; John L. Stifel, Toledo; Floyd
W. Craig, Coshocton ; Nelson D. Morris, Toledo ; H. W.
Brettell, Steubenville.
Committee on Industrial Health and Workmen’s Compen-
sation— H. P. Worstell, Columbus, Chairman ; Wm. F.
Ashe, Gallipolis ; Joseph Lindner, Cincinnati ; Robt. A.
Kehoe, Cincinnati; Louis N. Jentgen, Columbus; John M.
Van Dyke, Canton; James N. Wychgel, Cleveland; Warren
A. Baird, Toledo ; A. L. Bershon, Toledo ; Donald E.
Yochem, Columbus ; Rex H. Wilson, Akron ; Harold James,
Dayton.
Subcommittee on Legislation — George A. Woodhouse,
Pleasant Hill, Chairman ; Frank Mayfield, Cincinnati ;
William M. Skipp, Youngstown; Floyd M. Elliott, Ada; D. J.
Slosser, Defiance; Jay W. Calhoon, Uhrichsville ; James B.
Johnson, Jr., Newark ; Clyde M. Fitch, Portsmouth ; Donald
F. Bowers, Columbus ; George F. Linn, Norwalk ; Wm.
Garver, Cleveland.
Committee on Medical Service Plans — Robert C. Rothen-
berg, Cincinnati, Chairman ; Wm. M. Skipp, Youngstown ;
Jonathan Forman, Columbus ; R. K. Finley, Dayton ; Robert
E. S. Young, Columbus ; Carll S. Mundy, Toledo ; Robert
Allison, Akron ; Azel Ames, Jr., Hamilton ; Edmond
Yantes, Wilmington ; Carl A. Lincke, Carrollton ; R. J.
Whitacre, East Cleveland.
Committee on Mental Hygiene — Dwight M. Palmer, _ Co-
lumbus, Chairman ; Neil T. McDermott, Cleveland ; Louis J.
.Karnosh, Cleveland ; Maurice Levine, Cincinnati ; Howard
Fabing, Cincinnati ; R. E. Pinkerton, Akron ; O. M. Law-
ton, Youngstown ; J. L. Sagebiel, Dayton, Elmer Haynes,
Toledo.
Committee on National Emergency Medical Service-^C. C.
Sherburne, Columbus, and Robert Conard, Wilmington,
Co-Chairmen : Military Advisory Committee — Robert Conard,
Wilmington, Chairman; David A. Tucker, Jr., Cincinnati;
Homer D. Cassel, Dayton ; Lester C. Thomas, Lima ; A. A.
Brindley, Toledo ; Donald M. Glover, Cleveland R. L. Rut-
ledge, Alliance; Albert E. Winston, Steubenville; Walter
L. Cruise, Zanesville ; Carter L. Pitcher, Portsmouth ; E. L.
Montgomery, Circleville ; Charles R. Keller, Mansfield :
Committee on Civil Defense — C. C. Sherburne, Columbus,
Chairman ; Cyrus R. Wood, Port Clinton ; Carl R. Damron,
Mansfield ; Robert M. Zollinger, Columbus ; Harry R. Hus-
ton, Dayton ; W. O. Ramey, Cincinnati ; Morris G. Carmody,
Painesville ; E. A. Ockuly, Toledo; Claude S. Perry, Colum-
bus ; Drew L. Davies, Columbus ; Robert E. Tschantz,
Canton ; Maurice M. Kane, Greenville ; Fred Berlin, Lima ;
William J. Graf, Cincinnati; George Sackett, Cleveland;
Herbert B. Wright, Cleveland.
Committee on Rural Health — J. Martin Byers, Greenfield,
Chairman; Carl S. Mundy, Toledo; Jonathan Forman,
Columbus ; W. B. Recker, Leipsic ; E. G. Caskey, Mineral
Ridge; James M. Snider, Marysville; H. T. Pease, Wads-
worth ; A. D. Harvey, Lebanon ; L. E. Anderson, Green-
town ; H. R. Mayberry, Bryan ; Edmond K. Yantes, Wil-
mington ; F. M. Hartsook, Cardington ; Carl Goll, Hope-
dale ; Kenneth Taylor, Pickerington.
Committee on School Health — Thomas E. Shaffer, Colum-
bus, Chairman ; Carl A. Wilzbach, Cincinnati ; J. W. Wilce,
Columbus ; C. W. Wyckoff, Cleveland ; Charles T. Atkinson,
Middletown ; L. A. Hamilton, Athens ; T. L. Light, Dayton ;
R. E. Shell, Van Wert; John F. Miller, Newark; Margaret
O'Neal, Zanesville ; F. A. Halloran, Springfield ; H. B.
Thomas, Gallipolis; Russell C. Bane, Chillicothe ; J. M.
Painter, Kent ; Charles F. Good, Cleveland.
Delegates to American Medical Association — Edgar P. Mc-
Namee, Cleveland ; Herbert B. Wright, Cleveland, alternate.
Carl A. Lincke, Carrollton ; H. M. Platter, Columbus, alter-
nate. George A. Woodhouse, Pleasant Hill ; R. S. Binkley,
Dayton, alternate. William M. Skipp, Youngstown ; C. E
Hufford, Toledo, alternate. Frank M. Wiseley, Findlay;
Fred P. Berlin, Lima, alternate. L. Howard Schriver,
Cincinnati ; E. O. Swartz, Cincinnati, alternate. C. C. Sher-
burne. Columbus ; Richard L. Meiling, Columbus, alternate.
A. A. Brindley, Toledo ; H. W. Lehrer, Sandusky, alternate.
1142
for December, 1950
1143
COUNTY SOCIETIES’ OFFICERS AND MEETING DATES
FIRST DISTRICT
ADAMS — S. E. Gendelman, President, Manchester ; H. L.
Sproull, Secretary, West Union. 3rd Wednesday, April,
June, August, October, December.
BROWN — Wm. L. Faul, Jr., President, Georgetown ; Geo.
P. Tyler, Jr., Secretary, Ripley. 4 th Wednesday in
February, May and November.
BUTLER — Louis Skimming, President, Middletown; John
Carter, Secretary, Middletown. 4th Wednesday monthly.
CLERMONT — A. A. Gruber, President, Bethel ; J. M. Cole-
man, Secretary, Loveland. 3rd Wednesday, monthly.
CLINTON — R. H. Vance, President, Wilmington ; R. R.
Buchanan, Secretary, Wilmington. 1st Tuesday, monthly.
HAMILTON— J. S. Mathews, President, Wyoming; H. R.
Mendelsohn, Secretary, Cincinnati. lBt and 3rd Tues.,
monthly, except June. July, August.
HIGHLANI>— John G. Anderson, President, Lynchburg ; Rob-
ert G. Claeys, Secretary, Lynchburg. 1st Wednesday,
monthly.
WARREN — Frank Batsche, President, Mason; John DeBold,
Secretary, Morrow. 1st Tuesday, monthly.
SECOND DISTRICT
CHAMPAIGN — Lewis Inskeep, President, Urbana ; F. R.
Grogan, Secretary, Urbana. 2nd Wednesday, monthly.
CLARK — H. H. Ingling, President, Springfield ; W. K. Leh-
mann, Secretary, Springfield. 1st Thurs. and 3rd Mon.
DARKE! — Paul G. Lenhert, President, Arcanum ; Maurice
Kane, Secretary, Greenville. 3rd Tuesday, monthly
GREENE!— Ray W. Barry, President, Xenia ; Robert D.
Hendrickson, Secretary, Xenia. 1st Thursday, monthly.
MIAMI — W. W. Trostel, President, Piqua ; G. A. Wood-
house, Secretary, Pleasant Hill. 1st Friday, monthly, ex-
cept July, August.
MONTGOMERY— H. D. Cassel, President, Dayton ; Paul
Troup, Secretary, Dayton. 1st Friday, monthly, except
July, August and September.
PREBLE — A. L. Ross, President, West Alexandria ; B. R.
Smith, Secretary, Lewisburg. No regular meeting date.
SHELBY — R. L. Wiessinger, President, Sidney: John Ker-
rigan, Secretary, Sidney. Last Friday of the month.
THIRD DISTRICT
ALLEN — H. L. Basinger, President, Lima, (deceased) ; R.
L. Johnson, Secretary, Lima. 3rd Tuesday, monthly.
AUGLAIZE — Elizabeth Kuffner, President, St. Marys ; W.
F. Schmiesing, Secretary, Minster. 3rd Thurs., monthly.
CRAWFORD— D. D. Bibler, President, Bucyrus ; Donald R.
Wenner, Secretary, Bucyrus. 3rd Friday, monthly.
HANCOCK — H. K. Treece, President, Arlington ; Grant
Janes, Secretary, Findlay. 2nd Tues., monthly.
HARDIN — C. L. Johnson, President, Kenton ; Elizabeth
Brungard, Secretary, Kenton. 3rd Thursday, monthly.
LOGAN — C. K. Startzman, President, Bellefontaine ; F.
Blair Webster, Secretary, Bellefontaine. 1st Fri., monthly.
MARION — Robert T. Gray, President, Prospect; Wm. B.
Leffler, Secretary, Marion. 2nd Tuesday, monthly.
MERCER — R. G. Schmidt, President, Celina ; John Chrispin,
Secretary, Rockford. 2nd Thursday or Tuesday, monthly.
SENECA — W. R. Funderburg, President, Tiffin; W. A.
Daniel, Secretary, Tiffin. 2nd Tuesday, monthly.
VAN WERT — Roy E. Shell, President, Van Wert; T. L.
Edwards, Secretary, Van Wert. 1st Tuesday, monthly.
WYANDOT — F. M. Smith, President, Sycamore; R. T.
Murphy, Secretary, Carey. Last Friday.
FOURTH DISTRICT
DEFIANCE — Harold J. Weneinger, President, Defiance;
Francis M. Lenhart, Secretary, Defiance. 2nd Tuesday,
monthly.
FULTON — Ralph W. Reynolds, President, Fayette; Paul 1.
Geer, Secretary, Metamora. 2nd Tuesday, monthly.
HENRY — Thomas Quinn, President, Napoleon ; John
Schlereth, Secretary, Napoleon. 2nd Tuesday, monthly.
LUCAS — E. A. Ockuly, President, Toledo ; H. C. Gunderson,
Secretary, Toledo. 3rd Tuesday, monthly.
OTTAWA — H. O. Beeman, President, Port Clinton; James
I. Rhiel, Secretary, Port Clinton. 2nd Thursday, monthly.
PAULDING — K. C. Evans, President, Payne ; J. M. Poitras,
Secretary, Antwerp. 3rd Wednesday, monthly.
PUTNAM — M. W. Palestrant, President, Continental ; C.
J. Heitz, Secretary, Fort Jennings. 1st Tuesday, monthy.
SANDUSKY — H. L. Keiser, President, Fremont; E. L. Koons,
Secretary, Fremont. 3rd Wednesday, monthly.
WILLIAMS — P. G. Meckstroth, President, Bryan ; I. L.
Colvin, Secretary. Edon. 4th Thursday, monthly.
WOOD — R. N. Whitehead, President, Bowling Green ; Roger
A. Peatee, Secretary, Bowling Green. 3rd Thursday.
FIFTH DISTRICT
ASHTABULA — C. T. Risley, President, Conneaut ; R. C.
Irving, Secretary, Conneaut. 2nd Tuesday, monthly.
CUYAHOGA — Charles S. Higley, President, Cleveland ;
John D. Osmond, Jr., Secretary, Cleveland. 3rd Friday,
monthly, September through May.
GEAUGA — W. C. Cory, President, Chardon ; Isa Teed
Cramton, Secretary, Burton. Last Thursday of month.
Anril to December.
LAKE — Paul E. Reading, President, Painesville ; R. Keith
Miles, Secretary, Madison. 2nd Tuesday, monthly.
SIXTH DISTRICT
COLUMBIANA — R. J. Starbuck, President, Salem ; H. F.
Hoprich, Secretary, Salem. 3rd Tuesday, monthly.
MAHONING^ — Gordon G. Nelson, President, Youngstown ;
G. E. DeCicco, Secretary, Youngstown. 10th of each month.
PORTAGE— Myron Thomas, President, Garrettsville ; Edgar
A. Knowlton, Secretary, Mantua. 1st Thursday, monthly.
STARK — Ian B. Hamilton, President, Canton ; J. L.
Yahraus, Secretary, Canton. 2nd Thursday, Sept, thru
May.
SUMMIT — John D. Brumbaugh, President, Akron ; Donald
I. Minnig, Secretary, Akron. 1st Tuesday, Sept, thru
June.
TRUMBULL— E. G. Caskey, President, Mineral Ridge ; C. W.
Mathias, Secretary, Niles. 3rd Wednesday, monthly.
SEVENTH DISTRICT
BELMONT — H. H. Murphy, President, Barnesville ; Bertha
M. Joseph, Secretary, Martins Ferry. 3rd Thurs., monthly.
CARROLL — John H. Murray, President, Carrollton ; Chas.
H. Dowell, Secretary, Carrollton. 1st Thursday, monthly.
COSHOCTON — Geo. D. Mogil, President, Coshocton ; H. W.
Lear, Secretary, Coshocton. 2nd Tuesday, monthly.
HARRISON — D. L. Tippett, President, Cadiz ; Richard W.
Weiser, Secretary, Jewett. 2nd Wednesday, monthly.
JEFFERSON — S. L. Burkhardt, President, Steubenville ;
Sanford Press, Secretary, Steubenville. 3rd Tuesday.
MONROE — A. R. Burkhart, Secretary, Woodsfield. 2nd
Wednesday, monthly.
TUSCARAWAS— Wm. E. Hudson, President, New Phila-
delphia ; H. F. Wherley, Secretary, New Philadelphia.
2nd Thursday, monthly.
EIGHTH DISTRICT
ATHENS — M. H. Mitchell, President, Albany ; C. R. Hos-
kins, Secretary, Athens. 2nd Tuesday, monthly.
FAIRFIELD — W. D. Nusbaum, President, Lancaster; Arthur
B. Van Gundy, Secretary, Lancaster. 2nd Tuesday, monthly.
GUERNSEY — Reo Swan, President, Cambridge; F. G.
Lawyer, Secretary, Cambridge. 1st and 3rd Thursday.
LICKING!- — James B. Johnson, President, Newark ; R. G.
Mannino, Secretary, Newark. Last Tuesday, monthly.
MORGAN — C. E. Northrup, President, McConnelsville ; Galen
Rex, Secretary, McConnelsville. 3rd Tuesday, monthly.
MUSKINGUM — J. E. McCormick, President, Zanesville; W.
W. Renner, Secretary, Zanesville. 1st Wed., monthly.
NOBLE — Charles F. Thompson, President, Caldwell; E. G.
Ditch, Secretary, Caldwell. 1st Tuesday, monthly.
PERRY — Wm. D. Porterfield, President, Junction City; H.
F. Minshull, Secretary, New Lexington. 3rd Thursday.
WASHINGTON— K. E. Bennett, President, Marietta; Wm.
R. Stewart, Secretary, Marietta. 2nd Wednesday.
NINTH DISTRICT
GALLIA — Homer B. Thomas, President, Gallipolis ; J. Gor-
don Gibert, Secretary, Gallipolis. Last Thursday, monthly.
HOCKING — J. Ward Doering, President, Logan; Owen F.
Yaw. Secretary, Logan. 3rd Wednesday, monthly.
JACKSON — David S. Mack, President, Jackson ; Alvis R. Ham-
brick, Secretary, Wellston. 1st Thursday, monthly.
LAWRENCE — Anne-Marting Alstott, President, Ironton ; G.
N. Spears, Secretary, Ironton. 4th Tuesday, monthly.
MEIGS — J. J. Davis, President, Middleport ; Wm. H. Jeric,
Secretary, Pomeroy. 3rd Thursday, monthly.
PIKE — C. L. Critchfield, President, Waverly; Albert M.
Shrader, Secretary, Waverly. 1st Tuesday, monthly.
SCIOTO — L. B. Hatch, President, South Webster ; C. L.
Pitcher, Secretary, Portsmouth. 2nd Monday, monthly.
VINTON— R. E. Bullock, President, McArthur ; H. D. Cham-
berlain, Secretary, McArthur. No regular meeting date.
TENTH DISTRICT
DELAWARE — B. R. Lauer, President, Delaware; F. M.
Stratton, Secretary, Delaware. 3rd Tuesday, monthly.
FAYETTE- — Joseph M. Herbert, President, Washington
C. H. ; N. M. Reiff, Secretary, Washington C. H. 1st
Friday.
FRANKLIN — Grant O. Graves, President, Columbus ; Oscar
W. Jepsen, Secretary, Canal Winchester. 1st and 3rd
Mondays, monthly.
KNOX — Robert Hoecker, President, Mt. Vernon; C. E. Cas-
saday. Secretary, Mt. Vernon. 3rd Thursday, monthly.
MADISON — G. C. Scheetz, President, West Jefferson ; W.
T. Bacon, Secretary, London. Last Wednesday, monthly.
MORROW — L. W. Murphy, President, Cardington ; F. W.
Kubbs, Secretary, Mt. Gilead. 4th Tuesday, monthly
PICKAWAY — Lloyd Jonnes, President, Circleville; W. F.
Heine, Secretary, Circleville. 1st Friday.
ROSS — E. H. Artman, President, Chillicothe ; R. L. Counts,
Secretary, Chillicothe. 1st Thursday, monthly.
UNION — J. M. Snider, President, Marysville ; Malcolm Mac-
Ivor, Secretary, Marysville. 2nd Tuesday, monthly.
ELEVENTH DISTRICT
ASHLAND — G. D. Fridline, President, Ashland; H. J.
Marley, Secretary, Ashland. 1st Friday, monthly.
ERIE — C. J. Reichenbach, President, Sandusky ; A. G. Gros-
cost. Secretary, Sandusky. 4th Thursday, monthly.
HOLMES — Luther High, President, Millersburg ; Owen
Patterson, Secretary, Millersburg. 1st Wednesday, monthly.
HURON — C. J. Cranston, President, Wakeman ; G. F. Linn,
Secretary, Norwalk. 2nd Wed., March, June, Sept., Dec.
LORAIN — S. D. Nielsen, President, Elyria ; L. H. Trufant,
Secretary, Oberlin. 2nd Tuesday, monthly.
MEDINA — Louis S. Zwick, President, Wadsworth ; H. F.
Cowgill, Secretary, Wadsworth. 3rd Thursday, monthly.
RICHLAND— R. D. Campbell, President. Mansfield; C. O.
Butner, Secretary, Shiloh. 3rd Thursday, monthly.
WAYNE — John B. Beeson, President, Wooster; R. C. Paul,
Secretary, Wooster. 2nd Wednesday, monthly.
' * Stick - to -i t-i veness
is
fine —
for
everyone
else . . .
"but take me— I just can’t stick to my diet .
I can’t resist desserts . Oh, dear, this diet is getting me down!”
If she thinks it's getting her down what's it doing to physicians who have
to listen to such explanations every day? This is especially true for the doc-
tor who hasn't prescribed Efroxine Hydrochloride.
Efroxine makes it easier for most patients to reduce by depressing the appetite
and elevating the mood. Efroxine offers a number of advantages over other
sympathomimetic amines.
...It has a more rapid and longer-lasting effect with smaller dosage.
...It has little pressor effect in the recommended dosage range. This advan-
tage is particularly valuable in the treatment of obesity.
... It is more likely to produce cerebral stimulation with relatively few side
effects.
Efroxine Hydrochloride Tablets and Elixir
Maltbie Brando! Methamphetamine Hydrochloride
Maltbie Laboratories, Inc.
Newark 1, New Jersey
for December, 1950
1147
^JUe PUudiciaet'l QaoJziitell
By Jonathan Forman, M.D.
Textbook of Endocrinology, edited by Robert
H. Williams, M. D. ($10.00. W. B. Saunders
Company, Philadelphia, Pa.), presents the
knowledge gained in recent years about the
manner in which these hormones influence bodily
functions now that we have them in form.
The book is made of still greater worth to you
and me in that it takes up the way in which
these glands play a part — often a critical role
— in heart failure, hypertension, geriatrics,
gerontology, immunology, hematology, and the
treatment of tumors and collagen diseases. The
collaborators are the men who have maintained
intimate contact with the progress of both basic
and clinical investigations.
•
The Causation and Treatment of Delayed Union
in Fractures of the Long Bone, by Kenneth W.
Starr. ($9.00. Butterworth & Co. (Pubrs.)
Ltd., London, England. — The C. V. Mosby Co.,
St. Louis, Mo.) is the Jacksonian Prize Essay of
the Royal College of Surgeons of England. The
essay is divided into three parts: 1. The mor-
phogenesis of bone; 2. The healing of frac-
tures; 3. Delayed Union. This is a book for
the library of the hospital and for the bone
surgeon. Certainly the resident staff of the hos-
pital should read as they work up their bone
cases.
The 1949 Yearbook of Endocrinology, Meta-
bolism and Nutrition, edited by Willard O.
Thompson, M. D., and Tom D. Spies, M. D.
($4.75. The Yearbook Publishers, Chicago, III ),
is the fourth of these annual reviews which many
of us have come to depend upon to gather in-
formation for us. Significant as were the de-
velopments in our knowledge of the ovary and
testis, they have been overshadowed by the ob-
servations on Compound E, ACTH, and radio-
active iodine. Those of us of the advance guard
of those interested in soil-health relations are
more than delighted with Tom Spies’ review
of nutrition, for he begins thus: “Because the
earth’s nutrients are being depleted, mankind
from a nutritional standpoint is forced to live
unwisely. Soil erosion, floods, and improper use
of land are cutting down on man’s capacity to
produce food. ... For decades the production
of food and raw materials has been speeded up
at the expense of soil fertility, yet maintenance
of soil fertility is necessary for a long-continued
system of agriculture.” You will be interested
in the annotation and collection of literature
bearing on the problem of aging. The great
problem for old people is how to replenish their
cells.
Public Opinion and Propaganda, by Frederick
C. Irion, ($5.00. Thomas Y. Crowell Co., Nev:
York City), who is the assistant professor of
government in the University of New Mexico.
His position as assistant director of government
research has also led him to make a study of this
business of shaping public opinion. The book
is an attempt to present an objective description
and analysis of the forces that operate within
the framework of our culture to mold and
change our opinion. Judging the book by the
two things which I know something about in
this field — communistic activities, and our own
program against socialism of all sorts — I can
say that the author has done a fair and objective
presentation. He has, of course, covered all
of the subjects now receiving such treatment by
government officers of information, or by public
relations officers of all the other groups that
are bent on influencing people and making
friends.
The Merck Manual, ($5.00. Eighth Edition.
Merck & Co., Inc., Rahway, N. J.), contains
1,600 pages, 338 chapters on diagnosis and treat-
ment containing 1775 prescriptions. There are
new chapters on routine immunization, bedside
procedures, office laboratory tests, and a list of
items for the physician’s bag; an outline of
preoperative and postoperative care, a section
on diets, and the usual conversion tables, —
making this handy sized volume the best of the
desk reference books. It is the work of five
experienced physicians assisted by 100 nationally
known physicians as consultants. No wonder
that the first printing of 75,000 copies was ex-
hausted by advance orders.
Psychiatric Sections in General Hospitals, by
Paul Haun, M. D., Sc. D., ($4.00. Architectural
Record, 199 West 40th St., New York 18, N. Y.)
As Karl A. Menninger, M. D., says in his intro-
duction, “It is too seldom reflected upon that
the architects of today determine the procedures
and practices of tomorrow; and in turn they
must depend upon physicians who can look
ahead on the basis of today’s experience.” Cer-
tainly he is right when he points out that our
modern hospitals have been built around the
operating room to the neglect of the non-surgical
patient. This book attempts to meet all of
the objectives for the mental case. There are
eight detailed plans for the floors for a psy-
chiatric section of a general hospital and six
floor plans for incorporating a psychiatric floor
in a general hospital. A working bibliography
of 35 references is also incorporated. All who
1 148
The Ohio State Medical lournal
have anything to do with planning a hospital
will want to read this book.
Peace I Give Unto You, by Marie Winchell
Walker, M. D., ($2.50. Willing Publishing Co.,
P. O. Box 51, San Gabriel, California) , attempts,
and quite successfully, to integrate modern psy-
chology and practical Christianity.
Prayer Works, by Austin Pardue, Bishop of
Pittsburgh, ($2.00. M or ehous e-Gorham Co., New
York City), presents in book form a series of
radio broadcasts over WCAE. They were aimed
at people who had personal problems.
Practical Statistics in Health and Medical Work,
by Ruth Rice Puffer, ($3.75. McGraw-Hill Book
Co., Inc., New York City). At the present time
statistical work is being extended in health and
medical fields. Today, progress in a science is
usually dependent on the statistical approach
and the analysis of the data. Hence there is
great need for a text like this one.
Harvey Cushing: Surgeon, Author, Artist, by
Elizabeth H. Thomson, ($4.00. Henry Schuman,
New York City), the woman wrho assisted Dr.
John F. Fxlton write the bigger biography.
In writing this shorter and more popular work
Miss Thomson has used all of the new material
that Dr. Fulton’s work “smoked out.” Here,
too, we get a . much clearer picture of the part
that Mrs. Cushing played in Dr. Cushing’s life.
The Doctor’s relation with his patients is more
satisfactorily treated.
You and Your Heart, by Doctors H. M. Marvin,
I. S. Wright, I. H. Page, T. D. Jones, and D.
Rutstein, with foreword by Paul D. White, M. D.,
($3.00. Random House, New York City) is a book
written in simple terms for non-medical people,
dealing with normal and diseased hearts. Its
purpose is to bring some measure of enlighten-
ment and understanding to all who read it and
not with the idea of self-help. This impressive
list of authors bespeaks for high quality in this
book for laymen.
Pastoral Care of Nervous People, by the Rev.
Henry Jerome Simpson, ($2.50. Morehouse-
Gorham Co., New York City), written as an
elementary text by a clergyman who realizes
that many complaints of bodily ailing without
physical basis are not self-centered whinings
and lamentations, but really represent emo-
tional abnormalities.
Textbook of Bacteriology, by Joseph M.
Dougherty, Ph. D., and Anthony J. Lamberti,
($5.75. Second Edition. C. V. Mosby Company,
St. Louis, Mo.), is a revised text for premedical
and predental education as wrell as public health
and hygiene courses.
Review of Dentistry, edited by James T. Ginn,
D. D. S., ($5.75. O. V. Mosby Company, St. Louis ,
Mo.), has been prepared with a three-fold pur-
pose in mind: to be a guide in preparing for
examination, to serve as a general review for
the undergraduate student, and, finally, to serve
as a handbook of references. It has 790 pages
set up as questions and answers.
Occupational Therapy, edited by William Rush
Dunton, Jr., M. D., and Sidney Licht, M. D.,
($6.00. Charles C. Thomas, Pubrs., Springfield ,
III.), has been written for physicians — a source,
book of essential information in convenient form.
Cell Growth and Cell Function — A Cytochemical
study by Torbjoern O. Caspersson, M. D., ($5.00.
W. W. Norton & Co., Inc., New York City),
tells of the new methods and procedures that
have been developed at the Institute for Cell
Research at the Karolinska Institute in Stock-
holm that may be used to make a quantitative
study of the chemical background of vital proc-
esses.
Clinical Orthoptic Procedure, by William Smith,
O. D., ($8.00. The C. V. Mosby Co., St. Louis,
Mo.), is a reference book on the clinieal methods
of orthoptics. It describes in simple language
the proceedings which have proven themselves
by clinical trial.
The Criminality of Women, by Otto Poliak,
($3.50. University of Pennsylvania Press, Phila-
delphia, Pa.), gives the results of brilliant in-
vestigation of the female criminal. The author
shatters the age-old theory that women are
less criminal than men. He concludes that
women appear less criminal only because of the
masked quality of their transgressions which are
emphasized by their predilection for, and adept-
ness at, deceit.
S. Weir Mitchell — Novelist and Physician, by
Ernest Earnest, ($3.50. University of Pennsyl-
vania Press, Philadelphia), is the first full-
length study of this pioneer in psychosomatic
medicine in 21 years. Silas Weir Mitchell was
considered a genius by his contemporaries —
physician and for 30 years the leading psy-
chiatrist in America. Authority on gunshot
wounds, his discovery of the nature of rattle-
snake venom was the foundation stone for later
research in the field of immunology. No wonder
he came to believe what people said of his
genius.
A Symposium on Steroid Hormones, edited t>y
Edgar S. Gordon, ($6.50. University of Wiscon-
sin Press, 811 State Street, Madison, Wis.),
brings us up to date in our understanding of
the part played by steroid compounds in the
regulation of animal function and behavior.
These compounds promise to give us the next
great — possibly the greatest — development in our
understanding of disease processes. So each of
us should prepare ourselves for the immediate
future by reference to this valuable report. An
index, however, would be a great convenience.
for December, 1950
1149
Entrance to Grounds
HARDING SANITARIUM, WORToH,!^GTON'
For Nervous and Mental Disorders
NINE MILES NORTH OF STATE HOUSE— COLUMBUS
HARRISON S. EVANS, M.D. GEORGE T. HARDING, M.D. CHARLES L. ANDERSON, M. D.
Medical Director President of Board Clinical Director
L. HAROLD CAVINESS, M. D. CHARLES W. HARDING, M. D.
Telephone: Columbus FR. 2-5367
An institution for the study and treatment of NERVOUS and MENTAL DISORDERS
John H. Nichols, M. D., Medical Director Herbert A. Sihler, Director Edmund V. Sihler, Assoc. Director
Approved by American College of Surgeons
WINDSOR HOSPITAL. CHAGRIN FALLS, OHIO Phone: Chagrin Falls 7347
1150
The Ohio State Medical Journal
The Ohio State Medical Journal
Published under the direction of The Council for and by the members of The Ohio
State Medical Association, a scientific society, non-profit corporation, with a definite
membership, for scientific and educational purposes.
Vol. 46 December, 1950 No. 12
Jonathan Forman, M.D., Editor
Charles S. Nelson,
Managing Editor — Bus. Mgr.
R. Gordon Moore,
Asst. Managing Editor
Tobacco
Smoking: Some Hints of Its Biologic Hazards
CLARENCE A. MILLS, M. D.
The Author
• Dr. Mills, Cincinnati, Ohio, is a graduate
of University of Cincinnati College of Medi-
cine, 1922; fellow, American Medical Asso-
ciation; member, Ohio State Medical Associa-
tion, International Leprosy Association, Ameri-
can Society of Tropical Medicine, American
Physiological Society, American Society of
Biochemists, and Central Society for Clinical
Research; James T. Heady professor of experi-
mental medicine. University of Cincinnati;
and director of laboratories for experimental
medicine, University of Cincinnati.
IT may seem a long way from urban air
pollution to tobacco smoking, but the con-
nection is in fact very close. The much
higher price paid by men than by women for
living in dirty air1 aroused our interest in the
effects of tobacco smoking. The irritant mate-
rials of polluted air and of tobacco smoke seem
to produce similar types of damage to the air
passages — a chronic irritation which predisposes
to such respiratory diseases as pneumonia,
tuberculosis, lung cancer, and many minor com-
plaints. It seems quite likely that much of the
higher price paid by men for living in polluted
air may be due to the added air passage damage
brought on by their heavier tobacco smoking.
It behooves medical science to assay as clearly
as possible the biological effects of this heavy
tobacco usage by man. Such assay must deal
separately with the effects of tobacco smoke in
the air passages and with the effects of ab-
sorbed nicotine on more distant parts of the
body.
SMOKING HABITS IN COLUMBUS, OHIO
The study here briefly presented is purely sta-
tistical in nature, comparing the smoking habits
of different groups of disease victims or indi-
viduals with similar segments of a normal city
population. Columbus, Ohio, was selected as the
control survey group. Persons of both sexes and
races, of all ages above 20, were interviewed in
every census tract of the city. Table 1 presents
a brief summary of the smoking habits found.
The classification of smoking combinations used
in table 1 emphasizes pipe and cigar smoking
and is used in correlation studies involving can-
Submitted May 2, 1950.
cers and infectious diseases of the air passages
and lungs where the heavy tars may play a part.
In order to emphasize cigarette smoking in con-
nection with those diseases where absorbed nic-
otine may be important (peptic ulcer and cor-
onary occlusion), the smoking combination statis-
tics of table 1 were reclassified, listing as “cigar-
ette” any combinations which included this form
of smoking.
According to these Columbus statistics, 78
to 80 per cent of white men under 50 years of
age smoke, also roughly 40 per cent of white
women under the age of 40 years. Colored men
and women are more addicted to smoking than
corresponding sexes of the white race. Cigarette
smoking is most common in young adults and
diminishes with advancing age, while the reverse
is true with pipe and cigar smoking. This prob-
ably represents the results of advertising prop-
1165
TABLE I
TOBACCO SMOKING HABITS IN COLUMBUS. OHIO
(By Age, Sex and Color)
Percentage Incidence of Smoking
Age in Years Cigarettes Pipe, Cigars or Combinations Non-smokers
Only
White Men % No. % No. % No.
20 - 29 66.38 (233) 10.83 (38) 22.79 (80)
30 - 39 61.05 (116) 16.84 (32) 22.11 (42)
40 - 49 60.65 (131) 19.44 (42) 19.91 (43)
50 - 59 51.60 ( 97) 23.93 (45) 29.47 (46)
60 - 69 34.17 ( 41) 30.83 (37) 35.00 (42)
70 - 79 13.05 ( 9) 30.43 (21) 56.52 (39)
80+ 5.56 ( 1) 47.37 ( 9) 47.37 ( 9)
Colored Men
20 - 29 76.11 (188) 6.07 (15) 17.82 (44)
30 - 39 74.19 (138) 12.90 (24) 12.91 (24)
40 - 49 64.44 (125) 21.65 (42) 13.91 (27)
50 - 59 51.43 ( 90) 29.71 (52) 18.86 (33)
60+ 24.16 ( 36) 46.98 (70) 28.86 (43)
White Women
20 - 29
39.68
(123)
30 - 39
...
42.28
(104)
40 - 49
26.22
( 59)
50 - 59
15.93
( 36)
60 - 69
11.66
( 21)
70 - 79
3.33
(
3)
80 +
0.00
(
0)
—
60.32
57.77
(187)
(142)
73.78
(166)
84.07
(190)
88.34
(159)
96.67
( 88)
100.00
( 25)
Colored Women
20 - 29
51.54
(151)
48.46
(142)
30 - 39 ....
45.16
( 98)
54.84
(119)
40 - 49
32.35
( 55)
0.59
(
1)
67.06
(114)
50 - 59
18.01
( 29)
0.62
(
1)
81.37
(131)
60 +
6.48
( 9)
2.16
(
3)
91.36
r (127)
aganda by the cigarette makers during the last
quarter century. The percentage of non-smoking
men increases steadily above age 50, and of non-
smoking women above age 40. The smoking
statistics in Columbus were also segregated into
3 city zones: (1) Cleanest suburban areas, (2)
intermediate districts and (3) the downtown and
industrial districts of greatest air pollution.
Such zoning also gave a rough division of the
population on an economic basis. These detailed
statistics will be published elsewhere.2
PULMONARY TUBERCULOSIS AND SMOKING HABITS
Information on smoking habits was obtained
on 517 white male and 300 white female patients
above age 20, from the records of the Dunham
Hospital for tuberculosis in Cincinnati. These
patients were in very large part charity cases
from the poorer sections of the city, and hence
comparison is made with corresponding age
groups from the poorest section of the Columbus
population.
In deriving the Columbus control groups on
smoking habits for comparison with the smoking
habits of the various groups of disease victims
listed in this paper, special care was taken to
see that the control group had exactly the same
age distribution (decade by decade) as the disease
group with which comparison was being made.
This was not done by picking out the required
number of Columbus individuals from each age
decade, but rather by taking the proper per-
centage of the whole age decade group.
As seen in table 3 the incidence of cigarette
smoking is definitely and significantly higher in
both male and female tuberculous patients than
among appropriate Columbus controls. Since it is
scarcely conceivable that men or women would
take up smoking because they have tuberculosis,
we must conclude that smoking probably predis-
poses to the initiation of this disease or to the
likelihood that minimal infection will progress to a
clinically active stage.
CANCERS OF MOUTH AND RESPIRATORY TRACT
IN RELATION TO SMOKING HABITS
Information on smoking habits was obtained
from next of kin, by interview or questionnaire,
for some 175 such white male cancer victims
dying in Cincinnati during the years 1940 to 1945
TABLE II
WHITE MEN COLORED MEN
Cigarettes or Com- Cigarettes or Corn-
Age binations thereof Pipe and/or Cigars binations thereof Pipe and/or Cigars
% No. % No. % No. % No.
20 - 29 74.93 (263) 2.28 ( 8) 78.54 (194) 3.64 ( 9)
30 - 39 74.21 (141) 3.68 ( 7) 76.34 (142) 10.75 (20)
40 - 49 76.20 (143) 13.89 (30) 68.04 (132) 18.04 (35)
50 - 59 59.04 (111) 16.49 (31) 58.28 (102) 22.86 (40)
60 - 69 42.50 ( 51) 22.50 (27) 28.19 ( 42) 42.95 (64)
70 - 79 18.84 ( 13) 24.64 (17) (Includes all over age 60)
80 + 5.26 ( 1) 47.37 ( 9)
1166
The Ohio State Medical Journal
TABLE III
PULMONARY TUBERCULOSIS AND TOBACCO SMOKING
Group
Number
of cases
Mean
age
Cigarettes
Only
Incidence of Smoking
Pipe, Cigars or
Combinations
Non-smokers
% PE
% PE
% PE
White male patients
517
43.8
76.60 + 1.26
8.51 + 0.83
14.89 + 1.05
Columbus controls
777
43.8
56.24 + 1.20
19.56±0.96
24.20±1.04
Diff./PE diff.
20.36
11.05
9.31
=11.7
—8.7
—6.3
±1.74
+ 1.27
±1.48
White female patients
300
34.1
47.67 + 1.94
52.33 + 1.94
Columbus controls
600
34.1
36.00±1.32
64.00±1.32
Diff./PE diff. 11.67 11.67
=5.0 =5.0
±2.35 -+-2.35
and for 394 dying1 in Detroit from 1942 to 1946
inclusive. Comparison was made with the smok-
ing habits of white men of similar mean age
from the whole of Columbus, with results pub-
lished elsewhere.2
An abnormally high incidence of cigar and
pipe smoking was found among male cancer
victims of both upper and lower air passages,
together with a significantly low incidence of
non-smokers. Among victims of buccal cancers,
cigarette smoking habits were practically nor-
mal, but there was found a definite and signifi-
cant increase of cigarette smoking among vic-
tims of lower respiratory tract cancer (from the
larynx down).
The markedly abnormal percentage of cigar
and pipe smokers among both groups of cancer
victims was especially interesting, in view of
the fact that more sluggish combustion in these
types of smoking gives rise to more of the ir-
ritating tarry materials demonstrated to be
freely cancerigenic for susceptible animals.
Roffo3 found that 95 per cent of all respiratory
tract cancers occurred in smokers, while in our
series here detailed 93 per cent were smokers
(90 per cent among the buccal cancer victims).
PNEUMONIA AND TOBACCO SMOKING
Smoking habits were obtained for 60 white
male pneumonia victims dying during 1945-1947
in Cincinnati and on 58 others treated for pneu-
monia in the General Hospital, and comparison
made with appropriate age controls among Co-
lumbus men (table 4).
Even with this small series, pneumonia victims
show significantly more addiction to cigarette
smoking than is found in appropriate normal
control groups. Morton4 found postoperate
pneumonia 6 times more frequent among smokers
than among non-smokers following general gas-
eous anesthesia.
CORONARY OCCLUSION DEATHS AND
TOBACCO SMOKING
Smoking habits were obtained on 484 white
men dying of coronary occlusion in Cincinnati
during 1946 and 1947, and comparison made with
appropriate age controls among Columbus men
as listed in table 2.
All male coronary victims under 41 years of
age were cigarette smokers and all but 1 under
46 years! The percentage of cigarette smokers
among coronary victims is significantly higher
than normal up to age 60, while after this age
the incidence of pipe and cigar smoking is ab-
normally high (table 5). Tobacco smoking in some
form is thus abnormally prevalent among all ages
of coronary victims and the percentage of non-
smokers significantly below normal. The great
increase in cigarette smoking during recent de-
cades, especially among younger age groups, no
doubt accounts for the age differences in domin-
ant smoking types here observed.
TOBACCO SMOKING HABITS IN PEPTIC
ULCER VICTIMS
Medical opinion has long held that peptic ulcer
patients should abstain from tobacco smoking.
This is particularly true for cigarette smoking,
in which rapid absorption from the lungs and
direct distribution to peripheral tissues without
detoxification in the liver produces maximal
TABLE IV
PNEUMONIA AND TOBACCO SMOKING
(White Males Only)
Number Mean Incidence of Smoking
of Cases Age Cigarettes Pipe, Cigars or
Group Only Combinations Non-smokers
% PE % PE % PE
Pneumonia cases 118 49.6 63.56±2.98 2L19±2.52 15.25 + 2.23
Columbus controls 472 49.6 52.33±1.54 22.46±1.29 25.21±1.34
11.23 1.23 9.96
Diff./PE diff. =3.3 =0.4 =3.8
+ 3.35 +2.83 +2.60
for December, 1950
1167
TABLE V
SMOKING HABITS AMONG CORONARY VICTIMS
(White Males Only)
Groups
Number
of Cases
Ages
Cigarettes*
Incidence of Smoking
Pipe and/or
Cigars
Non-smokers
% PE
% PE
% PE
Coronary
2
20-29
100
0
0
Controls
351
20-29
74.93
2.28
22.79
Coronary
8
30-39
100
0
0
Controls
190
30-39
74.21
3.68
22.11
Coronary
56
40-49
83.93 + 3.30
8.93+2.58
7.14 + 2.30
Controls _
216
40-49
70.83 + 2.08
9.26 + 1.31
19.91 + 1.84
13.10
0.33
12.77
Diff /PE diff
— 3 4
—o.i
—4.3
±3.90
±2.89
±2.95
Coronary
135
50-59
82.23 + 2.23
11.11 + 1.81
6.66 + 1.38
Controls
188
50-59
59.94 + 2.42
16.49 + 1.80
24.47 + 2.10
23.19
5.38
17.81
Diff./PE diff.
— 7 1
—2.0
—7.1
±3.29
±2.65
±2.51
Coronary
153
60-69
49.02 + 2.72
32.68 + 2.56
18.30 + 2.10
Controls
114
60-69
43.86 + 3.13
21.05 + 2.57
35.09 + 3.01
5.16
11.63
16.79
Diff /PE diff
— 1 2
— 3 2
—4.6
±4.15
±3.63
±3.67
Coronary
130
70±
18.46 + 2.27
47.69 + 2.96
33.84 + 2.80
Controls
88
70+
16.47 + 2.63
29.41 + 3.26
54.12 + 3.58
1.99
18.28
20.28
Diff./PE diff.
— 0 6
—4 2
—4.5
±3.47
+ 4.40
+ 4.54
* Any smoking combination which included cigarettes.
nicotinic effects on autonomic ganglion cells.
Nicotine gaining entrance by way of the gastro-
enteric tract, on the other hand, faces con-
siderable detoxication in the liver before being
distributed generally to body tissues. Tobacco
chewing is thus least associated with peptic
ulcer incidence, pipe and cigar smoking comes
next, while cigarette smoking is overwhelm-
ingly prevalent in male ulcer victims.
Tyrell-Gray5 in 1924 reported a tobacco smoking
incidence of 96 per cent among male ulcer pa-
tients, and Trowell6 in 1934 a 92 per cent incidence
(90 per cent cigarette). Jamieson, et al.,7 reported
more severe symptoms among heavy cigarette
users and milder symptoms with lighter cigar-
ette use among 451 male peptic ulcer patients,
no such association being present among pipe
or cigar smokers. Wilkerson8 insists that
peptic ulcer patients must not smoke, if ef-
fective treatment is to be expected.
It is of interest, therefore, to find that 97
per cent of our 30 white male peptic ulcer
victims below 60 years of age were tobacco
smokers, (all but 2 smoked cigarettes). Be-
yond 60 years of age the tobacco smoking
habit of 25 ulcer victims showed no significant
deviation from normal. Below age 50, all
17 victims were cigarette smokers. The 55
cases in table 6 were those for whom tobacco
smoking habits were obtained from among
some 87 questionnaires sent out to next of kin
of those dying from this cause in Cincinnati
during 1946 and 1947.
TOBACCO SMOKING HABITS AND BREAST
FEEDING OF INFANTS
The past has seen much controversy but
little real evidence as to whether tobacco
smoking interferes with a mother’s ability to
nurse her child. A survey of American ob-
stetricians9 elicited a general condemnation of
excessive smoking during the latter months
of pregnancy and the nursing period. These
were only opinions, however, without statistical
support. Pearlman et al.10 did publish findings
which suggested an improvement in nursing
TABLE VI
SMOKING HABITS AMONG PEPTIC ULCER VICTIMS
(White Males Only)
Group
Incidence of Smoking
Number Mean Pipe and/or
of Cases Age Cigarettes* Cigars Non-smokers
Peptic ulcer
Columbus controls
Diff./PE diff
% PE
55 60.1 64.64±4.34
275 60.1 45.45±2.02
19.19
=4.0
±4.79
% PE
18.18±3.51
19.64±1.61
1.46
=0.4
±3.86
% PE
18.18±3.51
34.91±1.94
16.73
=4.2
±4.01
* Any smoking combination which included cigarettes.
1168
The Ohio State Medical Journal
TABLE VII
SMOKING
HABITS AND BREAST
FEEDING
Month of
Delivery
Number of
Cases
Smoking Mothers
Mean Nursing
Percentage Period
Percentage
Non-smoking Mothers
Mean Nursing
Period
Mo. PE
Mo. PE
Mo. PE
January
244
39.75-H-2.il
2.43-1-0.21 ( 82)
60.25
3.23-1-0.19 (120)
August
276
42.75-+-2.01
2.27 -*-0.17 ( 95)
57.25
2. 9H-0. 20 (129)
Jan. & Aug.
520
41.35-4-1.45
2.34 + 0.13 (177)
58.65
3.06-+-0.13 (249)
Special*
24
3.04-4-0.48 ( 24)
* 24 smokers who abstained for over three months before delivery, (12 in January group and 12 in August group).
ability with increasing1 degrees of cigarette
smoking, but their numbers of cases were in-
adequate to establish the validity of such con-
clusions.
Inhalation of tobacco smoke by pregnant
female rabbits11 led to an abnormally high
stillbirth rate and a small birth size of the
young, with only one-third the normal number
living on to maturity. There were even
hints that these effects held on into the second
and third generations of offspring from such
damaged individuals, without further exposure
to smoke. Any such lasting effects would in-
dicate a degree of smoke exposure probably
beyond that experienced by human beings.
In order to obtain stable statistical evidence
as to the effects of smoking on ability to
nurse, some 2500 white women giving birth
to their first living offspring in Cincinnati dur-
ing January and August, 1947, were questioned
as to smoking habits during pregnancy and
the nursing period. The study was limited to
white women 18 - 29 years of age so as to
minimize the statistical variables, and the two
months of January and August were chosen to
bring out possible seasonal differences in nursing
ability. Replies were received from 520 of these
mothers, with the results here briefly sum-
marized. (Table 7.)
No nursing data were obtained on 3 smokers
and 27 non-smokers in the January group and on
11 smokers and 29 non-smokers in the August
group. One item on the questionnaire was “Did
you desire to nurse this baby?” Where the an-
swer to this question was “no” and the indicated
nursing time not over ten days, the case was
discarded on the grounds of uncertainty. In
cases without desire to nurse but with a history
of nursing on beyond ten days, it was con-
sidered that the indicated nursing history really
represented the ability to nurse.
There are several points of interest in the
data set forth in table 8. In the first place,
the percentage of smokers in the wThole group
of 520 is 41.35, differing quite insignificantly
from the 39.6 per cent smokers among Colum-
bus white women 20 to 29 years of age. In
the second place, both smoking and non-smoking
mothers nursed their August-born babies for
slightly shorter periods than was the case with
the January-born. While these differences are
not mathematically significant, their uniformity
is strongly suggestive of a seasonal influence
in favor of January delivery. The differences
in length of nursing periods (between smokers
and non-smokers) are in every case in the realm
of probable significance, being over twice their
own probable errors. With the combined Jan-
uary-August group, the difference is 3.7 times
its own probable error.
Greatest interest, however, attaches to the
group of 24 smoking mothers who abstained
during the last 3+ months of pregnancy. The
mean nursing period for these 24 habitual
smokers was almost identical with that exhibited
by the non-smokers. While the differences in
nursing ability exhibited by the various groups
are not as clear-cut and significant as one would
desire, it does seem that smoking introduces a
nursing handicap.
There was no significant difference between
smoking and non-smoking mother groups in
total inability to nurse the offspring. Among
all mothers nursing their babies on to 2 months
and beyond, however, the mean nursing period
was definitely longer for the non-smokers,
(5.78±0.18 months as compared to 4.01±0.30).
Only 36 per cent of the smokers continued the
nursing to 2 months or beyond while 46 per cent
of the non-smokers did so (28 per cent of the
non-smokers carried the nursing on to 4 months
or more, while only 16 per cent of the smokers
did as well). It would thus seem that the prin-
cipal nursing handicap encountered by mothers
who smoke is not a total inability to nurse, but
rather an inability to continue the nursing func-
tion on the normal number of months.
ACTIVE INVESTIGATION OF OTHER MATERNAL
SMOKING INFLUENCES
We are still actively investigating the rela-
tionship of maternal smoking to the birth of
malformed infants, to stillbirths, and to the
increasing number of infants who develop hyper-
trophic pyloric stenosis (constriction of outlet of
stomach). Malformations and pyloric stenosis
are both definitely increasing in incidence, nor
has medical science much evidence as to their
cause. Swan and co-workers in Australia12
made the startling discovery that German
measles in the mother during the early months
for December, 1950
1169
of pregnancy caused a very marked increase in
the percentage of malformed infants. Wark-
any13 has shown equally marked effects on
animals by feeding diets deficient in certain
vitamins.
To date our own findings indicate that smok-
ing mothers are more likely to give birth to mal-
formed infants and to those who develop pyloric
stenosis in the first month of life. Stillbirths
are only slightly more prevalent among smoking
than non-smoking mothers. Since absorbed
nicotine would be only one of the many abnormal
factors disturbing foetal development, we will
consider it of considerable importance if we find
differences even in the lower ranges of sig-
nificance.
DISCUSSION
Almost every tobacco novice is familiar with
the acute effects of nicotine poisoning, — the
nausea, vomiting, abdominal cramps, diarrhea,
blurring of vision, clammy perspiration and pros-
tration of varying degree. Although amusing
to the onlooker, these symptoms of ganglionic
cell poisoning mean intense misery for the victim.
Few people realize, however, that this passing
discomfort from absorbed nicotine might often
be only a feeble forerunner of more profound
and fatal effects down through the years of
tobacco usage. Nicotine is a powerful drug,
with a characteristic action (stimulative-irritative-
paralytic) on ganglion cells of the nervous
system, particularly those of the involuntary
or autonomic nervous system. Its action is in-
deed so characteristic that all other drugs exert-
ing a similar effect are said to have a “nicotinic”
action.
Some years ago Raymond Pearl14 found the
life span to be significantly shorter for smokers
than for non-smokers, without limiting the effect
to any one cause of death. Now we begin to
see the disease groupings in which tobacco
smoking may be an important factor. In the
air passages themselves, tobacco smoke irritation
is significantly associated with the same three
killing respiratory diseases already linked so
closely with outdoor air pollution. The ex-
cessively high rates for these diseases among
men of dirty urban areas may well be due to a
pyramiding of effects of the two forms of
air pollution.
It is well recognized that only tobacco smokers
are afflicted with thromboangeitis obliterus, which
causes so much trouble by cutting off circulation
to the extremities, and that no treatment will
be successful unless the habit is given up com-
pletely. Wise physicians also have become in-
creasingly suspicious of nicotine’s baneful in-
fluence in the rise of heart and vessel diseases
to first rank among the causes of death in
man. Certainly the statistics here set forth
will in no way allay these suspicions. The asso-
ciation is equally close between smoking and
peptic ulcer or respiratory tract cancers.
Most disturbing of all, however, is the pos-
sibility that smoking by women in the child-
bearing period may seriously interfere with
normal reproductive functions and lactation.
This is a subject of paramount importance to
the race and is now being closely investigated.
There seems to be an abundance of hints of
biologic damage from tobacco smoking in both
men and women. For many the habit is a dif-
ficult one to break, hence the importance of
steps to prevent its beginning. This will be
difficult, so long as it is considered the mark
of the blase and sophisticated individual. Nor
will it be easy to discourage smoking among
children when their mothers habitually indulge.
Precept is never so potent as example in child-
rearing.
REFERENCES
1. Mills, C. A., and Mills Porter, Marjorie : Health
Costs of Urban Air Pollution. Occupational Med. 5 :614-633,
1948.
2. Mills, C. A., and Mills Porter, Marjorie: Tobacco
Smoking Habits and Cancer of the Mouth and Respiratory
System. Cancer Research, in press.
3. Roffo, A. H. : Presa med. Argent. 28:1003, 1941.
4. Morton, H. J. V. : Tobacco Smoking and Pulmonary
Complications after Operation. Lancet, 1 :368, 144.
5. Tyrell-Gray, H. : The Pathology and Symptoms of
Duodenal Ulcer. Brit. Med. Jour. 1:1040, 1924.
6. Trowell, O. A. : The Relation of Tobacco Smoking to
the Incidence of Chronic Duodenal Ulcer. Lancet, 1 :808-ll,
1934.
7. Jamieson, R. A., Illingworth, C. F. W., and Scott,
L. D. W. : Tobacco and Ulcer Dyspepsia. Brit. Med. Jour.,
2:285-8, 1946.
8. Wilkinson, S. Allen : The Peptic Ulcer Problem.
J. A. M A, 138 :805, 1948
9. Campbell, Alex. M. : Excessive Cigarette Smoking in
Women and Its Effects Upon Their Reproductive Efficiency.
J. Mich. State Med. Soc., 34:146, 1935.
10. Pearlman, H. H., Damenberg, A. M., and Sokoloff,
N. : Excretion of Nicotine in Breast Milk and Urine from
Cigarette Smoking. Effect on Lactation and Nursing.
J. A. M. A., 120 :1000-9, 1942.
11. Schoeneck, F. J. : Cigarette Smoking in Pregnancy.
N. Y. State Med., 41:1945-8, 1941.
12. Swan, C. et al. : Congenital Defects in Infants Fol-
lowing Infectious Disease During Pregnancy. Med. Jour.
Australia, 2 :201-210, 1943.
13. Warkany, Josef: Experimental Studies on Nutrition
in Pregnancy. Obstet. & Gynec. Survey, 3 :698-703, 1948.
14. Pearl, Raymond. The Biology of Death. Philadelphia,
J. B. Lippincott Co., 1922.
Nausea and Vomiting
The mechanism of nausea and vomiting in
the first trimester remains obscure. Indirect
approaches have been made recently by Dorsey,
and Bertling and Burwell. Dorsey uses pyri-
doxine 25 mgm. and adrenal cortex extract
(Upjohn and Armour) one-half cc. in two injec-
tions 24 hours apart; subsequent injections are
given in 3 to 5 days as needed. Among 30
primiparas and 32 multiparas, there were 3 fail-
ures, complete relief in 56, and marked im-
provement in 3 — an incidence of 95.1 per cent
success. Bertling and Burwell report 4 per cent
failures, 70 per cent complete relief and 26 per
cent improvement among 31 patients treated with
stilbestrol in doses of 5 mgm. daily. — G. A.
Mitchell, M. D., J. Tenn. S. M. A., 43:315, 1950.
1170
The Ohio State Medical Journal
Saline Solution in Treatment of Burn Shock
THE Surgery Study Section of the National
Institutes of Health has recommended to
the Surgeon General of the Public Health
Service that the use of oral saline solutions be
adopted as standard procedure in the treatment
of shock due to burns and other injuries in the
event of large-scale civilian catastrophe.
The recommendation followed action taken at
the January 1950 meeting of the Surgery Study
Section, when such treatment was approved in
principle. Dr. Carl A. Moyer, a member of the
Study Section, was designated at that time to
prepare a memorandum suitable for submission
to Dr. Norvin A. Kiefer, Director, Health Re-
sources Division (now Health Resources Office),
National Security Resources Board.
Dr. Moyer’s memorandum, which was submitted
to Dr. Kiefer, February 15, 1950, reads as fol-
lows:
“Since the publication of the experimental
work of Dr. Rosenthal, Dr. Coller, et al., orally
administered salt solutions have been employed
in the treatment of burns at the University of
Michigan Hospital, Ann Arbor, Mich.; at the
Wayne County General Hospital, Eloise, Mich.;
and at Parkland Hospital, Dallas, Tex. Per-
sonal clinical experience, in the above-named
hospitals, has convinced me that the orally ad-
ministered salt solutions are valuable adjunctive
agents in the treatment of shock incident to
burns, fractures, peritonitis, and acute anaphyl-
actoid reactions. Certain factors are important
in governing the effectiveness of the oral ad-
ministration of salt solutions. They are as
follows:
IMPORTANT FACTORS
“1. The composition of the salt solution: The
most palatable salt solution is made by dis-
solving 3 to 4 grams of sodium chloride and 2
to 3 grams of sodium citrate in each liter of
water. If sodium citrate is not available,
ordinary baking soda may be substituted for it.
“2. The concentration of salt should not be
in excess of 140 milliequivalents of sodium per
liter. If the concentration is above this, vomit-
ing and diarrhea became important complicat-
ing factors.
“3. Whenever profound peripheral circulatory
collapse is present, the intravenous route of ad-
ministration must be used until peripheral blood
flow has been reestablished. The salt solutions
that we have found most satisfactory for this
purpose are Hartmann’s solution (Lactate-
Ringer’s solution) or plasma. In addition to
the salt solution or plasma intravenously, whole
blood is given concurrently whenever peripheral
Submitted Oct. 14, 1950.
Editor s Note :
• In submitting the accompanying article,
Dr. Leonard A. Scheele, Surgeon General,
U. S. P. H. S., made the following statement :
“I would invite your attention to the
very important fact that this recommen-
dation will in no sense decrease the need
for whole blood, and must not be con-
strued as lessening in any way the im-
portance of blood bank programs. It is
our considered opinion, however, that in-
formation on sodium treatment might well
be included immediately, as an emergency
procedure, in first aid training programs.”
• The Editor concurs in the recommenda-
tion of the Surgery Study Section as well as
in the statement made by Dr. Scheele.
circulatory collapse exists. This materially im-
plements the effectiveness of salt solutions.
“The slightly hypotonic salt solution is the
only drinking fluid permitted the injured indi-
vidual until the edema of the injured parts
begins to subside. Certain exceptions to this
rule have to be made during the hot weather
of summer when it is sometimes necessary to
permit the partaking of some nonTsalty water.
“As much as 10 liters of the hypotonic salt
solution have been drunk in the 24-hour period
by adults who have been severely burned. Since
salt solution has been substituted for water,
as a drinkable fluid, no burned person who has
lived for longer than 3 hours after being
admitted to the hospital has suffered from
anuria. The ‘early toxemia phase’ of the burns
has also failed to appear and the osmotic con-
centration of the plasma electrolytes has been
well maintained.
MORE WORK NEEED
“We feel that much more clinical observation
and actual experimental work should be under-
taken regarding the effectiveness of the basic
principles of the supportive therapy of burns
that have been so beautifully demonstrated by
Dr. Rosenthal. It is obvious that the adoption
of a more active program of investigation into
the relative effectiveness of simple measures
to combat shock would be of extreme importance
to the Armed Forces and to the civilian popula-
tion in the event of another war.”
Because of the sharpened national emergency
that developed during the summer of 1950, the
Surgery Study Section, in approving Dr. Moyer’s
for December, 1950
1171
memorandum at its meeting on September 16,
changed the last paragraph to read:
“While further clinical research concerning
the effectiveness of oral salt solution in the
treatment of burns and other injuries is certainly
in order, there is already sufficient evidence
to suggest that this form of treatment should
be used in any large-scale disaster involving the
civilian population.”
The Surgery Study Section letter to the
Surgeon General, dated September 16, 1950,
reads as follows:
TEXT OF LETTER
“It is my understanding that one of the
functions of the Study Sections is to offer advice
to the Surgeon General in fields of medicine
lying within the special competence of the
Study Section members. At the January 1950
meeting of the Surgery Study Section, there
was considerable discussion concerning the use
of oral saline solutions in the treatment of burns
and other serious injuries. It was the consensus
of the Section at that time that, on the basis
of the animal work which had been done by
Dr. Rosenthal of the National Institutes of
Health, and the clinical work which had been
done by Dr. Carl A. Moyer, by the undersigned,
and by others, the efficacy of such treatment
had been definitely demonstrated and that, while
there is need to stimulate additional research
in this field, our present knowledge is sound
enough so that action can be taken on this
basis. Dr. Moyer was designated to draft a
short memorandum expressing our point of view
on this subject. Such a memorandum was pre-
pared and furnished to Dr. Norvin C. Kiefer,
Director, Health Resources Division, National
Security Resources Board, on February 15,
1950. A copy of Dr. Moyer’s memorandum is
attached.
“In view of the more acute national emergency
that has developed since Dr. Moyer wrote this
memorandum, the Study Section, at its meeting
on September 16, 1950, voted to recommend that
the principles of treatment outlined in his
memorandum be adopted for widespread use
in any large-scale disaster involving the civilian
population. Because of the present emergency
situation, we have modified the last paragraph
of Dr. Moyer’s memorandum to read, ‘While
further clinical research concerning the effec-
tiveness of oral salt solution in the treatment
of burns and other injuries is certainly in order,
there is already sufficient evidence to suggest
that this form of treatment should be used
in any large-scale disaster involving the civilian
population.’
“You are at liberty to transmit this recom-
mendation of the Surgery Study Section to the
National Security Resources Board or to other
proper agencies, and, if you see fit, to publish
it. We feel strongly that it is important
for the medical profession of the country and
for those planning for the handling of potential
disasters to be informed of the value of this
simple and easily carried out form of treat-
ment.”
THOSE SIGNING
The letter was signed by Frederick A. Coller,
M. D., University of Michigan, Chairman of the
Surgery Study Section. Members of the Study
Section, in addition to Dr. Coller, are: Dr. Claude
S. Beck, professor of neurosurgery, Western
Reserve University; Dr. Loren R. Chandler,
dean, Stanford University Medical School; Dr.
Lester R. Dragstedt, professor of surgery, Uni-
versity of Chicago; Dr. Daniel C. Elkin, profes-
sor of surgery, Emory University; Dr. Carl A.
Moyer, dean and professor of surgery, South-
western Medical School, University of Texas;
Dr. Harris B. Shumacker, Jr., professor of sur-
gery, Indiana University Medical Center; Dr.
Owen HI Wangensteen, professor of surgery,
University of Minnesota; Dr. Allen 0. Whipple,
clinical director, Memorial Hospital, New York
Owen H. Wangensteen, professor of surgery,
Staten Island Marine Hospital; Dr. Henry
Beecher, professor of anesthesiology, Harvard
University Medical School; Dr. J. Gordon Lee,
chief of surgery, Mount Alto Hospital, Wash-
ington, D. C.; Dr. Howard R. Lawrence, chief of
surgery, Francis E. Warren Air Force Base
Hospital, Wyoming; and Dr. G. Halsey Hunt,
Chief, Division of Hospitals, Public Health
Service.
REFERENCES*
1. Rosenthal, S. M., and Tabor, H. : Experimental
Chemotherapy of Burns and Shock. Public Health Reports
58:513-522; 1429-1436, 1943. 59:637-658, 1944. 60:373-381;
401-419, 1945. Am. J. Physiol. 149:449-464, 1947. Arch,
of Surg. 51:244-252, 1945.
2. Fox, C. L., Jr. : Oral Sodium Lactate in Treatment
of Burns and Shock. J. A. M. A. 124:207-212, 1944. Surg.
Gyn. and Obst. 80:561-567, 1945. Am. J. Physiol. 151:155-
167, 1947.
3. Moyer, C. A., Coller, F. A., lob, V., Vaughn, H. H.,
and Marty, D. A. : Study of the Interrelationship of Salt
Solutions, Serum, and Defibrinated Blood in the Treatment
of Severely Scalded, Anesthetized Dogs. Ann. of Surg.
120:367-376, 1944.
Moyer, C. A. : Texas State Jour, of Med. 45 :635-639,
1949.
4. Katz, L. N., Friedberg, L., and Asher, R. : Efficacy
of Isotinic Sodium Chloride and Glucose in Preventing
Shock Following! Venous Occlusion of a Limb in the Dog.
Am. J. Physiol. 140:65-71, 1943.
5. Scott, C. C., Worth, H. M., and Robbins, E. B. :
Comparative Value of Some Blood Substitutes Used for
Treatment of Experimental Shock. Arch, of Surg. 48 MIS-
SIS, 1944.
6. Allen. F. M. : Theory and Therapy of Shock. Am.
J. Surg. 62:80-104, 1943.
7. Harkins, H. N. : Sodium Therapy of Experimental
Tourniquet Shock. Am. J. Physiol. 145 :538-545, 1947.
8. “The Fluid and Nutritional Therapy of Burns,”
Report by the Sub-Committee on Shock. Natl. Research
Council. J. A. M. A. 128 :475-479, 1945.
9. McCarthy, M. D., and Parkins, W. M. : Comparative
Effectiveness of Albumin, Globin, Hemoglobin, Gelatin,
Oxypolygelatin, Saline, Ringer’s, Blood, and Plasma Upon
the Survival of Rats Subjected to Standardized Scald Burns.
Am. J. Physiol. 150:428-443, 1947.
10. Reynolds, M. : Cardiovascular Effects of Large
Volumes of Isotonic Saline Infused Intravenously into
Dogs Following Severe Hemorrhage. Am. J. Physiol.,
158:418-428, 1949.
* This does not represent a complete bibliography.
1172
The Ohio State Medical Journal
Superior Vena Cava Obstruction Due To Chronic
Mediastinitis and Phlebitis
SALVATORE M. SANCETTA, M. D., and HAROLD E. McDONALD, M. D.
CHRONIC mediastinitis with compression of
the superior vena cava, with or without
secondary intraluminal thrombosis, is the
third or fourth most common cause of obstruction
of this vessel. In the case which is the subject of
this report, chronic mediastinitis was present, but
rather than compression of the vessel, necropsy
revealed a replacement of the vessel wall and
almost complete obliteration of the lumen by a
process indistinguishable from the mediastinal
involvement.
REPORT OF CASE
A fifty-year old colored female was admitted
to the Medical Service, Cleveland City Hospital,
on March 7, 1949. with the comnlaints of progres-
sive dyspnea, and swelling of the neck, face and
upper extremities of five weeks’ duration. She
had worked as a housekeeper most of her life,
and in the past three years had been employed
as a ward aide on the psychiatric service. She
had had pneumonia in childhood, and in the
past five years had suffered five to six episodes
of upper respiratory infections yearly, char-
acterized by severe, scantily productive cough.
Four years previously a moderate arterial hyper-
tension was found. Two years before admission
she was kicked on the upper sternum by a pa-
tient, but suffered no apparent immediate after
effects. A chest film at this time revealed no
abnormalities other than a minimal inactive
tuberculous right subapical lesion. Follow-up
films revealed no change including the most
recent X-ray in October of 1948.
In December 1948 she developed two severe
bouts of acute upper respiratory infection, the
latter terminating in mid-January 1949. A
moderate non-productive cough persisted. About
February 1, 1949, she noticed dyspnea which
increased progressively in severity, orthopnea,
and slight swelling of the neck and supraclavic-
ular fossae. Within four weeks marked edema
of the entire face and of the upper extremities
supervened. She developed hoarseness, the
dyspnea became disabling, and she was admitted
into the hospital.
Physical Examination. The patient was an
alert and obese negro female who was moderately
dyspneic. The temperature was 37.2 degrees C.,
the respiratory rate 28, the pulse rate 72, and
the blood pressure 205/112 and 174/112 in the
right and left arms respectively. The lips
and nail beds were cyanotic. The face, neck,
and supraclavicular fossae were uniformly
swollen and firm. The parotid and submandibular
glands were enlarged and non-tender. There
was moderate edema of both upper extremities.
The jugular veins were distended and did not
visibly change in caliber on inspiration and
during the performance of Valsalva’s experi-
ment. Over the thorax were numerous dilated
From the Departments of Medicine and Pathology, West-
ern Reserve University, and the Medical Service, Cleveland
City Hospital.
The Authors
• Dr. Sancetta, Cleveland, Ohio, is a grad-
uate of Western Reserve Univ. School of Medi-
cine, 1941; diplomate of the Amer. Board of
Internal Medicine; member, American Feder-
ation for Clinical Research; teaching fellow in
medicine. Western Reserve Univ. School of
Medicine and Cleveland City Hospital; hospital
physician, Cleveland City Hosp.
• Dr. McDonald, Cleveland, is a graduate
of Western Reserve University School of
Medicine, 1944; formerly, special resident in
Pathology; now chief resident in Urology,
Cleveland City Hosp.
veins which filled from above. The veins of
the fundi were engorged with blood, but the
arterioles were normal. The heart was normal.
The remainder of the physical examination was
within normal limits.
Laboratory Work. Examinations of the blood
and urine were normal. The blood serology was
negative. The electrocardiogram was normal.
A six foot posteroanterior view of the chest
showed a minimal widening of the upper right
mediastinal shadow. The venous pressure in the
anti-cubital veins was 41 centimeters of water and
in the femoral veins 7 centimeters of water. The
venogram was made by injecting 70 per cent
diodrast® into the left median cubital vein (figure
1). An attempt at bronchoscopy was unsucess-
ful because of the marked edema of the pharynx
and neck.
Hospital Course. Phlebotomy was followed
only by transient relief of dyspnea, which
progressed rapidly in severity.
Both the angiograms and the presence of
surface collaterals favored the view that the
azygos vein was involved. Because of the
rapid progression of symptoms it was felt that
exploratory thoracotomy was warranted in the
hope of finding a chronic mediastinitis and per-
forming a lysis to relieve the compression. On
entering the superior mediastinum the superior
vena cava had to be freed by blunt and sharp
dissection from the dense enveloping fibrous
tissue. The vessel felt firm and fibrotic from
the innominate junction to the pericardial re-
flection. Since this defect could not be bridged
nothing further was attempted. The patient ex-
pired shortly after being returned to the ward.
Gross Pathology. The only significant ab-
normal findings were within the thorax. 100
cubic centimeters of bloody fluid were present
within the right pleural cavity. The pericardial
sac contained 75 cubic centimeters of chylous
fluid. The mediastinal tissues were distorted
for December, 1950
1173
Fig. 1. Right oblique roentgenogram of the chest taken
during diodrast visualization of venous return to the heart.
Note the marked narrowing of the superior vena cava and
the increased venous circulation about the left shoulder
girdle.
by much recent hemorrhage. The superior vena
cava had been partially surgically freed from
the thick, enveloping fibrous tissue. 1.5 centi-
meters above the entrance into the right au-
ricle the vessel wall became thickened, hard
and inelastic. This change extended from this
point to the junction of the innominate veins,
the involved vessel measuring 5 centimeters in
length and 2.5 centimeters in diameter. Multiple
transverse sections revealed firm homogeneous
Fig. 2. Cross section of the superior vena cava midway
between the right atrium and the innominate junction.
The specimen has been laid apart to show the contiguous
cut surface. The small, roughly cut triangular remnant of
the lumen is shown in the upper and lower right hand
corners.
yellowish gray cut surfaces. The remaining
lumen was eccentric and narrowed to 0.5 by 0.2
centimeters in its smallest diameters, gradually
widening at both proximal and distal ends
(figure 2). In the middle 2 centimeters of the
length of the superior vena cava it was impos-
sible to find a line of demarcation between the
adventitia of the vessel and the surrounding
mediastinal tissue. In the hilus of the right
lung was a discrete lymph node measuring
1.5 x 1 x 0.5 centimeters, which on section revealed
soft, yellow caseous material. The remaining
lymph nodes appeared grossly normal. Al-
though the right main stem bronchus, the
esophagus and the medial aspect of the right
upper lobe were adherent to each other by
this fibrotic process, there was no evidence of
compression of these structures.
Microscopic Pathology. Sections of the super-
ior vena cava showed only a small, slightly
thickened segment of the vein wall in which
the architecture was recognizable. The remain-
der of the wall was replaced by interlacing
and whorled bundles of collagen and fibrous
tissue, with only a few scattered fibroblasts.
The junction with the slightly thickened ves-
sel wall was diffusely and densely infiltrated
with lymphocytes and plasmacytes. In some
situations the fibrous bundles formed small
fusiform spaces, while in others there were
large, dilated, endothelialized spaces with a
moderate surrounding infiltration of lymphocytes
and plasmacytes. Scattered irregularly through-
out were focal collections of similar cells, while
in other situations a fine fibrous stroma was
similarly diffusely infiltrated. The microscopic
appearance was that of a non-specific granu-
lomatous process without foreign body reaction.
The lumen of the superior vena cava was eccen-
trically distorted by the fibrous tissue to a
narrow slit. The adventitia could not be posi-
tively identified. Sections of the fibrous tissue
surrounding the vein showed changes similar
to those described above. Masson, T.P.H., and
reticulum stains showed no stromal elements
other than fibrous tissue and collagen; iron
stains were negative.
DISCUSSION
Two excellent reviews of the subject of su-
perior vena cava obstruction have appeared
within the last year, those of Hinshaw2 and
of McIntyre and Sykes.3 The latter is compre-
hensive and complete. The authors reviewed
all the reliable cases reported to date.
Approximately 35 per cent of cases of ob-
struction of the superior vena cava are due to
compression by tumor, 24 per cent by aortic
aneurysm, and 10 per cent by chronic fibrous
mediastinitis, the etiology of the latter being
in considerable doubt. In the course of such
fibrosis, obstruction is due to mere compression
or secondary caval thrombosis, whether this be
purely mechanical or associated with local phle-
bitis. The unusual feature in this case was the
apparent lack of compression of the vein and
the absence of thrombosis. The vessel wall
had been in great part replaced by tissue iden-
tical to that surrounding the vein and the lumen
almost completely obliterated by similar en-
dothelialized tissue. The latter was exactly the
1174
The Ohio State Medical Journal
same as the photomicrographs reproduced in
the report of Erganian and Wade.1
Ultimate diagnosis of the mechanism of ob-
struction in upper caval compression rests en-
tirely on roentgenologic techniques followed by
exploratory thoracotomy. Failure to visualize a
mass points strongly to primary caval throm-
bosis or fibrous mediastinitis, where often little
is seen in the chest film but a slight, diffuse
hazy widening of the upper mediastinal shadow.
Angiocardiography aids in judging the extent
of obstruction and furnishes the surgeon with
the proper choice of the operative site. With
some exceptions, exploratory thoracotomy is
indicated. The latter procedure is no longer con-
sidered to be as formidable as it once was, and
unlike this case, it is possible in some instances
to remove the ensheathing fibrous mass with good
results.
SUMMARY
A case of superior vena cava syndrome due
to chronic fibrous mediastinitis is presented in
■which there was neither compression nor throm-
bosis of the vessel, but rather a replacement
of the wall and almost complete obliteration of
the lumen by collagen and fibrous tissue iden-
tical to that surrounding the vein.
REFERENCES
1. Erganian, J., and Wade, L. J. : Chronic Fibrous Medi-
astinitis With Obstruction of the Superior Vena Cava.
J. Thorac. Surg., 12 :275, 1943.
2. Hinshaw, D. B. : Obstructions of the Superior Vena
Cava ; A Review of the Literature With Two Case Re-
ports. Am. Heart J., 37 :958, 1949.
3. McIntyre, F. T., and Sykes, E. M. : Obstruction of
the Superior Vena Cava; A Review of the Literature and
Report of Two Personal Cases. Ann. Int. Med., 34 :925, 1949.
Classification of Cervical Cancer
The proposed modification of the classification
of cervical cancer follows:
Stage O
Carcinoma in situ — also known as preinvasive
carcinoma, intra-epithelial carcinoma and similar
conditions.
Stage I
The carcinoma is strictly confined to the
cervix.
Stage II
The carcinoma extends beyond the cervix, but
has not reached the pelvic wall. The carcinoma
involves the vagina, but not the lower third.
Stage III
The carcinoma has reached the pelvic wall.
(On rectal examination no ‘‘cancer-free” space
is found between the tumor and the pelvic wall.)
The carcinoma involves the lower third of the
vagina.
Stage IV
The carcinoma involves the bladder or the
rectum, or both, or has extended beyond the
limits previously described.
The Effects of Glove Powders on the Eye
The possibility of accidental instillation of
glove powder into the eye from unrinsed or
punctured gloves must be considered. Experi-
mental studies have been made which demon-
strate the harmful effects of magnesium silicate
(talcum powder) in general surgery. Cham-
lin has shown the harmful effects of the same
powder in the eye. Recently other substances
have been used in general surgery as glove
powders which do not have these effects. They
are potassium bitartrate and a modified starch
preparation known commercially as biosorb.
This study was made to compare the effects of
these newer substances with talc in order to
determine which is the safest for ophthalmic
surgery.
Various amounts of the powders were in-
stilled into the anterior chamber of rabbits’ eyes
and injected beneath the extraocular muscles
of the same animals. The rabbits were observed
for a period of three weeks when the eyes were
enucleated.
GROSS FINDINGS — A ten per cent suspen-
sion of talcum powder in water when injected
beneath one extraocular muscle produced a
moderately severe inflammation which persisted
the entire period of observation. The same con-
centration of potassium bitartrate and biosorb
did not cause as severe an inflammation of the
tissues and in each of these, there was a gradual
resolution of the inflammatory process.
0.1 cc. of a 1 per cent suspension of talc,
when injected into the anterior chamber, tended
to collect as granular deposits on the iris which
was practically absorbed in three weeks. No
gross changes could be seen after one week
from potassium bitartrate in the same dosage.
When .03 per cent mixtures of the same pre-
parations were used, no gross changes were ob-
served in any case.
HISTOLOGICAL FINDINGS— Sections of the
eyes enucleated after the three-week period
were examined for microscopic changes. These
will be reported in detail.
— Frank E. Schwartz, M. D.,
Jay G. Linn, Jr., M. D.,
Pittsburgh, Pa.
Brief authors’ abstract of paper presented at charter
session of the Association for Research in Ophthalmology,
East-Central Section, held in Cleveland, Jan. 10, 1950.
Absolute five-year survival figures on ninety-
nine consecutive cervix cancer patients treated by
x-ray and radium prior to 1944 show a survival
rate of 50.5 per cent. In the obese woman, the
survival rate declines to a 37 per cent average.
— R. C. Hildreth, M. D., Kalamazoo, Mich.; The
Journal of the Michigan State Medical Society;
Volume 49, Number 10, October, 1950.
for December, 1950
1175
Accidental Vaccination: Report of Three Cases in Adults
With Severe Generalized Vaccinia in One Case
HARRY WAIN, M. D., and WALLACE H. BUKER, M. D.
ACCIDENTAL vaccination is the condition
A-\ which results from the chance or accidental
“inoculation or contamination of a non-
immune person with the virus of vaccinia. In
view of the large number of vaccinations that
are performed, accidental vaccinations, while
not rare, are uncommon. Their mode of occur-
rence may be of two types: (1) Auto-inoculation,
in which there is direct transfer of the virus
from the site of vaccination to other portions
of the anatomy; and (2) Hetero-inoculation, in
which the virus is accidentally transferred from
a newly vaccinated person with an active pri-
mary vaccinia to some other person.
The importance and danger of accidental
vaccination depends primarily on the site. A
review of the literature reveals that one of the
most frequent locations is the region about the
eyes, and cases are reported of inoculation
occurring on the cornea with resulting blind-
ness. Vaccinations occurring on the face may
be quite disfiguring.
The lips, nose, tongue and genital organs
all have been reported as sites of accidental
inoculation and frequently present a serious
and confusing diagnostic problem.
Numerous reports are found in the literature
of physicians having had the unpleasant experi-
ence of developing vaccinia lesions on the
fingers and thumbs as the result of performing
vaccinations.
Trommer in the March 20, 1943, issue of
The Journal of the A. M. A. advises physicians
to tape their thumbs with adhesive and to wear
rubber gloves so as to prevent alcoholic de-
hydration and auto-inoculation of the fingers
when performing mass vaccinations. In addi-
tion all physicians should be sure of their
own immunity to smallpox.
A RARE BUT SERIOUS COMPLICATION
Generalized vaccinia is the term applied to
the generalized eruption of typical vaccinal
lesions occurring after vaccination. It varies
in degree from a mild illness with a few
scattered lesions to a severe fatal infection
with a clinical course similar to that of
smallpox. It is a rare but serious complica-
tion of vaccination and reliable surveys place
the incidence at 1 in 20,000 to 1 in 40,000
vaccinations with a case fatality rate of 12 to
30 per cent. About two-thirds of the persons
in whom this complication occurs have skin dis-
Submitted June 17, 1950.
The Authors
• Dr. Wain, Mansfield, Ohio, is a graduate of
Loyola University School of Medicine, Chicago,
1935; received his Master of Science degree in
Public Health at the University of Michigan,
Ann Arbor, 1939; diplomate, American Board
of Preventive Medicine and Public Health;
fellow, American Public Health Assn.; and
Health Commissioner, Dept, of Health, Mane-
field.
• Dr. Buker, Mansfield, Ohio, is a graduate
of Ohio State University College of Medicine,
1920; member of The American College of
Allergists; president of staff and staff consult-
ant, allergy and dermatology, Mansfield Gen-
eral Hospital.
eases and most of these are infants or children
with an atopic dermatitis.
Generalized vaccinia in persons with an atopic
dermatitis or eczema has been called eczema
vaccinatum. Clinically similar conditions occur-
ring in persons with cutaneous diseases have
been called Kaposi’s varicelliform eruption or
pustulosis variolioformis acuta when there was
no history of preceding vaccination or exposure
to recently vaccinated persons.
Tedder in 1936 reviewed many of the cases
reported as Kaposi’s varicelliform eruption and
pustulosis variolioformis acuta. His survey
showed that the clinical features of these
diseases and of eczema vaccinatum are identical.
The failure to obtain a history of exposure to
vaccine virus or the fact that vaccine virus
could not be demonstrated in the lesions was in
most cases the reason for their not being identi-
fied. It has been suggested that the eruptions
known under these three names are identical
and that the vaccine virus is the causative agent.
However, since then in a number of cases diag-
nosed as Kaposi’s varicelliform eruption or
pustulosis variolioformis acuta the virus of
herpes simplex has been recovered. A consider-
able number of cases have failed to yield either
vaccinia or herpes virus, despite appropriate
tests and this fact may be due to inoculation
with yet other viruses.
It is now well known that the virus of vac-
cinia is definitely disseminated by the blood
stream following vaccination. Paschen cited the
work of numerous investigators who showed
that the vaccine virus in all probability reaches
every organ in the body. It is this hematogen-
1176
The Ohio State Medical Journal
ous dissemination which is responsible for gen-
eralized vaccinia. Combes and Behrman state
that the distinguishing feature between general-
ized vaccinia and eczema vaccinatum is that
generalized vaccinia appears on a healthy skin,
whereas eczema vaccinatum occurs only on a
previously diseased skin. In addition generalized
vaccinia is due to hematogenous dissemination
of the virus from the individual’s own vaccina-
tion site. While eczema vaccinatum may also
occur in this manner, it usually follows accidental
contact of the diseased skin with someone else’s
vaccination site, with a subsequent local and
hematogenous spread of the virus.
In almost all of the cases of eczema vaccinatum
that have been reported a pre-existing dermatitis
was present and careful questioning elicited a
history of exposure to some newly vaccinated
person, a few days to several weeks before the
outbreak of the vessicles.
The vessicles of eczema vaccinatum, appear
on the previously diseased skin and exhibit the
characteristic changes of typical vaccination
Generalized vaccinia or eczema vaccinatum on patient E. D.
Note large confluent lesions on left elbow.
pustules. These pustules occasionally appear
in crops from several days to a week after the
initial outbreak. The patients are seriously ill
with high fever and chills and clinically may
resemble true variola. Typical pitting and scar-
ring of the skin is frequently noted upon recovery.
Death may ensue and a mortality of 12 to 30
per cent has been reported.
for December, 1950
The diagnosis of accidental vaccination, gen-
eralized vaccinia or eczema vaccinatum depends
upon clinical history and certain laboratory
findings. There should be a history of vaccinal
contamination within a period of two or three
weeks before the onset of clinical symptoms.
History of exposure of the patient to vaccine
virus is extremely important and is often dif-
Patient E. D. showing typical vaccinal lesions on her atopic
dermatitis. Note lesions are in various stages of eruption.
ficult to obtain. Because of the time element
involved and because of the numerous, devious
and unusual methods of exposure that may oc-
cur, repeated and careful questioning is re-
quired. In taking a history from parents and
even from the patient it must be kept in mind
that important sources of contact may have
seemed trivial and irrelevant and hence are com-
pletely forgotten.
The Paul test is the most convenient and re-
liable diagnostic laboratory procedure available.
Biopsy of an individual lesion is of value and
may show Guarnieri bodies which are thought
to be specific for the vaccinia virus.
REPORT OF CASES
E. D., an unvaccinated eighteen-year old white
female, has suffered from an atopic dermatitis
for the past three years and for several months
has been under the care of one of the authors.
On May 10, 1950, she reported to him for a
regular office visit and complained of some lesions
on her left elbow. She stated that on the day
1177
before her elbow itched and while scratching
it the lesions were noted. On examination ap-
proximately six or seven unbilicated vessicles
filled with a turbid material were noted and a
tentative diagnosis of virus pyoderma was made.
The patient was again seen on May 12 and con-
siderable spread to the hands, wrists, arms, and
neck was noted. The diagnosis of smallpox,
chickenpox, generalized vaccinia and Kaposi’s
varicelliform eruption were all considered, but
careful questioning of the patient failed to re-
veal any significant history.
On May 14 the patient was visited in her home
by the authors and was found to be acutely and
severely ill with a temperature of 103°. She
appeared quite toxic and complained of severe
headache. A widespread and generalized eruption
was present over the extremities, trunk, neck,
and face, and even the eyelids were involved.
Large confluent lesions were present on the
arms and face. The eruption closely resembled
that of true smallpox with the exception that
the vessicles were in various stages of develop-
ment.
Careful questioning of the patient and her
family finally brought forth the statement that
the patient’s twenty-one year old brother had
accepted employment at a nearby industry and
that as an employment requirement he had re-
cently been given “ a shot” against smallpox.
Upon questioning him, it was verified that he
had been successfully vaccinated against small-
pox on April 19 and prior to that time had never
been vaccinated. On examination a successful
primary vaccinal lesion now in the crusting
stage was found to be present on his left arm.
The patient E. D., then recalled that on
May 1, she laundered her brother’s clothes and
Accidental vaccination under left ear on Mrs. S. E., mother
of patient E. D.
1178
even recalled seeing the stains from his vaccin-
ation on his shirt sleeves. This was exactly
12 days after her brother’s vaccination and
within the 8 to 12 day period when his primary
vaccinia was at its height. The appearance
of her first lesions occurred exactly 9 days after
this exposure to vaccinal virus.
This significant history, plus the typical clini-
cal appearance of the lesions, now made positive
a diagnosis of eczema vaccinatum or generalized
vaccinia in an adult with an atopic dermatitis.
The patient had a stormy course being acutely
ill for approximately nine days with recovery
occurring about eighteen days after onset. For-
tunately only slight pitting and scarring occurred
on her face, but moderate to severe pitting and
scarring is present on her extremities and trunk.
The patient’s mother, Mrs. S. E., a forty-eight-
year old unvaccinated person stated she had a
“funny sore” starting in front of her left ear.
Examination on May 17 revealed a typical ac-
cidental vaccination in about the fifth or sixth
day of development. Mrs. S. E. had been caring
for and dressing her daughter’s numerous lesions
and had thoroughly seeded herself with vaccinal
virus. About five or six days after the ap-
pearance of her first lesion she developed two
other lesions in her right external auditory
canal and also developed a number of small
vessicles adjacent to her original accidental vac-
cination site. All-in-all, she developed a total
of seventeen vaccinal lesions. An uneventful
recovery occurred with several typical vaccina-
tion scars resulting on her left cheek.
R. D., the twenty-three-year old husband of
patient, E. D., also accidentally inoculated him-
self and developed a typical “immune take” on
his left check below the eye. R. D. gave a his-
tory of having been vaccinated as a child and
of being revaccinated while in the army in 1945,
thus giving him a currently satisfactory im-
munity.
The only member of the household to escape
accidental vaccination was the father, who gave
a history of two successful vaccinations a num-
ber of years ago.
SUMMARY AND CONCLUSIONS
(1) Three cases of accidental vaccination are
reported, one of which was a severe case of
generalized vaccinia in an adult with an atopic
dermatitis. These cases are presented because
of their unusual interest and the difficulty that
may be encountered in diagnosing such cases.
(2) A brief review of the literature on ac-
cidental vaccination, generalized vaccinia, eczema
vaccinatum and Kaposi’s varicelliform eruption
is presented.
(3) Generalized vaccinia and eczema vaccina-
tum at times closely resemble variola, but lack
the prodromal stage and the evolution of the
lesions differ. Furthermore the report em-
phasizes the importance of obtaining a history
of exposure to vaccinal virus in these conditions.
(4) Preventive procedures consist of the fol-
lowing:
(a) Properly instruct patients as to the
care of vaccination sites and the possible
danger of auto or hetero-inoculation.
(b) Keep recently vaccinated persons away
from contact with non-immune persons, espe-
. The Ohio State Medical Journal
dally those suffering from a chronic der-
matitis.
(c) Defer performing vaccination on in-
dividuals with cutaneous disorders.
(d) When vaccinating use the multiple
puncture method with a small insertion us-
ing a total area not exceeding one-eighth
inch in diameter and with 20 to 25 punctures.
(e) While shields, pads and dressings for
vaccinations are contra-indicated because
they favor softening and contamination of
the vesicles, it is wise to pin or attach
several layers of dry sterile gauze inside the
sleeve so as to protect the vaccination site.
If these simple precautions are used, it will
reduce to an even lower extent the present
relatively rare incidence of complications fol-
lowing vaccination.
REFERENCES
1. Tedder, J. W. : Eczema Vaccinatum. Arch. Dermat.
& Syph. 34:1008, Dec., 1936.
2. Hershey, F. B., and Smith, W. E. : Generalized Vac-
cinia in An Eczematous Child. Am. Jr. of Dis. Child.
69:33, Jan., 1945.
3. Collett, R. W., and Kennedy, R. L. J. : Accidental
Vaccinia. Report of Two Cases in Infants, With Eczema
Vaccinatum in One Case. Jour. Ped. 34 :284, March, 1949.
4. Combes, F. C., and Behrman, H. T. : Eczema Vac-
cinatum. N. Y. State J. M 43 :2283, Dec, 1943.
5. Perry, F. G., and Martineau, P. C. : Eczema Vaccin-
atum, J. A. M. A., 141 :657, Nov., 1949.
6. Rubenstein, A. D. : Eczema Vaccinatum, Report of
a Case. New England J. Med., 237 :395, September, 1947.
7. Riley, V. A., and Callaway, J. L. : Eczema Vaccina-
tum; Report of Two Cases with a Review* of the Litera-
ture. J. Investigative Derm. 9 :321, Dec., 1947.
8. Ruchman, I., and Dodd, K. : Eczema Vaccinatum : :
Recovery of Vaccine Virus from the Cutaneous Lesions of
Two Children and the Demonstration of an Antibody Rise
During Convalescence. Jour. Ped. 33 :544, Nov., 1948.
9. Good, R. A., and McLachlan, I. M. : A Case of
Generalized Vaccinia in an Eczematous Child Simulating
Variola. Public Health, London, England, 63 :59, Jan., 1950.
Benefits, Also Complications, Result
From New Hormones
Some of the complications that have arisen
so far from the use of these hormones (Cortisone
and ACTH) are hirsutism, diabetes in those sus-
ceptible to developing diabetes, excited agitated
state in certain individuals and Cushings Syn-
drome.
The whole subject is most exciting and prob-
ably will play a big part, if not in the treatment,
in enlightenment on the pathologic physiology of
many diseases. The whole group of so-called col-
lagen diseases seem to be benefited and also
those diseases in which allergy in its broad
sense seems to play a part.
So far these substances seem to be of probable
value in: (1) hypopituitism, (2) Addison’s dis-
ease, (3) allergy, (4) certain eye conditions, (5)
nephrotic syndrome, and (6) rheumatic fever.
They seem to be of questionable value in: (1)
rheumatoid arthritis, (2) lupus erythematosis dis-
seminata, (3) periarteritis nodosa, (4) nephritis,
(5) lymphomas, and (6) pneumonia. — Oliver
Abel, Jr., M. D., St. Louis, Mo.; The Journal of
the Missouri State Medical Association; Volume
47, Number 11, November, 1950.
The Story Behind the Word
Some Interesting Origins of Medical Terms
Crista Galli — A term descriptive of the ap-
pearance of this process of the ethmoid bone
which projects into the cranial cavity like a
cock’s comb. It is derived from the Latin
words crista or crest and gallus, a cock or
rooster.
Crazy — Literally means cracked or crack-
brained and comes from the Middle English
word crasen, meaning to crack or break. Also
said to come from the French word ecraser,
meaning to crush, crack or break.
Apothecary — This term comes from the Latin
word apotheca, meaning a storehouse. During
the middle ages, it came to mean a storehouse
for drugs. The Latin word in turn comes from
the Greek apotheke, which meant any kind of
storehouse, granary or keeping place. It is
derived from the Greek apo, or from and theke,
a box or chest.
Dyspareunia — This term for painful sexual
intercourse literally means difficulty in lying
beside or going to bed with. It comes from the
Greek dys or difficult and pareunos or lying
beside.
Diaper — This word is derived from the old
French term diaspre, which was applied to a
type of figured linen cloth of which table napkins
were frequently made. Hence the term w~as also
applied to a napkin for an infant. The term
diaspre is said to be a corruption of the name
d’Ypres because this type of cloth was manu-
factured in Ypres, France.
Kaolin — This clay-like substance which is a
silicate of aluminum was introduced into France
in the early part of the 18th Century by Father
d’Entrecolles a missionary in China. The
French word kaolin is a corruption of the
Chinese words kau-ling, meaning high ridge
and the substance was so called from the place
where it was first found.
Comedo — When a blackhead or comedo is ex-
pressed it has a worm like appearance and it was
formerly believed that there was an actual worm
present which ate into the flesh. Hence the
name comedo was given to these lesions, for the
word in Latin literally means a glutton and
comes from comedere, meaning to eat up.
Microbe — This term was suggested by Dr.
Sedillot, a famous French physician in a paper
he read in 1878 before the Academy on the
subject of Pasteur’s influence on medicine and
surgery. Pasteur promptly adopted the v/ord and
soon the whole world was familiar with it.
The word was coined from the Greek words
mikros or small and bios or life.
— Harry Wain, M. D., Mansfield, Ohio.
for December, 1950
1179
The Prevention and Treatment of Deafness in Childhood
HARRY C. ROSENBERGER, M. D.
The Author
• Dr. Rosenberger, Cleveland, Ohio, is a
graduate of Western Reserve University
School of Medicine, 1919; member, American
Academy of Ophthalmology and Otolaryn-
gology, American Laryngological, Rhinological
and Otological Society and American Otological
Society; Fellow, American College of Sur-
geons; and visitant in otolaryngology, St.
Luke’s Hospital, Cleveland.
IN this presentation deafness will be under-
stood to mean either total or partial loss of
hearing although otologic literature prefers
to designate the partially deafened as hard of
hearing. It is not only fitting but important that
an annual convention of doctors of medicine,
specialist and family doctor alike, should give
some consideration to this problem. Unfortu-
nately for the deafened there is no white cane
or tell-tale crutch to excite the sympathies. On
the contrary deafness is the only disability that
actually provokes hostility toward the victim
for the lack of hearing unfortunately is often
misinterpreted as stupidity or rudeness.
EXTENT OF DEAFNESS PROBLEM
If we physicians are interested in securing
the greatest therapeutic return for the least
medical effort then it is in childhood deafness
that we must emphasize and vigorously utilize
the concepts of deafness prevention and treat-
ment. Every physician knows that of 100 hard
of hearing adults possibly 50 suffer the affliction
needlessly. These 50 are the tragic symbols of
medical neglect or, even worse, of medical in-
competence during the patient’s childhood. Every
physician knows or should know that three or four
million school children in the United States have
hearing defects of varying degree. Of these
three or four million school children fully 70
per cent have a remediable hearing defect. Since
every practicing physician has a Hippocratic re-
sponsibility for the otologic welfare of these
thousands of children it is timely to enquire into
the ways in which we may discharge our
obligations toward this group.
HEREDITARY AND CONGENITAL FACTORS
In our busy professional lives we are apt to
forget that the unborn child may be crippled
acoustically by the inherited genes of familial
deafness. Otosclerosis is a case in point. We
doctors must be increasingly conscious of the
role of eugenics in the ills of our patients. In
the contemplation of matrimony the compatibility
of chromosomes would seem to be fully as im-
portant as the compatibility of temperaments.
Thus we see that heredity may be a factor to
consider in the prevention of deafness.
As regards congenital deafness it is possible
for the unborn child to suffer acoustic damage
from certain drugs ingested by the mother. As
is well known the administration of large doses
of quinine, salicylates and other medicaments
Read at the last General Session of the Ohio State Medi-
cal Association Annual Meeting, Cleveland, May 18, 1950.
to susceptible individuals may jeopardize the
auditory function of the fetus.
Another example of congenital deafness is
that induced by the childhood malady of rubella
or German measles afflicting the pregnant woman
in the first trimester of gestation. In this early
state of fetal development the neural epithelium
seems unusually susceptible to the action of
toxins. Therefore, if we are to do anything
constructive about the correction of these heredi-
tary and congenital hazards to the hearing func-
tion, the first step is the recognition that these
hazards exist.
THE ROLE OF THE COMMON COLD
Early in our consideration of the prevention
of deafness we must come to grips with that
evil ogre, the common cold. In spite of the
deluge of advertising of the past winter rela-
tive to the many cold cures, you and I know
that this largely is wishful thinking, to use
a euphemism, and that the common cold and its
dire effects are still with us. The common cold
is the precursor of congestion and blockage
of the nasal passageways and the Eustachian
tubes. This, of course, interferes with the proper
drainage and ventilation of the paranasal sinuses
and the middle ear spaces. In consequence there
may follow suppuration of these spaces. This
eventuality may be hastened by improper and
imprudent blowing of the nose.
In one respect at least it would be fortunate
if suppurative otitis media were the only con-
sequence of these congestive states induced by
the common cold for then the unhappy victims
would seek medical relief because of pain. In
this way guidance could be offered to the suf-
ferers and deafness prevention instituted. On
the contrary, more often the congestive state
stops short of suppuration and pain and pro-
duces merely an edema and cellular reaction
1180
The Ohio State Medical Journal
within the mucous membrane. In the middle
ear spaces there often is added a transudate
which offers still more hindrance to the proper
functioning of the part. If these conditions
persist the mucous membrane undergoes
myxomatous change, fibrous tissue is formed and
ossicular movement is interfered with.
INSIDIOUS NATURE OF CHILDHOOD DEAFNESS
The particular noxiousness of this process lies
in the partial loss of hearing that goes un-
recognized and untreated together with the lack
of discomfort which lulls the victim into neglect
of indicated therapy and promotes a false sense
of well-being. To be of aid to this group of
hearing defectives who more often than not are
unaware personally of their handicap we must
practice what might be termed medical sleuthing.
We must keep in mind that these patients exist
in great numbers and we must search them out.
We must remember that it is in childhood that
these hearing losses are frequently reversible
but if untreated they constitute the initial phase
of a greater and often irreversible defect in
later life.
DEAFNESS AND DISEASED ADENOIDS
Diminished hearing in childhood due to con-
gestion of the Eustachian tube can result from
other conditions besides the common cold. I
refer particularly to tubal catarrh incident to
obstructing or diseased adenoids. It is both
spectacular and satisfying to observe the spon-
taneous improvement in a child’s hearing follow-
ing a therapeutically indicated and well per-
formed adenoidectomy. Crowe of Johns Hopkins
has rendered children and otology a service by
calling attention to the relationship of diseased,
hypertrophied adenoids to hearing loss in child-
hood. It is regrettable that the use of radium to
alleviate this condition has been so overem-
phasized. Here again the prevention of hearing
loss must first begin with its being looked for
and then will naturally follow the appropriate
remedy.
AUDITORY DAMAGE FROM CONTAGIOUS DISEASES
In considering methods of deafness prevention
in childhood we must recall that auditory damage
may follow certain of the contagious diseases
common in childhood. Mumps and meningitis
are two such diseases. In epidemic parotitis
one or both ears may be involved and if uni-
lateral the disability may escape detection unless
looked for. The early use of convalescent serum
may be beneficial. Meningitis, whether epidemic
or pyogenic in origin, constitutes a serious hazard
to the hearing. The meningococcic type carries
the greater risk to the hearing but use of the
antibiotics has been efficacious. Ten years ago
scarlet fever was a common cause of impaired
hearing but today, thanks to chemotherapy and
the antibiotics, it no longer is the dreaded de-
stroyer of auditory function. I am sure that
many of us can recall the marked invasive and
destructive qualities of the ‘‘scarlet ear.”
DEAFNESS PREVENTION BY AUDITORY SCREENING
Certainly the greatest single forward step in
deafness prevention in childhood has been the
introduction and development of screening tests
for auditory dysfunction in school children which
now is a duty of all metropolitan school systems, -
while in the rural areas it is carried on under
supervision of the State Department of Health.
This health procedure is comparable to the mass
chest survey conducted by the Red Cross in the
fight to stamp out tuberculosis. By the routine
testing of hearing of grade school children there
is brought to light not only the neglected dis-
charging ear with impaired hearing but also,
and even more important, the thousands of ears
which are the seat of a congestive process caus-
ing only minor hearing loss. Here is the one dif-
ficulty most universal and most prolific of ill
consequence to the patient but which lends itself
fortunately to the most brilliant therapeutic re-
sults. It truly is a harvest ripe unto the reaping.
In harmony with the auditory screening pro-
gram of the modern school system it would be a
salutary thing if every practicing physician who
makes a physical examination would include an
evaluation of his patient’s hearing function. This
applies especially to children and young adults.
It should be more thorough than merely to dem-
onstrate adequate binaural hearing for ordinary
conversation but need not require elaborate equip-
ment or the expenditure of much time. Indeed,
if nothing more were done than to note the child’s
hearing response to an ordinary pocket watch
the effort would be laudable, the technic ex-
cusable and the results beneficial to all con-
cerned. A child with a hearing function de-
pressed more than slightly could then be investi-
gated more thoroughly.
PITFALLS IN ANTIBIOTIC AND CHEMOTHERAPY
Passing on now to a consideration of the
treatment of deafness in childhood it must be
pointed out that the following remarks are
largely generalizations rather than specific
recommendations. The ear condition that most
frequently brings the little patient to the family
doctor is the aching ear of otitis media associated
with the common cold or other upper respiratory
infection. Whether good or bad it nevertheless
is a fact that the routine prescribing of chemo-
therapy or antibiotics for this complication has
become almost a standard practice among many
medical practitioners. That good has been accom-
plished is indicated by the marked lessening of
chronic discharging ears and surgical mastoiditis
since these newer drugs have been commonly used.
jor December, 1950
1181
That harm has possibly resulted in some in-
stances by the masking effect of these drugs
on important symptoms cannot be denied. More-
over, warnings have been sounded by informed
workers that the indiscriminate and faulty use
of chemotherapy and antibiotics may provoke a
condition of drug fastness in the patient or or-
ganism which later may engender serious con-
sequences to the patient when his need for these
drugs may be greater. If it is decided to use
these newer drugs then they should be used with
the necessary precautions, in adequate dosage
and with alertness for possible masking.
Another condition that far too often insidiously
and progressively pilfers the hearing reserve
of the unsuspecting juvenile patient is the so-
called catarrhal otitis that often is concomitant
with or follows the severe and prolonged head
cold. This difficulty the child will seldom identify
or complain of and it must be suspected and
searched for by the interested and vigilant prac-
titioner. Its treatment is variable but often in-
cludes some form of tubal inflation. Associated
sinusitis and diseased tonsils and adenoids must
receive appropriate attention together with at-
tempts to control any allergy that may be present.
! THE CHRONIC DISCHARGING EAR
It is wise to say something about the treat-
ment of the chronic discharging ear which happily
is seen less and less among the school population.
For medical men who view with complacency the
chronic discharging ear of childhood a word of
censure must be spoken. The chronic discharg-
ing ear is always important for it jeopardizes
the hearing if not life itself. With persistent
and adequate treatment together with necessary
surgery when indicated it is surprising and
gratifying how often the chronic discharging ear
becomes dry. It is well to remember the rule
of thumb that designates as potentially serious
the ear that discharges longer than four weeks
no matter how mild the associated symptoms.
NECESSITY OF DOING GOOD ADENOID SURGERY
No discussion of the problem of deafness in
childhood would be complete without reference
to the spectacular hearing improvement which
occasionally follows the surgical removal of dis-
eased adenoids. There can be no denial of the
fact that hearing can be improved by the re-
moval of diseased or obstructing adenoids. Un-
happily this truth is sometimes debased by using
it as justification for the performance of un-
necessary and unjustified surgery. To be moral
our surgery should be indicated and it should
also be well done. As an examiner for the Army
in World War II, in my association with a trail-
ing program for residents in otolaryngology and
in my private practice, I have seen the results of
both good and bad tonsil and adenoid surgery.
I might aphoristically summarize my impression
of this surgery by stating that it is no better
than the scruples and surgical training of the
surgeon performing it. It therefore follows
that the frequency and degree of hearing im-
provement following adenoid surgery will be
directly proportional to the indications for, and
to the thoroughness and skillful performance of,
the operation.
USE AND ABUSE OF RADIUM
Utilizing the depressing effect of irradiation
on cellular mitosis the present enthusiasm, one
might almost say frenzy, for the use of radium
applicators in the nasopharynx in cases of child-
hood deafness has gotten somewhat out of
bounds. At the last meeting of the American
Academy of Ophthalmology and Otolaryngology
considerable information was presented by vari-
ous specialists including a physicist and a radi-
ologist calling attention to the basic dangers
inherent in such therapy. It was strongly recom-
mended that the radium applicators for the
nasopharynx be used with much more caution
than heretofore in the interest of both the pa-
tient and the doctor. This advice would seem
to be well considered and timely and will in
no way deprive the occasional needful patient of
this form of therapy. Surgery, with emphasis
on well done surgery, should still be the first
choice in most cases for eradicating the dis-
eased or hypertrophied adenoid. Irradiation
should be reserved for the exceptional case of
adenoid mass or lymphoid follicles inaccessible
to surgical attack.
NECESSITY FOR LIP READING AND SPEECH TRAINING
Although lip reading and speech training are
consigned to the last paragraph in this presen-
tation this fact in no way indicates their im-
portance in the scheme of the prevention and
treatment of deafness in childhood. It would
exercise a sobering influence on all of us were
we to visit the Ohio State School for the Deaf at
Columbus. There we would see some 300 resi-
dent children whose hearing is so inferior as to
require special training in lip reading. Also,
by reason of their inadequate hearing, the speech
of these children is likewise so faulty that speech
training is mandatory.
REHABILITATION CLINICS FOR HEARING
DEFECTIVES
War, along with all its attendant misery and
tragedy, also produces or hastens the develop-
ment of ideas and technics that aid humanity.
With the impetus of the last World War there
were developed in the United States several
military Rehabilitation Centers for the acoustic-
ally handicapped. These Centers are for the
2V2 million veterans who suffered acoustic dis-
ability and they are excellent models of efficiency.
1182
The Ohio State Medical Journal
However, no such superlative assistance exists
for the aid and comfort of the 13 million acoustic-
ally handicapped adult and juvenile civilians.
Nevertheless, a beginning has been made, paced
by such institutions as the Lexington School for
the Deaf in New York and the more recent John
Tracy Clinic in Los Angeles.
Here in Ohio in addition to the Ohio State
School for the Deaf, we have in Cleveland the
Alexander Graham Bell School for the hard of
hearing and the Cleveland Hearing and Speech
Center affiliated with Western Reserve Univer-
sity. Ohio State University has a similar af-
filiate while there are some fifteen smaller hear-
ing centers throughout the State. The existence
of these various schools and centers bespeaks
the growing public and private interest in the
problem of the acoustically handicapped child.
In this connection it is of interest to know that
last year in Ohio some 1300 acoustically handi-
capped children were enrolled in public hard-of-
hearing schools and classes and that this service
in the school year 1947-48 cost the taxpayer
$266,000.
CONCLUSION
In conclusion it is. evident that much has been
done and much more remains to be done in the
drive for the prevention and treatment of deaf-
ness in childhood. To be successfully carried out
this problem needs not only the best efforts
of otologists but especially the intelligent and
sympathetic cooperation of all pediatricians and
doctors in general medical practice.
SUMMARY
1. There can be no adequate prevention or
treatment of deafness in childhood until it is
recognized that actual or potential deafness
exists.
2. Practitioners of medicine must be willing
to acquire and to use the simple testing technic
that will indicate the presence of diminished
hearing.
3. Patients so diagnosed must receive the
necessary treatment either from the family doc-
tor or by referral to an interested otologist.
4. It must be common professional knowledge
that treatment is only one factor in the control
of the deafness problem, the others being deaf-
ness prevention, lip reading and the improvement
of faulty speech in the acoustically handicapped.
It is estimated that 40,000 people die in the
United States each year from carcinoma of the
stomach. This is an appalling number, to say the
least. The reported 5-year survival rates . . .,
indicate that the surgical treatment of carcinoma
of the stomach leaves much to be desired and
presents a vital challenge to the medical profes-
sion.— Sawyer & Marvin, Denver; J. of the
Kansas Med. Soc., 51:457, 1950.
KEEPING UP WITH MEDICINE
• Hyperventilation produces a fairly definite
pattern of symptoms — headache, lightheaded-
ness, dizziness, constriction around the chest,
dyspnea, palpitation, numbness and tingling of
the extremities.
* * *
• The eating of liver for the relief of weakness
was recorded in the history of many ancient
peoples.
* * *
• Whenever you see a patient with a dermatitis
and perhaps spikes of fever and abdominal pain,
you should think of drug allergy and stop the
medication at once.
* * *
• Last year for the first time, there were less
than 1000 deaths from whooping cough in
this country.
Hi ^
• Photosensitivity on an allergic basis can be
differentiated from food and pollen allergy in
most cases of solar dermatitis.
* * *
• Some of the side effects of aureomycin are
interesting: mucuous membrane changes have
been reported in the form of perianal irritation,
gross angular stomatitis, cheilosis, vesiculopapu-
lar eruptions on the buccal mucosa, glossitis
(occasionally the black hairy tongue), vaginitis
and vulvitis.
* * *
• The association of enuresis with abnormally
heavy sleep has received scant attention.
* * *
• In congestive heart failure it is desirable to
restrict the sodium intake as a maintenance
program. The desired limitation of sodium may
be attained if salt is not used in the cooking,
if salt is not added at the table, and if salted
crackers, meats, fish, potato chips, cheese,
broths, bouillon, pickles, relishes, gravies and
salted butter are omitted from the diet.
* * *
• The family is the basic economic, reproduc-
tive, and educational unit in every known society.
* * *
• Some of our students of cancer are now pre-
pared to transfer their experience with mice
to human beings and to warn all women with
family histories of cancer NOT to nurse their
babies. In this connection it would seem wise
if they were to discover what percentage of
women with breast cancer ever nursed their
mothers.
* * *
• The advantage of mask therapy is its ability
to provide high concentration of oxygen eco-
nomically.— J. F.
for December, 1950
1183
Cancer of the Tongue1*1
ARTHUR G. JAMES, M. D.
The Author
• Dr. James, Columbus, Ohio, is a graduate
of Ohio State University College of Medicine,
1937; diplomate, American Board of Surgery;
fellow, American College of Surgeons; mem-
ber of American Radium Society, and James
Ewing Society. Formerly, National Cancer
Institute fellow at The Memorial Hospital for
Cancer, New York City; at present senior at-
tending at University, White Cross, St. Francis,
and Children’s Hospitals, Columbus; and asst,
professor in surgery and oncology, Ohio State
University College of Medicine.
CANCER of the tongue is an important dis-
ease because it causes more deaths than any
other head and neck cancer. Next to can-
cer of the lip, it is the most frequently occurring
one in or about the oral cavity. The results
have improved in recent years due to refinements
in both radiation and surgical technique, and if
early suspicions are confirmed by biopsy and
appropriate therapy is applied, the chances of
curing the patient are good.
Cancer of the tongue occurs in both sexes,
but is about six or seven times more common in
the male. It occurs most often in the fifth to
seventh decades, although it has been noted
to occur in the teens and in the ninth decade.
It may occur on any part of the tongue but is
most frequent on the lateral margins and espe-
cially in the middle third.1 The second most
common area is the base. It is difficult to
properly evaluate the contribution of chronic
irritation to the formation of lingual cancer.
These lesions have been seen to develop in areas
that have been continuously irritated by an
irregular or jagged tooth. About one-third of
the patients with cancer of the tongue also
have syphilis.
Lingual cancer tends to be almost symptom-
less in its early stages. The usual story is that
the patient himself discovers either the primary
lesion or a metastatic node and the only com-
plaint is of its physical presence. Occasionally
pain is the first symptom, but is usually never
as painful as the benign ulcerated lesions of the
tongue such as herpes or traumatic ulcers. If
the lesion occurs in the base of the tongue,
hoarseness, dysphasia or dyspnea may occur,
depending upon the size of the tumor. Necrosis
and hemorrhage are usually late symptoms.
DIAGNOSIS
Cancer at the base of the tongue may be over-
looked because the physician is sometimes prone
to ascribe vague soreness of the throat to an
enlarged pair of tonsils. A diagnosis of cancer
of the tongue should always be verified by the
pathologist. A tentative diagnosis is not dif-
ficult in the usual case. Cancer should always
be suspected in chronic ulcers or indurated areas
in any part of the tongue. A specimen for
biopsy should be taken early, preferably at
the first visit of the patient. This can very
easily be performed with local anesthesia and
a biopsy forcep. If the lesion is located in the
* From the Surgical Service, University Hospital, Ohio
State University College of Medicine, Columbus, Ohio.
base it may not be obvious on direct inspection
of the oral cavity with flashlight and tongue
blade. A laryngeal mirror may be necessary
to view the base as far as the valleculae. A
biopsy specimen of the base can easily be taken
with a curved forcep. One should not hesitate
to perform a biopsy just because a patient is
luetic. There is never any justification in delay-
ing biopsy in order to rule out a gumma by
therapeutic trial. The occasional lesion that
will turn out to be a gumma will heal just as
well whether or not a specimen for biopsy was
taken. The idea that syphilis may simulate any
disease was so well taught to the past genera-
tion of physicians that many times a tumor of
the tongue is called a. gumma just because the
Wassermann reaction happens to be positive.
A biopsy specimen from a fungating cancer of
the tongue is usually best taken by a biting
forcep.
TREATMENT
The treatment of cancer of the tongue depends
on the type of cancer to be treated, on the loca-
tion of the lesion, and whether or not metastatic
nodes are present in the neck. Adenocarcinomas,
sarcomas, and other radioresistant lesions should
be treated by surgical eradication whenever pos-
sible. In the main, cancer of the tongue is epi-
dermoid in type. This is usually a radiosensitive
tumor. The treatment of this type of lesion
when located in the base is best by high voltage
external radiation, plus interstitial radium. In
this manner the lesion can be controlled in a
very high percentage of times.
In general, three external ports are used, one
on either side of the neck and one in the supra-
hyoid region. It is very important that these
1184
The Ohio State Aiedical Journal
ports be centered by actually palpating the base
of the lesion and determining as accurately as
possible where the center of that lesion would be
projected onto the skin surface. These centers
can be permanently located by tatooing that area
with India ink. This insures against the mark
being washed away and using a slightly dif-
ferent center for each treatment. These ports
should be just large enough to cover the lesion,
plus a little of the surrounding normal tissue.
Circular ports are preferred to square ones
because by actual figuring about 20 per cent less
normal tissue is irradiated. For the usual case
these ports are from five to seven centimeters
in diameter.
The amount of radiation given will vary with
the size of the ports and with the amount of
interstitial radium used. In general, the dosage
of external radiation is brought up to skin
tolerance. We prefer interstitial radium in the
form of radon seeds rather than the element
needles. These have several advantages over the
element. They may be implanted through the
skin of the neck in surgically cleaned fields in-
stead of being inserted through the mouth and
directly through the mucosa of the tongue, which
is usually at least somewhat ulcerated and super-
ficially infected. The radon seeds are more
economical than the element. The process of
inserting radon seeds is less cumbersome than
using the needles because it is not necessary
to remove the seeds. They may be inserted and
in a few minutes the patient may be on his way.
When the lesion is located elsewhere on the
tongue, the treatment may be x-ray and radium
or by surgical excision. The decision is usually
made on the basis of whether a peroral cone
can be used to cover the lesion. The cone treat-
ment yields as many cures as partial glossec-
tomy, yet functionally the results are better.
A field just large enough to cover the lesion is
used and the amount of radiation given depends
upon the size of the port and whether low or
high voltage radiation is used. If the patient
develops positive neck nodes at a later date after
the primary has been controlled, the best possible
treatment is by radical neck dissection.
SURGICAL TREATMENT
Many operations have been graced by the
term “radical neck dissection.” What we mean by
the term is an operation which exposes the en-
tire side of the neck and removes the sternocle-
idomastoid muscle, internal jugular vein, and all
the lymphatic-bearing tissue between the clavicle
below, mandible above, and between the skin and
the deep muscles of the neck. If the primary
happens to be a carcinoma of the base of the
tongue and at the same time a single node
metastasis is present in the neck and especially
if that node be located in the upper jugular
chain, then we prefer to treat that node by
radiation at the same time that the base is
irradiated. The reason for this is that it makes
it possible to treat both lesions at the same time.
Otherwise, we would have to wait until the
primary lesion were controlled before the neck
dissection could be carried out or vice versa.
If massive neck metastases are present at the
same time that the primary lesion is being con-
sidered for treatment, then we feel that the best
treatment is by combined neck dissection and re-
section of the primary tumor at the same time. In
this operation a portion of the mandible is re-
moved. It is a good cancer operation because it
removes the primary tumor, the metastatic areas
and all the intervening lymphatic tissues as one
specimen. This operation is very useful in cases
where the primary tumor has been inadequately
radiated and there has been persistence or
recurrence of disease, and especially in cases
where this primary tumor has eroded into the
floor of the mouth or into the mandible. Many
cases that are absolutely hopeless by any other
form of treatment may be salvaged by this
radical surgical eradication. The deformity fol-
lowing this type of procedure is not great. The
patients are able to eat and to talk almost as
well as before surgery.
SUMMARY
1. Cancer of the tongue is second only to
lip cancer in its incidence of occurrence in malig-
nancies of the head and neck.
2. It is easily possible to overlook a carcinoma
of the base of the tongue with tongue blade and
light examination only.
3. A laryngeal mirror examination and digital
palpation should be part of every examination
of the tongue when a tumor is suspected.
4. There is no contraindication in performing
a biopsy of the tongue as an office procedure.
This should be done — as a rule — on the first
examination of the patient.
5. The treatment of carcinoma of base of the
tongue is usually by radiation. Elsewhere on
the tongue, carcinoma may be treated either by
cone radiation or by partial glossectomy.
6. Cervical node metastases should be treated
by radical neck dissection.
7. If a lesion of the base of tongue is bulky
and comes near the bone, and in addition there
are metastatic nodes in the neck, then the only
possible treatment that stands a chance of
salvage is a radical procedure that combines
radical neck dissection with resection of the
mandible and involved tongue.
BIBLIOGRAPHY
1. Martin, H. E., Munster, H., and Sugarbaker, E. D.:
Cancer of the Tongue. Arch, of Surg, 41:888, 1940.
for December, 1950
1185
Unilateral Hodgkin’s Granuloma, Cause of a Sudden
And Unexpected Death
WILLIAM KULKA, M. D.* *
The Author
• Dr. Kulka, Cleveland, Ohio, who died
July 19, 1950, was a graduate of the University
of Vienna, Austria, 1905; a native of Austria,
he came to the United States following the
Nazi invasion of that country in 1939. At
the time of his death Dr. Kulka held member-
ships in The American Society of Clinical
Pathologists, the Ohio State Society of Path-
ologists,, the Cleveland! Society of Pathologists,
the Academy of Medicine, Cleveland, the Ohio
State Medical Association, and the American
Medical Association. He was formerly, path-
ologist, Our Saviour’s Hospital, Jacksonville,
111.; later, in charge of laboratories of Millard
Fillmore Hospital, Buffalo; from 1944 until
deceased, was pathologist on coroner’s staff,
Cleveland, Ohio, where he became head of the
laboratory of pathology and forensic medicine.
HODGKIN’S disease1’ 2- 3 or Lymphogranu-
lomatosis3’ 5’ 6 is characterized by its specific
effects on lymphoid and reticuloendothelial
tissue wherever they are found in the body. The
French call it a “Maladie de frontiere,” i. e., a
disease which presents symptoms of inflamma-
tion2’ 6 as well as neoplastoid qualities.1- 2 The
cause of this disease is still unknown in spite
of the numerous postulations and conjectures
involving various etiological agents.1- 2’ 3* 5
This borderline position has attracted the in-
terests of pathologists and clinicians increas-
ingly since the publications of C. Sternberg7 and
D. Reed.8 Studies and interest have been stimu-
lated continuously by the intensive development
of virus and tumor research. This is demon-
strated by the exhaustive review of Horter,
Rolnick, et al., of the Hodgkin’s Research Founda-
tion. This work published in 1948 listed 572
papers on the subject.
Important factors that hinder the inquiry are:
first, the low incidence of the disease (estimated
as 0.5 to 2.4 per 100, 000)1 2 and secondly, the
lack of a reliable specific clinical test other than
biopsy. The value of the Gordon test1- p-61 on
animals (producing encephalitis in rabbits) is
controversial and considered rather impractical
due to the necessary delay in the production
of positive results. A third factor retarding the
progress of the study of this disease lies in the
limited number of published reports of autopsies
of uncomplicated cases. Jackson and Park-
er,1- pps- 5 & 10 cited only 63 cases in 18,668 autopsies
at the Boston City Hospital performed during
the period of 1897- 1946. Since the introduction
of effective x-ray therapy the reports of post-
mortem examinations of untreated cases have
become exceedingly rare. Consideration of these
facts prompted me to present the following case.
CASK HISTORY
A white female, 30 years of age, died sud-
denly in the backyard of her home. As reported
by her mother, the girl was affected upon detec-
tion of fumes leaking from a refrigerator in the
basement. The mother rushed the daughter up
a short flight of stairs intending to escort her
to a neighbor’s home but the daughter collapsed
suddenly and attempts to revive her were futile.
These circumstances made the case subject for
investigation by the coroner’s office.
Data furnished by police reports, members of
From the Coroner’s Office, Cuyahoga County, Ohio.
* Submitted to The Journal by the author May 10, 1950,
this article is published posthumously. Dr. Kulka having died
on July 19, 1950.
the family and the physician who treated the de-
ceased several times before her death yielded ad-
ditional, although incomplete, information. Prior
to the age of 10 years she had suffered from
several attacks of tonsilitis and chorea. Fol-
lowing tonsillectomy, the chorea subsided. There
was no history of injuries or - illness, except
measles. There was no recollection of swollen
lymph nodes in the cervical or axillary regions.
Beyond the above mentioned conditions in child-
hood, she was never under a doctor’s care until
three months prior to her death. She was de-
scribed by her family as having been robust and
active as a Girl Scout leader. During World
War II she worked for a while as a drill press
operator. A routine x-ray inspection in 1942
revealed no abnormality in the chest. There
was no history of tuberculosis, fainting spells,
dizziness or any symptomatic pruritus.
Approximately three months before death she
developed a progressive cough and, later, at-
tacks of dyspnea. These symptoms improved
when the patient assumed a sitting position and
increased in severity following physical exertion.
The physician consulted made a tentative diag-
nosis of asthma. The cough was relieved by
medication. Unfortunately x-ray inspection was
not made at this time.
ABSTRACT OF AUTOPSY FINDINGS
The body was that of a well nourished white
adult female, 62 inches tall, weighing 158 pounds.
The cervical and axillary lymph nodes were
not markedly enlarged. A slight pitting edema
was demonstrated in the legs.
On opening the body, the subcutaneous fat in
the abdominal wall measured 5-6 centimeters.
1186
The Ohio State Medical Journal
There was no marked abnormality in the skull
or brain.
Chest: — The mediastinum was displaced to the
right. The left pleural cavity was filled with
5500 cubic centimeters of a yellow tinged, cloudy,
plasma-like fluid which clotted when removed
from the body. The entire left parietal pleura
of the thoracic wall, the diaphragm, and part of
the left side of the pericardial sac was lined by
a yellowish pink to grayish white layer of nodu-
lated, granulated tissue. The nodes were 5-10
millimeters thick. The visceral pleura of the left
lung was likewise coated with grayish white
tubercle-like nodes. The left lung weighed 180
grams and was grayish red, shrunken and
atelectatic.
There was no fluid in the right pleural sac.
The right visceral and parietal pleura appeared
smooth and glossy. The right lung weighed 880
grams and was grayish red and aerated.
The thoracic duct was hidden under the layer
of granulated tissue but showed no marked ab-
normality grossly.
In the pericardial sac there was about 50
cubic centimeters of a clear yellowish fluid. The
heart was displaced somewhat to the right, was
small (180 grams) and contracted, but showed
no abnormality on cross section.
Lymph Nodes: Chains of lymph nodes along
the left side of the trachea and along the onsets
of left carotid and subclavian arteries were
grayish red and enlarged to the size of a
cherry. Some were matted together.
The lymph nodes at the tracheal bifurcation
and at the hilus were grayish white. They were
markedly enlarged to the size of a walnut and
moderately hard. Some of them were matted
together. One was closely attached to the left
main bronchus but did not erode its wall.
On cross section these enlarged lymph nodes
were yellowish white to grayish white. Where
matted together, the separating lines between
them were distinct.
Abdomen: The diaphragm was positioned at
the third rib on the right side but descended
to 6 centimeters below the costal arch on the
left, displacing the fundus of the stomach to
the right. The spleen was moderately en-
larged weighing 290 grams and displaced down-
wards. The grayish white follicles were en-
larged, slightly bulging, and irregular in size.
There was no gross abnormality in the gastro-
intestinal tract.
The liver was moderately enlarged (1700
grams) and showed several hard white nodes of
rice kernel size in the capsule.
The kidneys, the urinary bladder, the men-
struating uterus, the ovaries and tubes showed
no abnormality.
The mesenteric lymph nodes showed no gross
abnormality but the retroperitoneal lymph nodes
along both sides of the abdominal aorta from
the hiatus of the diaphragm to the bifurcation
of the aorta were enlarged in the same manner
as those in the thorax. Some of them were
matted together. They were yellowish pink
and softened or, when matted together, grayish
white and fibrotic on cross section.
The inguinal lymph nodes in the left inguinal
triangle were moderately enlarged.
The endocrine glands and the persistent thymus
showed no abnormality grossly or on cross sec-
tion.
MICROSCOPIC EXAMINATION
Left Lung: (Figure 1) The alveoli were col-
lapsed, the alveolar capillaries and the pulmonary
veins widened and filled with blood. The vis-
ceral pleura was fibrotically thickened and en-
closed multiple nodes consisting of masses of
epitheloid cells surrounded by lymphoid cells.
There were some large cells with a lobulated
nucleus of the Sternberg-Reed character, several
Fig. 1 — Granuloma node in pleura of left lung dividing
collapsed pulmonary alveoli (lower part of photo). (1:100)
polynuclear giant cells and quite a number of
eosinophile cells present. The nodes which were
surrounded by a thin layer did not invade the
pulmonary parenchyma. Only occasionally a
group of lymphoid cells could be seen within the
connective tissue surrounding a small bronchus.
Right Lung: (Figure 2) The right lung
showed signs of acute pulmonary edema but no
trace of granuloma-like material.
Fig. 2 — Right lung. (1:140)
Tumor Mass Lining Wall of Left Thorax:
(Figure 3) The tumor mass lining the wall of
the left thorax consisted of a more or less
node-like arrangement of layers of epitheloid
cells reticuloendothelial cells, some plasma cells,
for December, 1950
1187
1
Fig. 3 — Granuloma node in pleura costalis.
(A) Granuloma tissue.
(B) Connective tissue between pleura costalis and
periosteum of ribs. (1:125)
enlarged cells with lobulated nuclei (Sternberg-
Reed), an increased number of polynuclear giant
cells and many eosinophiles. The stroma, when
visible was made up of a network of thin fibers
which occasionally were replaced by layers of
dense fibrous tissue. Blood vessels were con-
spicuously absent. The findings presented the
typical pictures that are considered as character-
istic for Hodgkin’s granuloma.
Nowhere did the granuloma tissue invade the
periosteum and the bony structure of the under-
lying ribs or the intercostal muscles and their
fascia.
Tumor Mass Lining Left Diaphragm: (Fig-
ure 4) The tumor lining the left diaphragm was
of the same structure as that lining the wall of
left thorax. The fascia of the musculature of the
diaphragm likewise was not affected.
Fig. 4 — Granuloma lining left diaphragm. (Fascia and
musculature at lower edge of picture.) (1:100)
Mediastinal, Left Paratracheal and Retroperi-
toneal Lymph Nodes: (Figures 5 and 6) The
normal picture was to a great extent or entirely
replaced by masses of granuloma-like tissue
rich in eosinophile cells, again characteristic of
Hodgkin’s granuloma. Nowhere was the fibrous
Fig. 5 — Granuloma and fibrosis in lymph node. (1:140)
Fig. 6 Hodgkin’s granuloma in pleural node. (1:400)
capsule invaded or broken through, not even where
the lymph nodes were matted together. In large
lymph nodes the described mixture of cells was
less impressive and replaced by fibrous stroma
rich in collagen,
Spleen: A number of lymphoid follicles were
replaced by nodes consisting of granuloma tissue
as previously described.
Ribs: Cross section through the sixth rib of
the right side showed a picture of callus forma-
tion. Cross sections of the left ribs were entirely
normal in appearance.
SPECIAL STAINS
Special stains of lungs, lymph nodes, granuloma
tissue and spleen failed to reveal the presence
of any organism. Acid-fast granules, resembling
minute organisms, seen in the slides stained ac-
cording to Ziehl-Neelsen technique, later could
be identified as eosinophilic extracellular granules.
Slides of blood and bone marrow revealed no
marked abnormality.
Fluid from Left Pleural Cavity : The fluid from
the left pleural cavity was of plasma-like ap-
1188
The Ohio State Medical Jot/rtial
pearance rich in fibrinogen and other serum
proteins. The sediment obtained by centri-
fugation was stained according to Gram’s, and
Ziehl-Neelsen methods and with hematoxylin-
eosin. No organism of any kind was visible.
However, there were some shadows of red cells,
many mononuclear cells, a number of larger cells
resembling the Sternberg-Reed type. Not in-
frequently polynucleated giant cells were seen.
DIAGNOSIS
All these descriptions led to the following
diagnosis: Rapidly growing Hodgkin’s granuloma
of the entire left pleura involving mediastinal
and retroperitoneal lymph nodes and the spleen
caused an enormous left pleural effusion with
collapse of the lung and marked displacement of
the heart and mediastinum to the right.
DISCUSSION
Noteworthy features in this case are: (1) the
rapid development of the disease uncomplicated
by tuberculosis or other conditions with fatal
termination, (2) the slight degree of fibrosis,
(3) the absence of cachexia, (4) the predilection
of the pathology to one side of the body.
Hodgkin’s disease is generally characterized
by a progressive enlargement of the lymph nodes
in chains or groups, the enlargement extending
over a period of months or years. The differen-
tial diagnosis from tuberculosis which frequently
follows in the wake of Hodgkin’s disease and
(terminally) from sarcomatous changes in the
absence of other reliable tests must be based on
biopsies and blood findings.
The age of 30 coincides with the computation
of Jackson and Parker1* pps- 13* i4 estimating that
the greatest percentage of all cases observed
were between 20 and 30 years of age, although
Hodgkin’s disease has been reported almost from
birth to over 80 years.
Extensive involvement of pleura costalis and
pulmonalis by Hodgkin’s disease is rare. Stern-
berg,3* p19 Frankel,5* p-358 Verse, 4* p 332 and Jack-
son1 mentioned some cases of their own and
cited cases from the literature. They described
them as occurring as a miliary chronic indurative
or, rarely, as harness-like spreading, coarsely
nodulated form.
Pleurisy with effusion in Hodgkin’s granuloma
is relatively infrequent, but appears, in the
opinion of Verse4 and of Jackson and Park-
er,i* pp8-13 & 72 to be dependent on the involvement
of the mediastinal lymph nodes or on the in-
cidence of tuberculosis, but rarely originates
from a granulomatous lesion of the pleura itself.
Furthermore, pleural effusions usually are seen
late in the disease and “do not appear to have
any definite bearing on the prognosis.”1* p-73
The possibility that characteristic giant cells
may be found in the pleural effusion has been
mentioned by Verse as a possible aid to diagnosis.
Involvement of the spleen is a common oc-
currence in Hodgkin’s disease.
Remarkable in this case is the complete absence
of lesions on the right side and the marked
confinement to the left lung and its pleura.
The somewhat enlarged fibrotic lymph node that
closely adheres to the left bronchus may have
some bearing on the atelectasis of the left lung,
as well as on the entrance and spreading of the
disease. Unfortunately there was no opportunity
to make elaborate use of this unique material
for research concerning etiology of this condition.
SUMMARY
Autopsy report of a 30-year-old white female
who died suddenly with an enormous unilateral
effusion caused by extensive pleural lympho-
granuloma (untreated Hodgkin’s granuloma) is
presented.
The process affected only the left thoracic and
visceral pleura producing total collapse of the
left lung and leaving the right lung and pleura
entirely unaffected. There were specific changes
involving the paratracheal, mediastinal, and re-
troperitoneal lymph nodes as well as the spleen.
The course of the disease was rapid and the
anatomical structure was not influenced by x-ray
or other therapy.
Multinucleated giant cells and eosinophiles
were found in the exudate as advanced by
Verse as a possible diagnostic aid.
No specific organism could be found. The
extracellular and intracellular acid-fast granules
resembling organisms noted in the slides seemed
to be derived from the granules of the numerous
eosinophilic leucocytes.
REFERENCES
1. Jackson, H., and Parker, F. : Hodgkin’s Disease and
Allied Disorders. New York City, Oxford Univ. Press, 1944.
2. Horter, Herman A., Dratmann, B., Crum, L., Rol-
nick, L. : Hodgkin’s Disease 1932-1947. Cancer Research,
8:1, 1948.
3. Sternberg, C. : Lymphogranuloma und Reticuloendothe-
liose. Erg. d. Allg. Path, und Path. Anat., 30:1, 1936.
4. Verse, M. : Lymphogranulomatose der Lunge und des
Brustfells Henke-Lubarsch. Hdbch d. spec., path. Anatomie
u. Histologie, 3 :280, 1931.
5. Frankie, E. : Lymphomatosis Granulomatosa. Henke-
Lubarsch, Hdbch d. spec. path. Anatomie u. Histologie,
1:348, 1931.
6. Forbus, W. D. : Granulomatous Inflammation, Spring-
field, 111., Charles C. Thomas, Publisher, 1949, 2-31.
7. Sternberg, C. : Ueber eine eigenartige, unter dem Bilde
der Psudoleukaemie verlaufenden Tuberkulose des lymphatis-
chen Apparates, Z. f., Heilkunde, 19 :21, 1898.
8. Reed, D. : On the Pathological Changes in Hodgkin’s
Disease with Special References to Its Relation to Tuber-
culosis, Johns Hopkin’s Hospital Rep. 10:133, 1902.
Actinomycosis is a rather infrequent endemic
disease. Cope stated that wherever there is a
microscope and a laboratory this fungus has
been found to be a cause of disease. It is the
commonest of the systemic fungus infections
and occurs in both the one anaerobic and numer-
ous aerobic forms. The aerobic form is so
rarely a cause of progressive disease that au-
thorities recommend that only the disease caused
by the anaerobic Actinomyces bovis be called
actinomycosis and any other of the family take
name from the genus Nocardia, i.e., nocardiosis.
— Nettrour, The Penn. Med. J., 53:1089, 1950.
for December, 1950
1189
The Ohio Anatomy Law of 1881
PART i
LINDEN F. EDWARDS, Ph. D.
The Author
• Dr. Edwards, Columbus, Ohio, professor
of Anatomy, Ohio State University; member
American Association of Anatomists, Sigma Xi,
Ohio Academy of Science, A. A. A. S., Int. Assn,
for Dental Research; and Assoc. Med. Hist.
O. S. Arch, and Hist. Society.
ONE of the most prevailing characteristics
of legislative bodies in our democratic form
of government is their policy of inconsist-
ency. A most noteworthy example of this policy
is illustrated by the attitude of our lawmakers
during the nineteenth century who demanded of
physicians a knowledge of the structure of the
human body while at the same time they made
it illegal for medical schools to obtain human
bodies for dissection by failing to provide for
legal acquisition of cadavers. Occasionally,
feeble protests like voices crying in the wilder-
ness would be heard from the members of the
medical profession. For example, in 1844, Dr.
Austin Flint declared that “the position which
legislation generally sustains at present toward
this subject is truly anomalous. In its require-
ments for ample knowledge and its penalties
for ignorance and mal practice, in effect, it holds
the following language to the medical student
and practitioner ‘you must not fail to make
yourself acquainted with the construction of the
human machine, composed of a multitude of
parts, combined, and variously involved with
each other; and if you are not found thoroughly
conversant with this intricate pursuit, you
render yourselves liable to heavy damages in a
civil suit . . . but do not dare to study the
constitution of the human body, and the operation
of its organs and functions, if you would avoid
the pain of punishment by fine and imprison-
ment’.”1
In 1849, Dr. R. L. Howard protested that “in
this enlightened age, while the community re-
quires of every physician a familiar knowledge
of anatomy, it takes from him, by its laws, the
only means of acquiring it, and subjects to the
Presented at the annual meeting of the Committee on
Medical History and Archives of the Ohio State Archaeological
and Historical Society held at the Ohio State Museum,
Columbus, April 23, 1949.
severest penalties whoever is detected in pro-
curing, ever so cautiously, the only means of
affording that knowledge. The law, everywhere,
condemns a man to fines and imprisonments who
procures a dead body for dissection; and yet
the very community which makes the law, com-
mands him to steal, by their very necessities . . .
the medical student is obliged to seek a subject
where he can find one, without doing sacrilege
to family feelings, or remain ignorant of one
of the most important branches by which he
is to benefit the human race.”2
As late as 1878, Dr. Starling Loving bemoaned
the fact that “in Ohio the practical study of
anatomy is criminal, yet the courts expect the
medical witness to know that as well as other
sciences when called upon to decide questions
involving life, honor and property.”3
In . spite of opposition to human dissection
from the ignorant and pious who adhered to a
superstition about keeping the body intact and
who argued that dissection blasphemously ex-
posed the secrets of nature, and notwithstanding
a deep-rooted human tendency to protect the
dead, the basic difficulty faced by the medical
colleges in the nineteenth century was lack of
proper legislation. As we look backward from
our vantage point in the twentieth century it’s
difficult- for us to comprehend the stupidity
1190
The Ohio State Medical Journal
of legislative bodies in failing at the very outset
to solve the problem of grave robbing by the
simple expedient of making it possible for medi-
cal schools to obtain dissection material legally.
The first legislative body in the United States
to view the problem realistically was that of the
state of Massachusetts, which passed an anat-
omy act on February 28, 1831, making it lawful
for boards of health and other specified public
officials “to surrender dead bodies as may be
required to be buried at public expense to any
regular physician for the advancement of ana-
tomical science.”4
THE ANTI-DISSECTION LAW OF 1831
Oddly enough, the same year that Massa-
chusetts enacted its anatomy law the twenty-
ninth general assembly of the state of Ohio,
on March 8, 1831, passed “An Act for the
Punishment of Certain Offences Therein
Named.”5 Section 19 of this act reads as follows:
“That if any person shall wantonly dig or take
up any corpse or dead human body, buried or
entombed in any cemetery or burying ground,
either public or private, or shall attempt to do
so; or shall carry away from such cemetery or
burying ground, any such corpse or dead body;
or shall aid, assist, or be in any way concerned,
either in the attempt, or in digging or taking up,
or in carrying away such corpse or dead body,
as aforesaid: every person offending in either of
the aforesaid instances shall, upon conviction
thereof, be fined in any sum not exceeding one
thousand dollars, or be imprisoned in the cell or
dungeon of the county jail, and fed on bread and
w^ater only, not exceeding thirty days, or both,
at the discretion of the court.”
Doubtless, the most enlightened physicians
and surgeons of the state bitterly opposed the
act of 1831. Hbwever, the first concerted voice
of disapproval was not heard until 1835 when
a general medical convention was held in Co-
lumbus. One of the items of business of this
convention was the adoption of the following
resolution, to-wit:
“1. Resolved, That this Convention deem it ex-
pedient and proper, to memorialize the Legis-
lature to so amend the criminal law, as to modify
or repeal the 19th section of the act entitled
“An Act for the punishment of certain offences
therein named,” passed March 8th, 1831; and
further praying the enactment of a law au-
thorizing the dissection of all persons convicted
of capital offences, who die either in common
jails or the Ohio penitentiary, or that are hanged
in pursuance of law.
2. Resolved, That a committee of three mem-
bers be appointed to draft a memorial in the
name of this Society, and present the same to the
Legislature at its present session, in accordance
with the foregoing views.
“Respectfully submitted,
M. Z. Kreider, Chairman.”6
From 1831 onward for the next fifty years a
bitter contest ensued in the Ohio General As-
sembly between the proponents for rigid and
strict laws which curtailed human dissection
on the one hand and the proponents for legis-
lation providing legalization of dissection on
the other hand. The present paper deals with
this see-saw legislative contest and the events
which likely precipitated the various acts in-
troduced in the general assembly bearing on
these two phases of the anatomy problem.
THE WORTHINGTON RIOT
In December 1839 a riot occurred at the
Worthington Reformed Medical College follow-
ing the discovery that several bodies had recently
been exhumed from neighboring cemeteries. The
details of this episode have been enumerated
elsewhere.7 However, it is interesting to follow
the repercussions of this event.
That the Ohio General Assembly had already
been alerted to the charges of grave robbery
brought against the faculty and students of the
Worthington Medical College is evidenced by
the fact that a bill to amend “the act for the
punishment of certain offences therein named”
was introduced and debate begun in the house of
representatives on Monday, December 30, 1839.
The bill proposed to substitute for the existing
penalty of confinement in the dungeon of the
county jail for not more than thirty days for
the offenses of removing or concealing dead
human bodies, imprisonment in the penitentiary
from one to three years.
The following account of some of the debate
on this proposed amendment illustrates the fact
more forcibly than the present writer could
possibly express it, that supposedly rational
lawmakers during this period were more swayed
by human prejudice and passion than by sane
judgment:
“Mr. Morris moved its indefinite postpone-
ment.
“Mr. Patterson remarked, that trespasses were
committed every year upon the graveyard in
the town of Delaware. How long these things
were to continue, he could not tell. Enormities
of the same kind were committed in the burial
ground of this city. These transactions had
been committed so frequently, as to call for
severer enactments on this subject. In introduc-
ing the resolution of inquiry which led to this
bill, he had been governed not only by his own
feelings, but by what he believed to be the senti-
ments of his constituents and a large majority
of people of the State. An institution, not far
from this city, had been charged with taking
bodies wherever it could find them — of doing it
in daylight, and not merely for its own use, but
for traffic. Should we not put a stop to this
nefarious business? Should the remains of par-
ents, of children and relations, be dragged from
their graves for the use of these institutions?
He was aware of that gentleman’s opposition
to the bill. It was, he supposed, because he was
a member of the medical profession. He hoped
the motion would not prevail, but that the bill
might lie on the table, if the House was not yet
satisfied of its necessity.
“Mr. Flood said this offence was, by the exist-
for December, 1950
1191
in g law, punishable by fine and imprisonment.
This bill proposed to substitute imprisonment
in the penitentiary. It was well known that
some outrageous instances of this offence had
occurred within the year past. He would mention
the case of a respectable lady of Washington
County, whom he had well known. She had been
unfortunate, and became deranged, and was
placed in the Lunatic asylum in this city. While
there, she sickened and died, and was buried.
Soon after her decease, her son came for the
purpose of removing the body to Marietta for
interment; but, to his horror, found it had been
taken away. He procured a warrant, and pro-
ceeded to the medical institution at Worthington.
The President of that institution denied the
right of the officer to search. Search was made;
and upon opening a trap door in the center of
the building, the first object that met the eyes
of the son was the body of his mother with
the head mutilated. He had been informed, by
a respectable authority, that persons belonging
to this institution dug up bodies, not for ana-
tomical purposes only, but for trade. Now, was
not an offence like this deserving of imprison-
ment in the penitentiary? He was astonished
that his colleague, (Mr. Morris), who was a
physician, opposed it. In his opinion, the bill
did not make the punishment severe enough. He
would go for a heavier penalty.
“Mr. Morris thought it passing strange —
supremely astonishing, that in this age of im-
provement, when all the arts and sciences and
literature were on the advance, a bill should be
laid on their desks calculated to operate as a
prohibition on the most important science in the
range of natural philosophy, and to subject the
devotee of science to ignominious punishment.
It was a conceded fact, that a knowledge of
anatomy was indispensable, a sine qua non,
in the acquisition of medical science. Without
it, the physician could not exercise his profes-
sion with credit to himself or comfort to the
community. No one would employ a mechanic
who did not understand his business, much less
would anyone entrust the health of himself or
his family to a physician unlearned and unskilled
in his profession, destitute of that knowledge
which cannot be acquired without anatomical
dissection. Mr. M. went at considerable length
into details, somewhat technical, to show how
much the triumphs of modern improvement in
the medical science was indebted to the knowl-
edge of practical anatomy. He would not en-
courage a sacrilegious violation of the grave, or
disregard of surviving friends. Barriers suf-
ficiently strong were already thrown around the
habitations of the dead, by laws now in force.
A law like this would drive from our colleges
poor young men, ambitious of obtaining a knowl-
edge of the profession, and carry into other
States fifty or a hundred thousand dollars, an-
nually spent in the acquisition of the medical
profession. Our own schools would dwindle, and
those abroad reap the benefit we cast away.
Physicians were made accountable to the laws
for mal-practice, unskillfulness and ignorance.
With what consistency, then, could they be
denied the means of perfecting their art?”8
The bill passed the House on Tuesday, Decem-
ber 31, 1839, yeas 47, nays ten.9 Mr. West moved
to amend the title so as to read, ‘‘an act to
prevent the study of anatomy and surgery,”
but this was negatived.
The following day, January 2, 1840, the bill
was reported back to the senate and on motion
was recommitted to the committee on the judi-
ciary.10 On February 14, 1840, the committee on
the judiciary, to which had been referred the
bill to amend the act for punishment of certain
offenses therein named, reported the bill back,
a majority of the committee recommending its
indefinite postponement. The bill was laid upon
the table.
Meanwhile there appeared in various Ohio
newspapers a “Physician’s Notice” signed by
thirty Ohio physicians who bitterly protested
the pending amendment to the act of 1831, and
who threatened reprisals to all legislators vot-
ing for the amendment by declaring their refusal
to give them medical attention if called upon.
They urged other Ohio physicians to take the
same stand.11
Unusual as this method of attack by the
medical profession might appear today, accord-
ing to present-day ethical standards, neverthe-
less, it was evidently effective, since the bill
in question failed to pass the senate when it
came up for final vote on March 21, 1840.12
FAILURE OF FIRST BILLS FOR LEGALIZATION
OF DISSECTION
On March 9, 1840, Senator Allen introduced a
bill to allow subjects for anatomical investiga-
tion in medical schools.13 On March 14, Senator
Glover of the committee on medical colleges
and societies reported this bill back and recom-
mended its indefinite postponement.14 This was
agreed to. Thus was defeated the first attempt
to legalize human dissection in Ohio, and, as
we shall see, it was not until thirty years later
that a law to encourage the study of anatomy
was enacted.
(To Be Continued in January Issue.)
REFERENCES
1. Flint, Austin : Reciprocal Duties and Obligations of
the Medical Profession and the Public. Introductory Lec-
ture Delivered at Rush Medical College, Chicago, 1844.
2. Howard, Richard L. : Lecture, Introductory to the
Course in the Starling Medical College, Columbus, 1849.
3. Loving, Starling : Report on the Progress of Medi-
cine. Trans, of 33rd Ann. Meeting of Ohio State Med.
Soc., 172, Columbus, 1878.
4. Laws of Massachusetts, III, 333-335, Boston, 1831.
5. Laws of Ohio, 29 (1831), 144-155.
6. J. of Proceedings of Convention of Physicians of
Ohio (Cincinnati, 1835) held in Columbus Jan. 5, 1835.
7. For an account of this riot, see Harvey W. Felter:
Worthington College, Ohio, Reformed Medical Department.
The Old Northwest Genealogical Quartely, VI (1903),
157-170; Jonathan Forman: The Worthington Medical
College, Ohio State Archaeological and Historical Quar-
terly, 50 (1941), 373-379; Frederick C. Waite: The Second
Medical School in Ohio at Worthington, 1830-40. O. S. M. J.,
33 (1937), 1334-1336; and Joseph H. Creighton: Life and
Times of Joseph H. Creighton, A. M. (Cincinnati, 1899),
26-27.
8. Ohio State Jour., Columbus, Dec. 31, 1839.
9. Ibid., Jan. 1, 1840.
10. Ibid., Jan. 3, 1840..
11. Ibid., Feb. 18, 1840.
12. Ibid., March 21, 1840.
13. Ibid., March 9, 1840.
14. Ibid., March 14, 1840.
1192
The Ohio State Medical Journal
• • •
Income and Other Taxes
Two Major Changes Are Effected for 1950; Other Federal and State
Tax Laws Are Summarized; Utmost Care in Filing Returns Necessary
THE big story for 1950, as far as taxation
is concerned, is increase in the Federal
Income Tax structure, effected by Con-
gress in the face of a mounting preparedness
program. Another major change in the tax
picture was brought about by revision of the
Social Security Act. Other than those two
major changes, tax laws remain much the same
as those in effect for 1949. The following
summary is submitted in order that physicians
may apprise themselves of changes and review
other tax laws.
Most physicians are in the category of per-
sons who must file returns on (1) Federal Income
Tax; (2) Federal Social Security — (a) Old Age
and Survivors’ Insurance Tax and (b) Unem-
ployment Insurance Tax; (3) Ohio Unemploy-
ment Compensation Tax; (4) Ohio Personal
Property Tax; (5) Ohio Use Tax; and (6)
Ohio Workmen’s Compensation Tax. Obligations
of the taxpayer in regard to laws governing
each of the foregoing are summarized in suc-
ceeding paragraphs.
REVENUE ACT OF 1950
The Revenue Act of 1950 does not change the
rate of tax on individuals, the tax being com-
puted at the same rates applicable to the year
1949. Increased income tax liability of indi-
viduals for 1951 and subsequent years is ac-
complished under the act by removing from
the law as to 1951 and later years the per-
centage reductions (of the total tentative tax to
arrive at the net amount of tax liability).
Technically, the increased tax burden began
with the last quarter of 1950 (the three months
beginning October 1, 1950). However, the use
of October 1, 1950, as a starting date for the
1950 increase does not mean that income re-
ceived or accrued after September 30, 1950, is
segregated and taxed at a higher rate. The way
it works out for the calendar year 1950 is that the
tax is computed on the net income for the entire
year, but the percentage reduction of the total
tentative tax is only about three-fourths of what
it was in 1949.
For the calendar year 1950 an individual will
compute his total tentative tax (normal tax and
surtax) at the same rates that applied on 1949
income, but the reduction of the total tentative
tax will be smaller than for 1949.
(Special provisions are made for those per-
sons who compute their tax for a fiscal year
other than the calendar year.)
The accompanying information in regard
to Federal income taxes is based on mate-
rial supplied to The Journal by Mr. S. F.
Noggle, Columbus, for many years chief of
Income Tax for the 11th Ohio Internal
Revenue District. Every effort has been
made to keep it as authentic as possible
within the limits of brevity. Physicians are
advised, nevertheless, to obtain advice and
assistance in the preparation of their re-
turns from competent tax authorities or
from staff members of the office of District
Collectors of Internal Revenue.
For the 1950 calendar year the percentage
reductions on the tentative tax are as follows:
13 per cent of the first $400 of tentative tax;
9 per cent of that part of the tentative tax
in excess of $400 and not in excess of
$100,000;
7.3 per cent of that part of the tentative
tax in excess of $100,000.
The 1950 Act does not change the personal
exemptions and dependency credits. An exemp-
tion of $600 may be claimed for each dependent
of close relationship. To claim dependency, the
taxpayer must have furnished over half of the
actual amount used for the dependent’s support
in the taxable year. A dependent cannot be
claimed if he has a gross income of $500 or
more for the taxable year.
An additional personal exemption of $600 is
allowed for those who reach the age of 65 and
to those who are blind. The additional credit
applies both to the taxpayer and/or to his
spouse (but not to other dependents).
The 1950 Act does not disturb the system
of splitting the income of married couples
adopted in the Revenue Act of 1948. In effect
this provision places individuals in non-
community property states — for example, Ohio
— on the same basis for income tax purposes as
those living in community-property states. That
is, a husband and wife in many cases may effect
substantial reductions by splitting their income
on a joint return. On such a joint return, the
taxable income (adjusted gross income less
optional standard or ordinary deductions and
less exemption credits) is then divided in half
for December, 1950
1193
and a tentative tax computed on half of the
income.
In addition to the reduction in rates because
of the computation being made only on half
the income, credits are provided after arriving
at the amount of the tentative tax. There is
to be deducted 13 per cent of the first $400 of
such tentative tax, or $52. If the tax is in
excess of $400, the deduction will be $52 plus
9 per cent of the amount in excess of $400. The
net tentative tax is then multiplied by two to
arrive at the total tax liability.
WITHHOLDINGS
The new law increased the withholding rates,
changed the definition of “wages” and added a
new provision in regard to statements furnished
members of the Armed Forces.
A new wage bracket withholding table is
applicable to wages paid on or after October 1,
1950. If wages are paid on or after October 1,
the new tables apply regardless of when wages
were earned.
The rate for withholdings was increased from
15 to 18 per cent (after personal exemptions of
$600 for the taxpayer and each dependent).
Enlisted personnel and all classes of warrant
officers are exempt from tax on the pay they
receive from active service in the Armed Forces
of the United States for any month during any
part of which they served in a combat zone,
after June 24, 1950, and before January 1, 1952.
The first $200 of monthly compensation received
by commissioned officers for similar service is
also exempt. The exemption does not extend to
pensions and retirement pay.
A Supplement to Employer’s Tax Handbook
issued by the Bureau of Internal Revenue gives
new tables for tax withholding rates effective
October 1, 1950.
REPORT OF FUNDS PAID
As in previous years, it is necessary to report
salaries of office assistants and other employees
whose salaries are subject to the withholding
tax. As in previous years, payments in excess of
$500 made during 1950 for interest, rents or
commissions, not subject to withholdings and
paid to anyone other than a corporation, must
be reported on Form 1099 and transmitted with
Form 1096, on or before February 15, 1951, to
the Commissioner of Internal Revenue, Process-
ing Division, Kansas City, Mo.
FORMS AND PAYMENTS
Every person whose gross income for 1950
was $600 or more must file certain income tax
returns with the Collector of Internal Revenue
for his district, not later than March 15, 1951.
Every physician in private practice who comes
within the provisions of the Income Tax Law
must do the following:
1. File a complete income tax return for 1950.
He should use Form 1040, either the short form
or the long form. The short form may be used
only when the adjusted gross income, minus
allowable business deductions, is less than $5,000
and when the tax is taken from the table. The
long form must be used when the income is
$5,000 or more or when the taxpayer wishes
to claim credit for non-business deductions,
such as charitable contributions, personal interest
or taxes.
2. Pay the difference, if any, between the in-
come tax paid during 1950, based on the esti-
mated return for 1950 which he filed during that
year and the amount of the tax computed on
his final return for 1950 filed on or before
March 15, 1951. If he has overpaid, the excess
amount will be refunded or credited against
future tax payments. Amounts refunded carry
interest at six per cent from March 15, 1951,
to date of payment.
3. File a declaration of estimated tax for the
year 1951, and pay one fourth of the estimated
tax for 1951, the balance payable quarterly there-
after. Blanks for filing the 1951 return will
be mailed to taxpayers of record by the district
collectors of internal revenue. If estimated re-
turns for 1951 are based on 1950 income and the
tax computed at the 1951 rates, no penalty will
be assessed even though the estimated tax is
understated by more than 20 per cent.
DISTRICT OFFICES AND DISTRICTS
Income tax payments and returns must be
made at the office of the District Collector of In-
ternal Revenue for the district in which the tax-
payer has his legal residence. There are four
internal revenue districts in Ohio. The counties
comprising each district follow:
For the Columbus District (Ohio 11th) Col-
lector of Internal Revenue, Federal Building,
Water and Gay Sts., Columbus; comprising the
folowing counties:
Adams, Athens, Coshocton, Delaware, Fair-
field, Franklin, Gallia, Guernsey, Hocking, Jack-
son, Knox, Lawrence, Licking, Madison, Marion,
Meigs, Morgan, Morrow, Muskingum, Noble,
Perry, Pickaway, Pike, Ross, Scioto, Union, Vin-
ton and Washington.
For the Cleveland District (Ohio 18th) Col-
lector of Internal Revenue, 262 Federal Building,
Cleveland; comprising the following counties:
Ashland, Ashtabula, Belmont, Carroll, Colum-
biana, Cuyahoga, Geauga, Harrison, Holmes, Jef-
ferson, Lake, Lorain, Mahoning, Medina, Monroe,
Portage, Richland, Stark, Summit, Trumbull,
Tuscarawas and Wayne.
For the Cincinnati District (Ohio 1st) Collector
1194
The Ohio State Medical Journal
of Internal Revenue, Customs Building, Cincin-
nati; comprising the following counties:
Brown, Butler, Clark, Clermont, Clinton, Fay-
ette, Greene, Hamilton, Highland, Miami, Mont-
gomery, Preble and Warren.
For the Toledo District (Ohio 10th) Collector
of Internal Revenue, Toledo; comprising the fol-
lowing counties:
Allen, Auglaize, Champaign, Crawford, Darke,
Defiance, Erie, Fulton, Hancock, Hardin, Henry,
Huron, Logan, Lucas, Mercer, Ottawa, Paulding,
Putnam, Sandusky, Seneca, Shelby, Van Wert,
Williams, Wood and Wyandot.
ADJUSTED GROSS INCOME
Individuals who are employed and receive a
salary have no difficulty in arriving at the amount
of their adjusted gross income. The total salary
received plus any amounts which might be re-
ceived from interest or dividends would in such
cases constitute the gross income.
The physician has more difficulty in arriving at
his adjusted gross income. From the amount of
his cash receipts — if he reports income on the
basis of cash received and disbursements, or
on the amount of total charges if he uses accrual
method of reporting his income — he may deduct
all items of expenditure necessary in earning his
income. These items are described in more detail
in the following sections.
DEDUCTIBLE BUSINESS EXPENSES
Office Rental — If a physician pays rent to
another person for office space, he may deduct
such amount. If he rents a combined home and
office, he may deduct that portion of the rent
charged for the office. If he owns his own home
and maintains an office in it, he cannot claim
deduction for office rent. However, he is entitled
to claim depreciation on that portion of the prop-
erty occupied as an office.
Automobile — The cost of repair and upkeep of
an automobile, including gasoline and oil, used
in professional visits may be deducted. That
part of the salary paid to a chauffeur and
attributable to time spent in driving his employer
on professional calls, may be deducted. Sums
spent for taxi hire, car fare, etc., while on pro-
fessional calls, may be deducted.
Depreciation may be deducted on an automo-
bile used in professional business. The deprecia-
tion which should be deducted annually is figured
by dividing the cost price of the machine by the
number of years of its usefulness. On the as-
sumption that the useful life of an automobile is
four years, the government allows 25 per cent
of the cost price for* depreciation each year. If
a physician has one automobile which is used
exclusively in professional business, he may
deduct the full depreciation each year. If the
machine is used only partly in professional busi-
ness, the deductible depreciation should be com-
puted on the basis of the amount of time the
car is used for professional purposes. If a phy-
sician possesses two cars, each of which is used
partly in professional business, the deductible de-
preciation on each car should be computed on the
basis of the amount of time each car is used for
professional purposes. In other words, if an
automobile is used only partly for business pur-
poses, depreciation may be deducted only on a
proportionate part thereof, the amount of de-
preciation depending on the amount of time the
machine is used in professional business.
A loss occasioned by damage to an automobile
maintained either for business or pleasure, which
is not due to the willful act or negligence of the
taxpayer, is deductible loss in the computation
of net income, provided the taxpayer has not
been reimbursed for such loss by insurance.
It is suggested that physicians be prepared to
substantiate claims for deductions from gross
income for professional use of automobiles in
case income tax officials should call on them for
written records to show the mileage traveled by
them in connection with professional practice,
or to prove just what part of their automobile
maintenance expense was a professional expense,
and therefore deductible.
Professional Dues — Dues paid to professional
associations to which, in the interest of his pro-
fession, the physician belongs, may be deducted.
Expenses incurred in taking graduate courses
have been held not to be deductible.
Traveling Expenses — Traveling expenses neces-
sarily incurred by a physician on professional
calls and in attending medical conventions for a
professional purpose are deductible from gross
income.
Salaries and Wages — Deductions are permitted
for the salaries or wages of nurses, laboratory
workers, technicians, assistants, stenographers,
or other clerical workers in a physician’s office
so long as their duties are connected with pro-
fessional work; also for wages paid maids, jani-
tors, etc., for services rendered in connection
with professional practice.
Medicine, Supplies, Etc. — Cost of medicines
used in the office to treat patients, medicine dis-
pensed, bandages, laboratory materials, chem-
icals and other supplies “consumed in the using”
and necessary to operate the office may be de-
ducted.
Equipment, Furniture, Library, Etc. — Cost of
surgical instruments and laboratory appliances
of more or less permanent value may not be
deducted but a percentage of the purchase price
may be deducted annually under a depreciation
account. The same rule applies to office furni-
ture and books purchased for the physician’s
office library. If improvement to offset obso-
lescence and wear and tear or injury has been
made and deduction for the cost claimed else-
for December, 1950
1195
where in the return, claim should not be made
for depreciation.
General Office Expenses — The cost of tele-
phone, telegrams, heat, light, water, etc., used in
professional services is deductible. Physicians
who keep current magazines and newspapers in
their waiting rooms for the benefit of their
patients, may deduct this item as a business ex-
pense. The cost of professional journals for the
physician’s own use is also a deductible item.
Debts — If the physician’s books are kept ac-
cording to the “Cash Receipts and Disburse-
ments” system, he may not charge off any un-
paid debt because he is then only reporting
as gross income those accounts which have
proved to be good. Bad accounts have not been
reported and are therefore not deductible.
If books are kept on an “Accrual Basis”
(i. e., all fees, either cash or account are in-
cluded in income reported for tax purposes)
it is permissible to charge off all debts which
have been definitely ascertained to be worth-
less during the fiscal year covered by the report.
The physician using the latter system must
be careful to include in gross income bad debts
which have been charged off in previous years
but collected during the calendar year for which
the return is filed.
Taxes and Licenses — All state and county
taxes, except those assessed against local benefits
of a kind tending to increase the value of the
property assessed and those imposed upon the
taxpayer upon his interest as shareholder of a
corporation which are paid by the corporation
without reimbursement from the taxpayer, are
deductible. Taxes on one’s own home are not to
be considered as business expenses, such taxes
being allowable as ordinary deductions only. All
license fees which the physician is required to
pay, including narcotic tax and local occupational
taxes, are deductible. The cost of an automobile
license, unless the car is used exclusively for
business, is to be taken as an ordinary deduction
only. The tax paid on telephone bills, if the
telephone is used for business only, is deductible
as a business expense. This would apply to
office phones. The tax paid on other telephone
bills would be deductible only as an ordinary
deduction. Federal taxes on amusements, club
dues, furs and luxuries are not deductible for
Federal income tax purposes.
Federal Old Age Benefits and Unemployment
Compensation Taxes paid by employers under the
Social Security Act are proper deductions in
making income tax returns. Such taxes are de-
ductible in returns for the taxable year in which
they are accrued or paid, depending upon the
method of accounting employed by the taxpayer.
Social Security taxes withheld by an employer
are not deductible by the employee in computing
his tax liability.
Insurance Premiums — Premiums paid for in-
surance against professional losses are deductible.
This includes insurance against damages for
alleged malpractice, against liability for in-
juries to a physician’s automobile while in use
for professional purposes, and against loss from
theft of professional equipment and damage to
or loss of professional equipment by fire or other-
wise. Premiums paid on life insurance are not
deductible.
Sales Tax Payments — The sales tax paid in
connection with purchase of items used in busi-
ness become a part of the cost thereof and as
such are deductible as business expenses. Other
amounts expended for sales tax are ordinary
deductions and not to be taken as business ex-
penses.
Ohio Gasoline Tax — This tax is deductible to
the extent of four cents per gallon. However,
if a physician has already included cost of gas-
oline as part of his business expenses, the tax
is not again deductible. The tax paid on gasoline
not used in business is deductible as an ordinary
deduction.
Interest — Amounts paid as interest on business
indebtedness may be taken as business expenses.
Interest items paid on personal indebtedness are
deductible only as ordinary deductions. Interest
paid to carry tax free securities may not be
deducted.
Losses by Fire and Theft — Loss or damage to
a physician’s equipment by fire, theft, or other
cause, not compensable by insurance or otherwise
recoverable, may be computed as a business ex-
pense, and is deductible, provided evidence of
such loss or damage can be produced. Such loss
or damage is deductible, however, only to the
extent to which it has not been made good by
repair, and the cost of the repair is claimed as
a deduction.
Legal Expenses — Expense incurred in the de-
fense of a suit for alleged malpractice is deduc-
tible as business expense. However, expense in-
curred in the defense of a criminal action is
not deductible.
ORDINARY DEDUCTIONS
In addition to items mentioned in the foregoing
paragraphs which would not fall under the cate-
gory of ordinary deductions, the following may
be taken under that heading:
Contributions, Gifts, Etc. — It is permissible to
deduct from gross income, contributions made
to charitable, religious, educational and scientific
organizations, no substantial part of the activities
of which is carrying on propaganda, or other-
wise attempting to influence legislation, to an
aggregate amount not to exceed 15 per cent of
the adjusted gross income.
Medical and Dental Expenses — Deduction is
1196
The Ohio State Medical Journal
permitted for extraordinary medical-dental ex-
penses paid during the year, not compensated
for by insurance or otherwise, which are in ex-
cess of five per cent of the adjusted gross in-
come. In the case of a husband and wife filing a
joint return, the expenses are not deductible un-
less they exceed five per cent of the aggregate
adjusted gross income of both. The maximum
allowable deduction on a joint return is $2,500
plus $1,250 for each dependent listed on the
return, not to exceed two. The maximum deduc-
tion is $5,000. The maximum allowed for a
single person with no dependents is $1,250. The
term “medical care” as used in the act, is broadly
defined to “include amounts paid for the diag-
nosis, cure, mitigation, treatment, or prevention
of disease, or for the purpose of affecting any
structure or function of the body (including
amounts paid for accidents or health insurance).”
In order to obtain this credit for medical and
dental expenses, the taxpayer is required to list
the name and address of the person to whom the
payment is made, the approximate date of actual
payment and the amount. It should be noted
that this will furnish the Internal Revenue De-
partment with data which can be used in check-
ing returns filed by physicians and dentists —
another reason why they should keep accurate
records and compile their returns carefully.
OPTIONAL STANDARD DEDUCTIONS
The optional standard deduction permitted
in lieu of listing amounts paid for contributions,
interest, taxes, and other ordinary deductions
is 10 per cent of the adjusted gross income,
but not in excess of $1,000.
DEPOSIT OF WITHHOLDINGS
An employer who accumulates as much as
$100 per month for the purposes of income tax
liability and F. I. C. liability (employer’s and
employee’s shares) shall take these funds with
Form 450 to a bank and deposit them. The bank
transmits this form to the Federal Reserve Bank
in Cleveland for validation, after which it is
returned directly to the employer. The deposi-
tary receipt, Form 450, is then eligible for use.
SOCIAL SECURITY TAXES
The Federal Social Security Act embodies
laws pertaining to Old Age and Survivors’ In-
surance and Unemployment Insurance. Because
the procedures for paying these taxes are dif-
ferent, they are discussed here under separate
headings.
Extensive changes in the whole Social Security
structure were effected by passage of H. R. 6000,
signed by the President on August 28, 1950.
These changes have been incorporated into the
following paragraphs on the subject.
Under the new provisions for coverage of
self-employed workers, physicians are specifically
excluded, as are certain other professional per-
sons and farmers.
New provisions for coverage go into effect on
January 1, 1951. Increased benefits went into
effect as of September 1, 1950.
ADDITIONAL EMPLOYEES COVERED
Domestic workers in private homes who are
employed by a single employer for at least 24
days in a calendar quarter for which they re-
ceive wages of at least $50 are covered. In
general, if a person has a maid or other domestic
worker for one day in the week, she does not
come under provisions of the Act; if a person
has such a worker for two or more days in the
week, she must be covered. Domestic workers
in farm homes come under the same provisions
as farm workers.
A farm worker becomes eligible after he
works continuously for one farm operator for
three months and then continues to work for him
on a full-time basis on at least 60 different
days every three months and earns $50 or more
in cash wages every three months.
Only cash is considered in the wages paid
to domestic or farm workers, not wages paid in
kind.
Household or farm workers are reported to
the Collector of Internal Revenue on Form 941.
If the household employer is already making
Social Security reports on Form 941 for em-
ployees in his professional practice, he may re-
port his household employees on this same form.
Many other types of employees are covered
under the new act. The Federal Security
Agency estimates that an additional ten mil-
lion workers may be brought under its provisions
— bringing the total number covered to about
45 million, or about three-fourths of the nation’s
paid workers.
OLD AGE AND SURVIVORS’ INSURANCE TAX
The Old Age and Survivors’ Insurance Tax is
payable by every physician who employs one
or more persons in his office. An increase in
the rate of payment became effective on Jan-
uary 1, 1950, to the effect that the employer
must deduct IY2 per cent of the employee’s
wages, and must contribute a like amount him-
self. This same rate was carried over under
the new act and continues through 1953.
Through 1950, the amount is deducted and con-
tributed on the first $3,000 of each employee’s
wages. Beginning January 1, 1951, the rate
will be deducted and contributed on the first
$3,600. The tax return and informational re-
turn, combined in one report, is to be filed quar-
terly. The tax must be paid and the return filed
prior to April 30, 1951, for the months of
for December, 1950
1197
January, February and March, 1951 in the office
of the District Collector of Internal Revenue,
and quarterly thereafter, payable the month
after the quarter ends.
FEDERAL UNEMPLOYMENT TAX
The Federal Unemployment Insurance Tax ap-
plies only to employers who have had eight or
more persons on their payrolls on 20 or more
days in the Calendar year, each of the 20 days
being in different calendar weeks. It is payable
to the Collector of Internal Revenue by Jan-
uary 31 for the previous year. The gross tax
is three per cent on all individual wages up to
$3,000, and is paid exclusively by the employer
— the employee making no contribution. (The
$3,000 limit is retained for the unemployment
tax and is not to be confused with the $3,600
maximum under the old age and survivor pro-
visions.) A credit not to exceed 90 per cent
of this tax is allowed on all payrolls which were
reported to the state unemployment compensation
agency (see under Ohio Unemployment Com-
pensation Tax) and the state tax paid by Jan-
uary 31. If an employer has paid his state
unemployment tax in full, the Federal tax is
reduced to three-tenths of one per cent.
OHIO UNEMPLOYMENT COMPENSATION TAX
In general, employment of three or more per-
sons in any one day renders the employer
liable for this tax. There are certain exceptions.
A physician who is in doubt as to his liability,
therefore, should request clarification from the
Bureau of Unemployment Compensation, Co-
lumbus.
Reports are made during the month following
each calendar quarter on forms supplied by
the Bureau. The tax rate is established for
each employer annually according to a table in
the law which is based on the ratio the tax
paid by the employer bears to the benefits paid
to his former employees and chargeable to the
employment the claimants had with the employer.
This rate starts at 2.7 per cent and may be
reduced to as low as three-tenths of one per
cent. Only the first $3,000 paid by any em-
ployer to any one individual within a calendar
year is taxable.
OHIO WORKMEN’S COMPENSATION LAW
Every employer of three or more employees is
required under the Workmen’s Compensation Law
of Ohio to file during the month of January a
statement containing the following information:
The number of employees employed during the
preceding year, the number of such employees
employed at each kind of employment and the
aggregate amount of wages paid to such em-
ployees. The employer must pay into the fund
a premium based upon occupational hazard
of the job in which the employee is engaged.
An employer of less than three persons, although
not obligated to do so, may elect to pay pre-
miums into the funds on employees.
OHIO SALES AND USE TAX
Section 5546-2 of the General Code levies an
excise on each retail sale made in Ohio of
tangible personal property.
The Ohio Use Tax Law, passed in 1936, sup-
plements the Retail Sales Tax Law and imposes
a tax on the same basis as the sales tax on
purchases made outside the State. Its purpose is
to protect Ohio merchants from discrimination.
Many out-of-state firms have made arrangements
with the Ohio Department of Taxation to add the
amount of the tax to invoices covering purchases
by Ohio consumers, collecting the tax and pay-
ing it directly to the Department. However, if a
physician purchases drugs or supplies from an
out-of-state firm which has not made such an
arrangement with the Tax Department, he is re-
quired to report such purchases to the Treasurer
of State and pay the tax. Returns must be filed
with the Treasurer by April 15, 1951, for pur-
chases, during the period January 1 to March 31,
1951, and quarterly thereafter. The report is
filed on Ohio Use Tax Form 1014, “The Quar-
terly Consumers Return.”
Rule 102 of the Ohio Tax Commissioner ap-
plies specifically to physicians and dentists. It
reads: “Physicians and dentists are the con-
sumers of the various items of tangible per-
sonal property which they use in the rendi-
tion of their professional services and the tax
will apply upon their purchase of all items
of tangible personal property, including equip-
ment. The tax does not apply to the fee for
professional services rendered by physicians and
dentists. If physicians and dentists apart from
their professional services are engaged in selling,
to the public such articles as medical supplies,
mouth washes, dentifrices and the like, they
are vendors and must procure a vendor’s license
and collect the tax on all such sales.”
OHIO PERSONAL PROPERTY TAX
There have been no fundamental changes in
the Ohio Personal Property Tax provisions.
Returns under the Ohio Personal Property
Tax Law must be made between February 15
and March 31 annually. One half the amount
of the tax is paid; when the return is filed, and
the other half is due September 20.
The State Tax Commissioner is currently con-
ducting a campaign to increase efficiency in the
collection of this tax, and penalties are being
assessed against those who have been delinquent
or have failed to declare personal property for
taxation.
All intangible personal property in possession
of a physician on January 1, 1951, and tangible
1198
The Ohio State Medical Journal
personal property (not real estate) used by him
in his business, which is subject to taxation
under the Ohio law, should be listed on the re-
turn which should be filed with the county auditor
between those dates. Form 910 is used by in-
dividuals and partnerships, and Form 930 by
corporations.
It must be kept in mind that tangibles to be
listed include personal property used in busi-
ness, such as a physician’s office furniture, fix-
tures, equipment, supplies, etc. Such tangible
property should be listed at its book value. A
depreciation of 10 per cent annually from cost
will be allowed until such equipment reaches a
value of 30 per cent of cost which value should
be used as a utility value.
Such returns should be made in duplicate. The
so-called tangible tax statutes are intricate and
complicated so each physician having taxable
personal property for listing should obtain com-
petent advice in case of doubt as to the meaning
of any of the provisions of the law.
One of the complicated provisions of the tax
law is that involving the listing of credits which
are taxable at 3 mills on the dollar and which
involves the computation of accounts receivable.
Accounts receivable are to be listed in ac-
cordance with Section 5389 of the General Code.
As defined in Section 5327 of the law, credits
“mean the excess of the sum of all current ac-
counts receivable and prepaid items used in busi-
ness when added together estimating every such
account and item at its true value in money, over
and above the sum of current accounts payable
of the business, other than taxes and assess-
ments.”
The same section states that “current accounts
include items receivable or payable on demand or
within one year from the date of inception, how-
ever evidenced.”
In listing his current accounts receivable, the
physician should note after each account what he
considers the value of the account. If he be-
lieves the account can be collected in full, it
should be listed at its full face value. Otherwise,
it should be listed at 75 per cent, 50 per cent,
25 per cent, 10 per cent, etc., of its full face value,
or of “no value” in case that is considered the
“actual value” of this account. The total of these
estimates is the total to be entered as “current ac-
counts receivable” and used in computing credits.
This procedure permits the physician to charge
off bad debts since in his 1950 return he would
be permitted to return as of “no value” accounts
receivable which he listed in 1949 but no part of
which was collected during the past year. More-
over, it permits a physician to depreciate the
actual value of accounts returned in 1949 but
which have decreased in actual value during the
past year.
A. M. A. Announces Standards for
Approval of Sun Lamps
The Council on Physical Medicine and Re-
habilitation of the American Medical Association
recently announced its requirements for the
performance and advertising of sun lamps in
order to obtain the council’s Seal of Acceptance.
“These requirements,” it was explained by
Howard A. Carter, secretary of the council, “are
designed to protect the public against unwar-
ranted claims of the curative and beneficial values
of sun lamps.”
Natural sunlight contains a band of wave-
lengths in the extreme ultraviolet, extending
from about 2,900 to 3,200 angstroms, that is
specific in preventing and curing rickets and
also in producing vitamin D, reddish skin and
tan. With the exception of the tanning reaction,
which extends to about 3,700 angstroms, solar
radiation of wavelengths longer than about
3,200 angstroms has been found to be of no
specific biologic action.
To comply with the requirements for minimum
intensity, a sun lamp must generate sufficient
ultraviolet energy to produce a minimum per-
ceptible erythema (reddening of the skin) on the
average untanned skin in not more than one hour
at a minimum distance of two feet. If the in-
tensity is less than this, the council is of the
opinion that the radiation is too weak to have
any significant prophylactic effect against
rickets. An operating distance of two feet, it
adds, is too short for use in a nursery.
“In accepting sun lamps, the council requires
physical evidence of their production of energy
from 2,800 to 3,200 angstroms in wavelengths
at an intensity which is adequate and safe for
use by laymen,” said Mr. Carter.
“It has been demonstrated both clinically and
experimentally that adequate ultraviolet energy
between 2,800 and 3,200 angstroms plays an
important role in deposition of calcium and may
prevent rickets. There is no warrant for the
claim, however, that ultraviolet rays will insure
normal tooth structure or that ultraviolet rays
will prevent dental caries. Direct exposure of
the skin to ultraviolet rays from the sun or
from artificial sources results in the formation
of vitamin D within the organism, but the
council cannot recognize statements or implica-
tions that vitamin D has all the beneficial effects
of exposure to sunshine.
“Advertising claims for sun lamps containing
statements that exposure to ultraviolet radia-
tion increases or improves the tone of tissues
of the body as a whole, stimulates metabolism,
acts as a tonic, increases mental activity or
tends to prevent colds are not acceptable.”
for December, 1950
1199
Rights of Limited Practitioner . . .
Strong Decision by Judge Emmons, Akron, Holds He Cannot Prescribe
Or Use Drugs; ‘Minor Surgery,’ ‘Drugs,’ Defined; Board Rules 0. K.
A DECISION of far-reaching importance —
citing what mechanotherapists and other
limited practitioners of that category can
and cannot do under the license granted to them
under the provisions of the Ohio Medical Practice
Act and upholding the rules and regulations of
the State Medical Board which govern such
practitioners, was handed down recently by
Common Pleas Judge Claude V. D. Emmons,
Summit County, (Earl Botkin, appellant vs.
State Medical Board of Ohio, appellee).
In affirming the judgment of the State Medi-
cal Board in revoking the license of Earl Botkin,
Akron, to practice mechanotherapy for violating
the rules and regulations of the Board and Sec-
tion 1274-3 of the Ohio General Code, Judge
Emmons set forth the following conclusions in
his written opinion:
FINDINGS OF THE COURT
1. A licensed mechanotherapist must not pre-
scribe or administer drugs of any kind in
performing minor surgery.
2. Minor surgery which he is permitted to
perform must be an operation within the limits
of mechanotherapy.
3. Vitamins and liver extract, as well as sul-
fathiazole ointment and metycaine, are drugs
within the meaning of the statutes of the State
of Ohio.
4. The order of the State Medical Board is
supported by sufficient evidence and is not con-
trary to law.
5. The rules and regulations of the State
Medical Board of Ohio pertinent to the within
action are not invalid or repugnant to the pro-
visions of the Constitution of Ohio and are not
contrary to the laws of this State.
6. The statutes drawn in question in this action
are not invalid for indefiniteness, ambiguity or
uncertainty and are not repugnant to the pro-
visions of the Ohio Constitution and the laws
of the State of Ohio.
SUMMARY OF FACTS
The facts in this case are briefly these: On
June 12, 1946, Botkin, who held a state license
to practice mechanotherapy, was charged by
the State Medical Board with using thiamine
chloride, liver extract, sulfathiazole ointment,
nupercainal, quinocaine, metycaine and otozole,
and that the use of these remedies was in viola-
tion of the rules and regulations of the Board
governing limited practices and violative of the
provisions of section 1274-3, Ohio General Code.
Testimony was submitted to the Board that
Botkin admitted using the drugs referred to
and that he did not testify in his own behalf
nor introduce testimony to deny the charges
at the hearing before a referee appointed by the
Board.
On August 3, 1948, a copy of the opinion of
the referee was filed with the State . Medical
Board, which Board adopted the recommendations
of the referee and on October 5, 1948, entered
an order revoking the license issued to Botkin
and from which order he filed an appeal in the
Summit County Common Pleas Court.
EXCERPTS FROM DECISION
Following are additional pertinent excerpts
from Judge Emmons’ decision, excluding cer-
tain references to sections of the General Code
and court decisions which were cited in the
briefs filed by Botkin and the State Medical
Board and considered by Judge Emmons in re-
viewing the case:
At the outset it will be noted that the power
to revoke a limited practitioners’ license is
governed by sections 1274-6 and 1275 Ohio
General Code.
Part of the general rules and regulations of
the Board governing limited practitioners is as
follows:
‘‘The certificate does not permit the holder
to treat infectious, contagious or venereal
diseases nor to prescribe or administer drugs
or to perform major surgery.”
The appellant complains about the indefiniteness
of the charge made by the Secretary of the
Board, but it is an accepted fact that charges
made by a ministerial body do not have to be in
the same form for exactness and definiteness as
do the pleadings in a court of law or equity.
The appellant was charged with prescribing
and administering certain drugs, and if these, or
any of them, are found by substantial evidence
to be drugs, and the statute is not invalid for
vagueness, or the delegation of the powers to the
Medical Board is not unconstitutional, or their
orders ultra vires, then the Board could well
find the appellant guilty of the violations of the
rules and regulations of the Medical Board and
also section 1275 Ohio General Code, for the
reason that the appellant would have been
1200
The Ohio State Medical Journal
acting contrary to the rules and regulations of
the Medical Board and also acting grossly im-
morally under the statutes of Ohio, which term,
to this court, means wilfully unjust in his
limited practice of medicine or surgery.
The principal questions for the Court’s con-
sideration are as follows:
1. Are the pertinent rules and regulations of
the State Board of Medicine invalid, ultra vires
or unconstitutional?
2. Are the General Code sections 1274-1 and
1274-3 invalid for indefiniteness, uncertainty and
ambiguity ?
3. May the appellant, a duly licensed me-
chanotherapist, prescribe or administer in the
performance of minor surgery any or all of the
following: sulfathiazole ointment, metycaine,
nupercainal, quinocaine or otozole, and in his
limited practice may he prescribe or administer
vitamins or liver extract?
RULES ARE VALID
Are the pertinent rules and regulations of the
State Medical Board invalid and ultra vires or
unconstitutional ?
This question was asked and an attempt made
to answer it in the appellant’s brief wherein he
cites numerous cases, all of which are untenable
because in his cited cases the inherent police
power was not present, while in this case it is.
The right to practice limited or unlimited
branches of medicine or surgery is not an in-
herent or God-given right, nor is it a right
once obtained that is perpetual. It is a right
given to some one who, because of his training,
education and experience, has been found to
have the qualifications to perform in his respec-
tive field, subject, however, to the laws and
rules and regulations governing that right. When
one is given a license to practice in a limited
branch of medicine or surgery, that one im-
pliedly agrees to conform to and abide by the
laws, rules and regulations prescribed for his
particular branch of medicine or surgery, the
nonperformance of which will result in dis-
ciplinary measures such as suspension or revo-
cation of license.
Counsel for the appellant contends that sec-
tion 1274-1 of the Ohio General Code, which
states that the Medical Board shall establish
rules and regulations governing such limited
practice, shall rightly be construed to mean that
the board shall have the right to establish
rules and regulations for the administration
rather than enlarging or restricting the statutory
laws.
“Govern” means to regulate by authority.
Did the Board in this instance enlarge or
restrict the statutory laws? What do we find
in this case?
It is to be noted that the last paragraph in
section 1274-3 and the rules and regulations of
the State Medical Board are practically the
same. They both set out a prohibition therein
whereby limited practitioners cannot use drugs
or practice major surgery, so that by reading
the intention of the legislature into the rules
and regulations of the State Board it makes it
a violation for using drugs, and is such a viola-
tion that the practitioner’s license could be
revoked, and it is not conferring a vagrant
or unconfined discretion upon the State Medical
Board for the legislature has established a
standard of practice and canalized that Board’s
discretion.
The right given by the legislature by statute
to the Medical Board was a right that was a
proper grant under the exercise of police powers*
and such as is a constitutional investment, and
the rules and regulations pertaining to the in-
stant case are valid and not ultra vires.
LAW VALID AND NOT INDEFINITE
Are General Code Sections 1274-1 and 1274-3
invalid for indefiniteness, uncertainty and ambi-
guity?
The appellant claims that since the term
“drug” is not defined in the statute or in the
rules and regulations the term then becomes
vague, indefinite, uncertain and ambiguous.
It is the contention of the appellant that the
evidence clearly indicates that a great uncer-
tainty exists even in the minds of medical men,
and then proceeded to quote the testimony of
Deitrich, who is the inspector for the Medical
Board, but he is not qualified to speak on the
subject of drugs since he is not a doctor,
pharmacist or a chemist.
In this instance Deitrich was expressing a
personal opinion as an investigator, and the
Court does not consider this testimony effective
as the questions propounded to him, in fact, are
such as would make him interpret the rights
of a mechanotherapist under the law, which
province is not his.
It is true that Dr. Platter, the secretary
of the Medical Board, testified that a chiropodist
under the rules and regulations of the Board
prior to the amendment of section 1274-3 Ohio
General Code, was permitted to use drugs in his
limited practice, however, the Court is not
passing upon the right that they had at that
time, whether it was under the proper exercise
of police power or whether the Board arbitrarily
discriminated against the other branches of
limited practitioners — that question is not before
the Court.
So regardless of an added right that the
chiropodist formerly had under the rules and
for December, 1950
1201
regulations of the Board, the rights of Botkin
would not be decreased or increased.
DEFINITION OF “DRUG”
The term “drug” is defined under the pharmacy
laws of this state. Section 1296-1, paragraph 2,
is as follows:
“The term ‘drug’ or ‘pharmaceutical pre-
paration’ means (a) articles recognized in
the official United States Pharmacopoeia,
or official National Formulary, or any sup-
plement to either of them, intended for use
in the diagnosis, cure, mitigation, treat-
ment or prevention of disease in man or
other animals; and (b) all other articles
intended for use in the diagnosis, cure, miti-
gation, treatment or prevention of disease
in man or other animals; and (c) articles
(other than food) intended to affect the
structure or any function of the body of man
or other animals; and (d) articles intended
for use as a component or any articles spe-
cified in clause (a), (b), or (c); but does
not include devices or other components,
parts or accessories.”
The term “drug” as this Court views it,
cannot have a different and varying definition
under the heading of Pharmacy Laws than it
would have under the Medical Board laws. One
works in conjunction with the other, as the
druggist supplies the doctor, and the definition
of the term “drug” should be compatible one
with the other.
The Court is not obligated to read only the
sections of the statute that are contained under
a separate heading and to reconcile them alone,
but all statutes incident to and which have any
bearing on a question should be read together
and interpreted in the light of common under-
standing and reason.
So while the Medical Practice Act does not
have the term “drug” defined, neither do we
find a definition for it under the rules and regu-
lations of the State Medical Board, the Court
does have the right to accept and should recog-
nize the definition of that term under the
Pharmacy Laws of this state, as that section
is in pari materia with the provisions of the
Medical Practice Act, and the legislation is
presumed to be consistent and harmonious in the
enactment of these laws.
Assuming for the purpose of argument that
there was no definition of the word “drug” ap-
pearing in the statutes of Ohio or in the rules
and regulations of the State Board, the Court
must look then to the common conception and
meaning of that word as it is understood in the
profession in which that word is commonly and
professionally used.
Dr. Sollman, a professor emeritus of Western
Reserve University and a man recognized as one
well qualified to speak in medical circles, de-
fines drug as “a substance that is used in the
treatment or prevention or diagnosis of disease.”
This definition is of substantial clarity that no
confusion could result, nor is that definition
unlike the definition contained in the statute
under the Pharmacy section.
The Court, therefore, cannot agree with the
appellant that section 1274-1 and 1274-3 are
invalid for indefiniteness, uncertainty or ambi-
guity.
MAY NOT USE DRUGS
May the appellant, a duly licensed mechan-
otherapist, use any of the following remedies in
the performance of minor surgery; sulfa-
thiazole ointment, metycaine, nupercainal, quino-
caine or otozole, and may he prescribe or ad-
minister vitamins or liver extract?
The fact that the appellant is charged with
administering or prescribing all of the above
styled items does not make it necessary that
all such facts be established. Were the fact estab-
lished by evidence that he administered one or
prescribed one of the above remedies, and that
that one item was a drug, the charge against the
appellant would be sufficiently proved.
It must be remembered that the appellant
did not take the stand to deny the fact that he
told Dietrich that he had administered or
prescribed all of these items to his patients, and
therefore that fact, standing unrebutted, the
Referee and the Board had the right to accept
this testimony of Dietrich’s as the truth.
Were these remedies or materials “drugs”
such as were intended by the legislature and the
Medical Board?
Dr. Sollman testified unequivocally that sul-
fathiazole ointment, metycaine, liver extract
and thiamine chloride were drugs but that the
other substances were not known to him. His
testimony, as the Court has already indicated,
wras not rebutted.
PROHIBITION UPHELD
At first blush to say that a limited practitioner
of medicine or surgery should not be allowed
to prescribe or administer vitamins or liver
extract for a physical deficiency seems rather
farcical, for immediately one realizes that
these items can be purchased generally without
prescription. Upon meditation, however, one
must necessarily conclude that this prohibition
is not an absurdity, for some one in whom you
place your future health and in whom you put
your trust should be a person who is qualified
to speak, to comprehend the nature of your
deficiency and to know the necessary prescription
therefor. Since Botkin is a limited practitioner
it is presumed that he is not qualified or versed
1202
The Ohio State Medical Journal
in the use of vitamins or liver extract, even
though he may well be. However, the line must
be drawn somewhere, and the legislature has
seen fit, from the standpoint of public safety,
to say by legislation that practitioners of
mechanotherapy shall not administer or prescribe
drugs, regardless of their knowledge. And since
the court concludes that vitamins and liver ex-
tract are drugs, such then cannot be prescribed
or administered by limited practitioners.
By statute 1274 Ohio General Code osteopaths
were given the express authority to use anes-
thetics and antiseptics, and 1274-3 as amended
gave chiropodists the right to use such drugs
as are necessary to such practice as are set out
in the rules and regulations of the State Board.
Thus, if by implication one would say that the
mechanotherapist had the right to use drugs
to perform minor surgery, that thought is
definitely expelled by making an exception by
giving osteopaths and chiropodists that right,
but no others of the limited practice.
The appellant suggests that since his practice
was limited only by the prohibition not to
prescribe or administer drugs or perform major
surgery he could, therefore, perform operations
for all minor surgery.
To perform various types of minor surgery
it was testified that local anesthetics and
antiseptics were a necessary adjunct to success-
ful operations, and therefore Botkin concluded
that since he is entitled by implication to
perform minor surgery, and a necessary adjunct
to some cases of minor surgery is local anesthet-
ics and local antiseptics, he therefore by law
is permitted to use them in his limited practice.
MINOR SURGERY DEFINED
What then can the appellant herein do by
way of minor surgery?
He is a mechanotherapist, and mechanotherapy
is defined in the rules and regulations of the
State Medical Board as being the use of manual,
physical or mechanical measures for the treat-
ment of disease, but such physical or mechanical
measures shall not include the, use of X-ray or
radium for therapeutic purposes. That definition
in itself sets out just how far the appellant can
go in his practice.
It impresses the Court that the mechan-
otherapist, under the right by implication given
by statute, is allowed to practice minor surgery,
but must be sv.ch as is accomplished by massage
or other similar means, either manually or
mechanically, and he can go no further.
Legislative enactments must be so construed
as not to present an absurdity.
ARGUMENT ERRONEOUS
Can a court conscientiously say that while
the legislature by fiat has prohibited limited
practitioners the right to prescribe or administer
drugs, but since they might practice some minor
surgery that therefore the legislature, even
though it has spoken clearly, did not mean
what it said and that drugs can be used, since
in some instances they are considered a neces-
sary adjunct to minor surgery? This Court
believes that such a pronouncement would be
unconscionable and erroneous, and it would be
establishing a right by implication in the face
of expressed legislative restriction and prohibi-
tion.
HEALTH OF PUBLIC AT STAKE
Botkin is presumed to have known the law
and, therefore, the limits of his practice as a
mechanotherapist, and if he were dissatisfied
with these limits he should have qualified for an
unlimited practice, but as long as he has only
a limited license he cannot transgress into the
field of unlimited practice.
The unlimited medical profession guards
zealously their legal rights against the trespass
and encroachment of others, and rightfully so,
for they sacrificed many years of their lives in
qualifying for this very highly skilled profes-
sion, and if that right were not guarded by
law or the profession, the health and welfare of
the people of Ohio would be constantly in jeop-
ardy.
Here we are dealing with the very lives of
people, generally treasured above all things, and
the legislature, by its exercise of police power
has the right to adopt precautionary measures
governing the practice of medicine and surgery
to the end that, in so far as humanly possible,
the lives and health of the citizens of this state
will be given the greatest possible safeguard.
American College of Surgeons Elects
Dr. Elmer R. Arn, Dayton, and Dr. B. Noland
Carter, Cincinnati, were elected to three-year
terms on the Board of Governors of the Ameri-
can College of Surgeons at the annual meeting
of the organization in Boston, October 26.
Among officers elected are: Dr. Alton Ochsner,
New Orleans, president-elect; Dr. Thomas K.
Lanman, Boston, first vice-president; and Dr.
Joel W. Baker, Seattle, second vice-president.
Officers will be installed at the 1951 Clinical
Congress in San Francisco, dates of which will
be announced later.
Two clinics, one on “Surgical Principles of
Pelvic Relaxation,” and the other on “Hysterec-
tomy— Indications, Physiological Principles and
Technique,” were given by Dr. John C. Burch,
Nashville, Tenn., at the October meeting of the
Dayton Surgical Society.
for December, 1950
1203
Civil Relief Act . . .
Those Who Go Into Service Are Reminded That Their Rights Back Home
May Still Be Protected If They Apply Under World War II Provisions
OHIO physicians who are now on active
duty with the armed forces, or who may
be called may be interested to know that
they can secure coverage under the Soldiers and
Sailors Civil Relief Act of 1940.
The law, which was intended to protect per-
sons in service during the last war, is still in
effect as amended in 1942. The law is mainly
self-executing since there is little provision for
administration. This makes it necessary for
the individual to seek protection under its pro-
visions. The law is not automatic, although
application for coverage by its provisions may be
made at any time, providing proof of active
military service can be provided.
The law provides for temporary or long range
relief for servicemen from: Installment contracts
on household goods, automobiles and personal
property; mortgages on home or business loans
(V. A. included) or homesteads; premium pay-
ments on commercial insurance policies (National
Service Life Insurance is not covered) and rent
payments for housing occupied by the service-
men’s dependents.
V. A. LOANS COVERED
T. B. King, director of the V. A. Loan Guar-
antee Agency, recently said all V. A.-guaranteed
loans are covered by the provisions of the act,
and accordingly no foreclosures can be made
while the borrower is in service. Mr. King said
it was the intention of the V. A. to “encourage
the extension of the modification of the terms
of the loan by a postponement of all or part of
the monthly payments.” But he emphasized
that the lender and the veteran must reach an
agreement before the V. A. will recognize any
adjustments.
If an agreement cannot be reached otherwise,
a court must settle the dispute and make proper
adjustments — giving the serviceman full protec-
tion under the provisions of the Soldiers and
Sailors Civil Relief Act.
All men called up, whether veterans or not,
should seek legal advice in securing coverage
under the act. Recommended proceedure in
securing coverage is to first seek competent
legal counsel, second contact creditors and
advise them of entrance into armed service, and
make whatever arrangements possible with them.
Normally attorneys charge a fixed minimum
fee for processing establishment of claims under
the act. To claim relief under the act the
claimant should, under the direction of his at-
torney, sign an affidavit to the effect that he is
called into military service and seeks relief
under the Soldiers and Sailors Civil Relief Act.
In most areas the bar associations have a set-up
to handle this service without cost in cases of
need.
RIGHTS ENUMERATED
Outlined are the basic points of the law:
1. Eviction — If rent of premises used chiefly
as a dwelling is not over $80.00 a month, it is
a misdemeanor to attempt to evict the dependents
of one in military service without permission of
a court, which may stay eviction for not over
three months.
2. Lease Termination — Leases made before
service may be terminated upon written notice
to the landlord, effective 30 days after the next
monthly rent date.
3. Taxes — (a) Payment of Income Taxes be-
fore or during service may be deferred, without
interest, until six months after service ends if
the person’s ability to pay is materially impaired
by his service.
(b) Taxes on Real Estate and Personal
Property — No tax sale or other proceedings shall
be instituted against persons in the service for
delinquencies on taxes and assessments and stay
of such sale may be made until 6 months after
service ends, if ability to pay is materially im-
paired by his service.
Extending Time to Pay — A service man during
the period of his military service may have ex-
tention of time to pay on certain types of con-
tracts until 6 months after his service period
has expired.
Mortgages, Trust Deeds, Chattel Mortgages,
Etc. — Unless an agreement to that effect has
been executed by a person in the military serv-
ice or a person ordered to report for induction
or service, no sale by foreclosure, or seizure of
property for nonpayment of any sum due under
the terms of a mortgage, trust deed, or other
security in the nature of a mortgage on real
or personal property, or for any other breach
of the terms thereof, whether under a power
of sale or upon cognovit judgment shall be
valid if made during the period of military serv-
ice or within three months thereafter unless upon
an order previously granted by the court. (50
USC App. 532 (3)).
Execution of judgments may be suspended if
in the discretion of the court his ability to pay
1204
The Ohio State Medical Journal
is impaired by his military service. A divorce
decree may be modified if upon application, but
in no manner may the enlistment discharge the
obligation under a separation agreement or for
that of support of wife or child.
Statutes of Limitation are suspended under
Ohio law, being Senate Bill 283, dated June 11,
1943, during the period of service.
In rending actions, it is necessary to file an
affidavit as to military service of the defendant
before taking a final decree. Filing of a false
affidavit is a misdemeanor. The Court may re-
quire bond if it is not known if the person is
in military service.
Ordinarily attorneys do not draw compensation
for services in representing a defendant who is
in military service.
No judgment may be entered by default unless
the affidavit shows that the defendant is not in
military service, unless the plaintiff obtains an
order of the court directing that said judgment
be entered.
It has been held in numerous cases that the
failure to file the proper affidavit renders the
judgment voidable and not void.
If, during a person’s period of military serv-
ice, or within thirty days thereafter, any judg-
ment is rendered against him and it appears
that he was prejudiced by reason of his military
service from making his defense thereto, upon
application made either by him or his legal
representative, within ninety days after the
termination of his service, the judgment may be
opened by the court which rendered it, in order
to enable such person or his legal representative
to put in a defense, provided, of course, it is
made to appear that he has meritorious or legal
defense. The rights or titles acquired by bona
fide purchasers for value under a judgment so
rendered are not impaired by the setting aside
or reversing of the judgment.
It is emphasized, however, that this act is
entirely permissive, and without any formal
administration. Therefore, it is necessary to
make specific application under its provisions
to receive protection. The law does not func-
tion automatically upon entrance of a man into
service, but application can be filed after the
man enters the service through his post legal
officer or other legal counsel.
Industrial Health Congress
Safeguards for the health of workers will be
emphasized at the eleventh annual Congress on
Industrial Health which will be held in Atlanta’s
Biltmore Hotel, February 26-27. This event will
be sponsored by the A. M. A. Council on Indus-
trial Health, the Medical Association of Georgia,
the Fulton County Medical Society of Atlanta
and the DeKalb County Medical Society of
Decatur, Ga.
Second District Holds Annual
Meeting in Davton
Dr. B. M. Hogle, Troy, was named president
of the Second District of the Ohio State Medical
Association at the annual meeting held in Day-
ton, October 18. He succeeds Dr. R. Dean Dooley,
of Dayton.
Elected secretary and treasurer, respectively,
were Dr. F. W. Anzinger, Springfield, and Dr.
W. H. Hanning, Dayton. Dr. M. D. Prugh,
Dayton, is the Councilor for the Second District.
During the afternoon scientific program, Dr.
Alan C. Barnes, chairman of the Department of
Obstetrics and Gynecology, Ohio State Univer-
sity College of Medicine, spoke on “The Use
of Radioactive Cobalt in Treatment of Cancer
of the Cervix.”
A panel discussion was held on the subject,
“The Use of Radioactive Isotopes in Medicine,”
with the following participants: Dr. F. L. Shively,
Jr., chairman; Dr. D. C. Caudill, Dr. W. H. Fries,
Dr. G. A. Nicoll and R. E. Zipf. Program chair-
man was Dr. Harold H. M. James. Special
equipment in the use of isotopes was furnished
by the Monsanto Chemical Company’s Mound
Laboratory.
Speaker at the banquet was Hon. Clarence I.
Brown, Blanchester, representative from the
Seventh U. S. Congressional District.
Surgeon General Puts “Go Slow” Sign
On Mass Blood Typing
Dr. Leonard A. Scheele, Surgeon General of
the U. S. Public Health Service, issued a warn-
ing against a hasty nationwide blood typing
program, in an address before the Association
of State and Territorial Health Officers.
Such a program might be advisable later, he
said, but for the present “the best thinking of
governmental agencies and professional societies
. . . is that any state or local pi’ograms for
mass blood-typing should be in conformity with
a National Civil Defense program, the American
Red Cross, American Medical Association, Ameri-
can Association of Blood Banks and American
Hospital Association. Emphasis should be placed
on typing people who can and will give blood,
either in advance for storage in blood banks
or for use at the time of an emergency.”
He further said that the immediate need is
to identify in advance type 0 donors in the 18
to 60 year old group. He cautioned that mass
blood-typing campaigns would place severe de-
mands on manpower and supplies of typing
serum, and that errors might be expected from
hastily trained personnel.
The Surgeon General’s precautionary recom-
mendations ran counter to a proposal of the
Chronic Disease Division of the U. S. Public
Health Service which shortly before had recom-
mended a national mass-typing program.
for December, 1950
1205
'TftaiC (fatfraa 'Tfeea
And Assure Yourself a
Hotel Reservation
for the
1951 Annual Meeting
Ohio State Medical Association
Cincinnati, April 24-26
NAME OF HOTEL
SINGLE
DOUBLE
DOUBLE
TWIN BED
NETHERLAND PLAZA HOTEL
$4.00-10.00
$6.50-13.00
$9-50-14.50
ALMS HOTEL
$4.85-6.85
$6. 50-9.00
BROADWAY HOTEL
$3.50
$5.50-6.50
FOUNTAIN SQUARE HOTEL
$4.00-5.50
$6. 50-7.50
$8.00-8.50
METROPOLE HOTEL
$3.00-6.00
$5.50-10.00
$6.50-10.00
PALACE HOTEL (CINCINNATIAN)
$2.50-4.00
$4.00-6.00
$5.00-7.00
SHERATON-GIBSON HOTEL
$4.00-12.00
$6. 50-12.00
$8.00-12.00
SINTON HOTEL
$4.00-10.00
$6.00-12.00
$8.00-12.00
TERRACE PLAZA HOTEL
$8.00-13.00
$11.00-16.00
VERNON MANOR
$4.00-6.00
$5.00-9.00
HOTEL RESERVATION BLANK
Mail the coupon to hotel selected
Manager Hotel, Cincinnati, Ohio
You are requested to reserve the following accommodations during the period of the Annual Meeting
of the Ohio State Medical Association, April 24, 25, 26, 1951, or for such other period as may be
indicated herein.
□ Single Room with Bath □ Double Room with Bath Price
□ Twin Bed Room with Bath □ Suite
Arriving April at A. M P. M.
PLEASE VERIFY MY RESERVATION
Name
Address
1206
The Ohio State Medical Journal
Doctors and the War . . .
Classification of Physician Registrants About Completed . . . Some Ordered
Up for Physical Examinations . . . Role of Local Committees Emphasized
WHEN some of the physicians who regis-
tered with Selective Service on Oct. 16
will be ordered to active duty was un-
certain as this issue of The Journal went to press.
However, the classification of most of the
registrants has been completed by the local
Selective Service Boards, the deadline having
been November 15.
All physicians who registered on Oct. 16 and
who are in the first priority group (those with
90 days of active duty or less) were scheduled
for physical examinations on Friday, December 1.
This included all such registrants, regardless
of classification. However, it does not mean
that those classified as essential or who have
been deferred by their local boards will be in-
ducted at this time.
The physical examinations were made at ex-
amining centers in Canton, Cincinnati, Cleve-
land, Columbus, Toledo and Portsmouth.
The date for physical examination of reg-
istrants in the second priority group (those with
more than 90 days but less than 21 months of
active service) has not been announced.
LOCAL COMMITTEE FUNCTIONS
It is presumed that all Selective Service Boards
have followed the directive of the Ohio Selective
Service Office, Columbus, and have conferred
with Local Medical Advisory Committees as to
how registrants should be classified.
Advisory committees have been set up in each
county by the County Medical Society. Of
course, each board will make the final decision,
but is expected to give very serious considera-
tion to the advice given by the advisory com-
mittee.
CAN REVISE CLASSIFICATIONS
Under Selective Service regulations, a board
may change the classification of a physician
registrant at any time up to the time he is sent
notice to report for induction.
Any physician who is commissioned in the
medical corps of one of the components of the
armed forces prior to the time he is sent a
notice to report for induction will not be subject
to induction. Such physician will be under the
jurisdiction of the armed force component which
commissioned him and will be subject to call
as a reserve officer.
REGARDING RESERVE OFFICERS
Recently Secretary of Defense Marshall issued
an “orderly procedure” directive regarding calls
issued to reserve officers. This will give reserve
Return Questionnaire Sent To
You, Immediately
By this time every physician in
Ohio should have received the
Biographical and Professional Ques-
tionnaire issued by the Military Ad-
visory Committee of the Ohio State
Medical Association.
The purpose of this questionnaire
is to secure vital information on all
physicians in the state which can be
taken into consideration in making a
decision on what medical and health
personnel must be retained in any
community to meet the health
needs of the community.
A fair decision on how many phy-
sicians can be spared from an area
for military service and how many
physicians must be retained in the
area for civilian needs cannot be
made unless the committee has an
over-all picture of the present medi-
cal personnel of the community.
For this reason, every physician
should fill out and return the ques-
tionnaire immediately.
officers advanced warning and more time to get
ready before reporting for duty. Also, the di-
rective provides that reserve officers now on
duty shall be relieved from active service just
as soon as suitable replacements are provided
by Selective Service or can be secured from
among newly commissioned medical officers.
The Army and Navy are continuing to call
some medical reserve officers who have had
active service, primarily to fill specialized cate-
gories. The Army has followed the policy
of conferring with and obtaining clearance
from the State Medical Advisory Committee be-
fore ordering its medical reserve officers to active
duty. The Navy has not done so but it
may adopt the same policy in the near future.
All physicians, especially reserve officers and
others within the age groups subject to military
service, will be interested to know that Dr.
Richard L. Meiling, former Columbus physician,
now director of Medical Services, Department of
Defense, is making an effort to have the armed
for December, 1950
1207
services adopt a 3.5 medical officer ratio instead
of the traditional 6 or 6.5 ratio. Obviously, fewer
physicians would have to be taken from civilian
practice if Dr. Meiling’s recommendation is
adopted.
INTERNS AND RESIDENTS
Interns who do not hold a reserve commission
are being advised to secure one promptly in
order to avoid difficulties with their Selective
Service Boards. If commissioned they will not
be called to active duty until completion of their
internship.
It is reported that the Navy and Air Force
are about to discontinue granting commissions
to physicians who registered on Oct. 16 in order
to permit the Army to meet its needs for medi-
cal officers from physicians of that group.
Physicians inducted will not receive the extra
$100.00 per month pay even though they are
commissioned after induction, the Department
of Defense has ruled. Whether physicians who
applied for a commission before induction but
does not receive the commission until after induc-
tion, will get the extra $100.00 per month pay
is still under debate in Washington.
Physicians now eligible for the draft who do
not pass their physical examinations for reserve
commissions will not be inducted later, if
present Selective Service regulations are fol-
lowed.
NEEDS OF HOSPITALS AND SCHOOLS
Local advisory boards are being cautioned to
give very serious study to the needs of hospitals,
medical schools and health departments.
Hospitals having residents who are essential;
medical schools with essential teachers; and
health departments with personnel essential to
public health activities should contact local ad-
visory committees, if they have not done so,
and request that these men be considered for
essential classification. As already stated, local
Selective Service Boards can revise the classi-
fication of any registrant up to the time he is
ordered up for induction. Also, the evidence
submitted to the advisory committee will be
important in requesting that certain reserve
officers now serving in hospitals, medical schools
and public health departments not be called to
active duty until suitable replacements are
available.
In many instances residents in their final
year are being classified as essential until com-
pletion of their training. A formula regarding
other residents may be worked out soon.
OUT-OF-STATE REGISTRANTS
Institutions and agencies having essential medi-
cal personnel which may be under the jurisdiction
of a Selective Service Board in another county
or another state should initiate their requests
that such personnel be classified as essential with
the Local Advisory Committee. That com-
mittee will then send its recommendations to the
State chairman, Dr. Robert Conard, in care of
the Columbus Office of the Ohio State Medical
Association, who will forward the proper in-
formation to the local Selective Service Boards
involved.
Former medical officers who are in doubt about
whether or not their commissions are still in
force will find the answer or suggestions on
how to find the answer in the following state-
ment just issued by the Council on Emergency
Medical Service of the American Medical Asso-
ciation:
IS YOUR COMMISSION IN FORCE?
Many former medical officers have been con-
cerned as to whether or not their commissions
are still in force.
The following statements from the offices of
the Surgeons General of the Army, Navy and
Air Force and released by the Council on Na-
tional Emergency Medical Service of the Ameri-
can Medical Association may help them decide
that question.
STATUS OF FORMER ARMY MEDICAL OFFICERS
The key to whether a person, once commis-
sioned, now holds a reserve commission lies in
his letter of appointment. If the letter states
that the apopintment was made under Section 37,
National Defense Act, as amended; sets forth
the grade, serial number and effective date,
and states that “by direction of the President
you are appointed in the Officer’s Reserve Corps/’
he holds a reserve commission and it is still
effective, unless notice of termination has been
received from the Adjutant General.
Some of the older letters of appointment do
not mention “Section 37 . . .” or “Officers’ Reserve
Corps.” However, they do mention that the
appointment is in the Reserve, in connection
with the person’s name, rank and corps (e.g.,
John Smith, 1st Lt. Med. Res.). Holders of
such letters of appointment also hold a reserve
commission, and it is still effective unless of-
ficially terminated.
Appointments in the Officers’ Reserve Corps
are for five years, subject to renewal. During
the war all reserve commissions were automati-
cally extended for the duration of the emergency
plus six months. Since no official declaration has
been made ending the emergency, such commis-
sions are still in force, with the exception of
those which have been terminated through resig-
nation by the individual and acceptance by the
government or which have been terminated for
cause or the convenience of the government.
During World War II many persons were com-
missioned directly in the Army of the United
States (AUS). These commissions do not con-
stitute appointment in the Jfficers’ Reserve
1208
The Ohio State Medical Jo zonal
Corps. AUS commissions authorized during the
period of World War II, under the provisions of
Section 37, National Defense Act, as amended,
are valid and will remain in force for the dura-
tion of the war and six months thereafter. All
other AUS commissions were terminated by Pub-
lic Law 239 of the Eightieth Congress.
If the letter of appointment or other pertinent
papers have been lost and the person is still
uncertain of his reserve status, he should write
directly to the Adjutant General of the Army,
Attention: Reserve Branch, Washington 25, D. C.
The letter should contain a direct request as
to whether the person holds a reserve com-
mission and, if so, whether the commission is
in force at this time. The letter should contain
the writer’s Army serial number.
Any statement to a person concerning his re-
serve status or nonreserve status which comes
from any source other than the Adjutant General
is not official.
STATUS OF FORMER NAVY MEDICAL OFFICERS
Medical officers of the Navy who served as
reserve medical officers on active duty during
World War II and have since returned to an
inactive status are, in the majority of cases,
still commissioned as reserve medical officers of
the Navy. When these officers were released
to inactive status from active duty, it was neces-
sary that the individual take positive action
to resign his commission in order to change
his status from that of reserve medical officer
to a civilian. A release to inactive duty did
not automatically cancel the reserve commission
which the officer had been issued prior to or at
the time he went on active duty.
Physicians and dentists may have resigned
their commission after their release to inactive
duty, but this resignation was necessary as an
individual action on the part of each person,
who must have submitted his resignation of
commission to the Secretary of the Navy or to
other proper authority. Those physicians who
are still doubtful as to their present status may
obtain clarification by addressing an inquiry to
the Surgeon General, Bureau of Medicine and
Surgery, Navy Department, Washington 25, D.C.
STATUS OF FORMER AIR FORCE OFFICERS
Those physicians who served with the Army
Air Forces prior to the designation of the Air
Force as a separate military department served
as Army medical officers, and the above state-
ments concerning AUS and Army Reserve com-
missions are applicable to them. Those with re-
serve commissions still hold these commissions
in the Army unless they have personally applied
for transfer to the Air Force Reserve and have
received notification that such a transfer has
been effected.
Dr. Beck Conducts Resuscitation
Course in Cleveland
A practical course for resuscitation of pa-
tients who die in the operating room is being
offered by Dr. Claude S. Beck under sponsorship
of the Cleveland Heart Society. The course,
available to surgeons and anesthetists, is being
offered once each month through March.
The first course was held in November. Dates
for the remaining courses are as follows:
December 14-16; January 25-27; February 15-17;
and March 15-17.
Program for each of the courses is as follows:
First Day, 9:00 a.m. to 12:30 p.m. — (Surgical
Laboratory, Western Reserve University School
of Medicine) General presentation of subject and
demonstration on dogs (Dr. Beck, Dr. Robert W.
Hosier, Dr. Richard Hahn, Kenneth Wolfe and
Mary Ellen Kaiser, R. N.)
2 to 4 p. m. — (Institute of Pathology) Trans-
thoracic and subdiaphragmatic approach to the
heart — cadaver demonstration (Dr. Alan Moritz
and Dr. Hosier).
4 to 5 p. m. — (Institute of Pathology) the
Sterile Package (Dr. Hosier).
Second Day, 9 a. m. to 12 m. — Lecture, “Fac-
tors in Cardiorespiratory Failure”; danger
signals; intubation of the trachea. Lecture to
be given on alternate basis by Dr. B. B. Sankey
at St. Luke’s Hospital and Dr. Donald E. Hale,
Cleveland Clinic Hospital.
1:30 to 3 p. m. — Laboratory Demonstration;
effect of procaine and adrenalin on the heart;
effect of dislocation of the heart; methods of
massage of the heart (Dr. Beck and Dr. Hosier).
3 to 5 p. m. — Lecture; physiological aspects
of resuscitation; drugs; maintenance of circula-
tion after restoration of heart beat (Dr. Herman
Hellerstein).
Third Day, 9 a. m. to 12 m. — Practical ex-
ercise on dogs; demonstration of oscillograph
and electronic stethoscope (Dr. James H. Rand.
III).
12 m. to 1:30 p. m. — Program of action in the
operating room; drill (Dr. Beck).
Those interested in enrolling are requested
to contact Jerry H. Bruner, executive secretary,
Cleveland Heart Society, 613 Public Square
Building, Cleveland 13.
Dr. John J. Douglas, Canton, discussed the
subject, “Radiological Diagnosis of Congenital
Heart Disease,” at the annual Rochester Medi-
cal School Alumni meeting in Rochester, N. Y.
Dr. Edmond J. Booth, Coshocton, spoke on the
subject, “Genito-Urinary Diseases,” at a meeting
of District Six, Ohio State Nurses’ Association.
for December, 1950
120S>
Admission to Mental Institutions . . .
Legal Counsel Clarifies for Physicians’ Benefit Changes in the Law
And Procedures for Having Mentally 111 Placed in State Institutions
^yp^HE terms “mental illness,” “mentally ill,”
“mental disease,” and “mentally deficient”
have been defined in Ohio as “an illness
which so lessens the capacity of the person to
use self control, judgment, and discretion in the
conduct of his affairs and social relationships
as to make it necessary or advisable for him
to be given treatment, care, supervision, guid-
ance, or control.”
The above definition also includes the terms
“lunacy,” “unsoundness of mind” and “cases in
which such lessening of capacity for control is
caused by excessive addiction to narcotics,
stimulants, or sedatives as to make it necessary
for him to be under treatment, care, supervision,
guidance, or control.”
With this legal definition of mental illness
of such broad scope, almost any physician may
expect to have under his care, sooner or later, a
person whose illness falls within the meaning of
the definition. Many neuroses, whether they
result from physical illness or otherwise, can be
expected to cause sufficient emotional disturbance
that a patient may enter one of the above cate-
gories, if adequate treatment is not achieved.
Facilities for outpatient treatment have as yet
come no wise near satisfying the demand.
Therefore, a problem arises for the physician
and for the relatives and friends of a mentally
ill patient, as to where treatment can be pro-
vided, how quickly it can be provided, and what
procedure must be followed under the laws of
the State to place the patient in the proper
custody and under suitable care.
FOUR TYPES OF METHODS
Under the laws of Ohio, procedures for handling
these cases are fairly well defined and are de-
signed as far as possible to answer the prob-
lems in each case. The immediate source of
information on these matters is the Probate
Court of the county in which the patient re-
sides. However, it is of material aid to in-
terested parties, and especially to physicians,
that they have a general knowledge of what
the necessary procedures are. There are four
general types of methods by which a patient
can be handled.
A. Formal Commitment or Placement.
Under Section 1890-20 of the General Code of
Ohio, the next of kin of the patient, or an in-
terested person residing in the county may go
before the Probate Court of that county and file
Editor’s Note: The accompanying ar-
ticle, prepared by Mr. Wesley L. Neville,
legal counsel, Support Bureau, State Divi-
sion of Mental Hygiene, summarizes the
present Ohio laws pertaining to admission
to mental institutions and clarifies admis-
sion procedures.
The article was written with the intent
of making it helpful to physicians. It
should be read carefully by all readers of
The Journal, then clipped and filed for
ready reference.
an affidavit or sworn statement giving the fol-
lowing information:
(1) The name and residence of the pa-
tient.
(2) His belief that the patient is mentally
ill or in need of specialized observation or
treatment.
(3) A statement as to whether or not
the patient is dangerous to himself or others,
and would be dangerous to the community
by reason of the supposed mental illness, if
he were to remain at large.
(4) A statement as to any prior commit-
ment to a mental or penal institution in this
state or elsewhere.
(5) The name and address of the personal
physician or physicians known to the patient,
if any.
After this affidavit is filed the Probate Court
issues a warrant for the detention of the patient
and may have him held in the county jail or
otherwise as the court may direct, until a hear-
ing may be had on his case. The court notifies
the relatives or interested parties of the date
of the hearing and allows the patient to select
such persons as he may wish to attend.
If the patient is incapable of making a selec-
tion, his attorney, relative or a friend may be
notified. If no one is available, the court is re-
quired to appoint a suitable person to act as
Guardian ad litem for the patient. The court
will appoint a physician to be the official ex-
aminer of the patient. The physician must be
registered in the State with at least three years
of experience in the practice of medicine.
COURT CONDUCTS INQUIRY
When these persons have been served with
notices and the hearing date has arrived, the
1210
The Ohio State Medical Journal
court conducts an inquiry, without a jury, and
examines the witnesses who have appeared and
such others whom he may wish to hear on the
subject. A report of the examination of the
patient is made by the physician appointed by
the court. This report becomes a part of the
records of the case. If, at the end of the hear-
ing, the court is certain that a patient is men-
tally ill, he has several alternatives upon which
he may proceed at his discretion.
1. He may order the patient to be placed
in a Receiving Hospital for observation
or treatment or both.
2. He may commit him to the proper state
hospital for the mentally ill for treatment.
3. If he finds that the patient has been
convicted of a felony, and finds him to be
mentally ill, mentally deficient, psycho-
pathic, or insane, he may order him com-
mitted to such hospital as the Department of
Public Welfare may designate for such
cases.
4. If the patient is a veteran of any war,
military occupation, or expedition, and is
eligible for treatment in a United States
veterans’ hospital, the court may communi-
cate with the official in charge of the veter-
ans’ hospital, and upon receipt of a certi-
fication from that official the patient may be
committed to that hospital.
5. He may order the patient placed in a
private hospital, (one of the institutions rec-
ommended and approved by the Division of
Mental Hygiene) at his own expense.
6. He may release the patient to the
custody of a relative, friend, or another
suitable person, whom the court deems
proper.
7. He may commit him to a county home
or to the place provided by the county com-
missioner, if any.
8. He may discharge him.
This procedure is most used in cases where
the patient is difficult to handle, refuses to co-
operate in treatment, and refuses to voluntarily
enter an institution for treatment. On the other
hand, some objections to this method are: The
time consumed; the fact that the proceedings
become a part of the records in the Probate
Court; and the fact that in many cases the con-
dition of the patient does not warrant such
a formalized procedure. It is because of these
factors that many people are reluctant to use
the formal commitment. (G. C. Sections 1890-23,
24, 25, 27.)
All of the forms necessary to institute the
foregoing method are obtainable at the County
Probate Court.
B. Voluntary Admission.
Physicians will have many cases where the
patient is aware, or may be made aware, of his
condition and the need for proper treatment.
Thus, the physician is able to obtain his co-
operation in voluntarily entering a mental in-
stitution. This is a relatively simple procedure,
since it involves only the written application
of the patient himself, together with a certificate
from a reputable physician on forms provided by
the Division of Mental Hygiene.
There is nothing mandatory about the volun-
tary admission procedure since the patient goes
of his own free will and is accepted with only
the proviso that he remain in the hospital for
ten days. At the end of this time he may make
a written request for dismissal.
If the superintendent and medical staff feel
that he should not be released and the patient
refuses to continue treatment, he cannot be
retained unless the superintendent initiates
formal commitment proceedings as mentioned in
the preceding section.
Voluntary admission can only be made at the
hospital serving the district in which the patient
resides, and the superintendent may accept or
refuse any voluntary patient.
This procedure may also be used by parent or
Guardian on behalf of a minor or on behalf of
an adult incompetent, respectively. The primary
value of this method lies not only in the fact
that a patient may obtain his own admission,
but also that many mental illnesses may be
forestalled or cured in the same manner as a
physical illness could be controlled or cured
by early hospitalization in a general hospital.
Besides this, there is no likelihood of the pub-
licity possibly resulting from a court commit-
ment. (Section 1890-52, G. C.)
The forms necessary for voluntary admission
may be obtained from the county Probate Court
or from the Superintendent of a State Hospital.
It is suggested that a number of such forms
be made available to the Secretaries of the County
Medical Societies or to County Health Centers
where they would be readily obtainable by phy-
sicians who were recommending this course of
treatment for their patients.
C. Emergency Admission.
Cases arise from time to time where a men-
tally ill person may be violent and dangerous to
himself or members of the community in which
he lives. In such cases a member of the family,
a police official, or a member of the Board of
Health of the community may provide for the
detention of such person without a warrant
and may take him at once to a Receiving Hos-
pital.
These Receiving Hospitals are of a compara-
for December, 1950
1211
tively recent origin and it is proposed that they
be established in each district now served by
a state hospital. Receiving hospitals are estab-
lished to provide preliminary and emergency
care and for observation and treatment, espe-
cially of those cases where the condition is mild
or incipient only and is expected to be of com-
paratively short duration. Receiving hospital
cases which do not improve in a relatively short
time are transferred to state hospitals. This
method of handling cases such as the above
is expected to remove a considerable load from
the present state hospitals.
The law provides that if no such Receiving
Hospital is immediately available, the person
may be placed in the city or county jail until
further disposition can be made. When he has
been placed in jail, the arresting officer or the
person in charge of the jail is required to file
an affidavit in the Probate Court on the next
succeeding law day. Persons who are held in
jail are required to have an immediate exami-
nation by a physician and medical and nursing
care will be at the expense of the county or
city having jurisdiction of the jail.
Under the terms of this provision such a
patient may be held for a period of five days
in either the receiving hospital or the county
jail. His period of detention in a city or village
jail may not exceed twelve hours. At the
end of the five day period, the superintendent
of the receiving hospital must begin proceedings
for formal commitment according to the statute.
Persons acting in good faith under the terms
of this statute are specifically protected from
the possibility of a law suit by the patient or by
persons acting for him by reason of his arrest
and restraint. The intention of this statute
is to provide adequate and immediate protection,
both for the patient and the community, when
the patient indicates homicidal or suicidal ten-
dencies or other violent dispositions. It is a
temporary and emergency measure only and as
noted above, the formal legal procedures for
proper detention must be followed within a short
period of time. (Sec. 1890-26 G. C.)
D. Admission Without Formal Commitment.
In order to satisfy a need that was not ade-
quately met by the foregoing procedures, a new
means of admission to mental hospitals was pro-
vided by the General Assembly on June 24, 1949.
Under this law, a patient may be placed in the
appropriate hospital or other institution desig-
nated by the Division of Mental Hygiene without
immediate court procedure. The period of the
admission in any case cannot exceed six months.
Under this form of admission, a written request
must be made by a member of the patient’s
family, a friend, any person with whom the pa-
tient lives, or by any law enforcement officer,
who has taken the patient into custody. Cer-
tain other authorized persons are the chief of-
ficers or superintendents of a hospital, a chari-
table institution, or a licensed social agency. If
the patient is a veteran and is otherwise eligible,
arrangements may be made to enter him in the
appropriate veterans’ hospital.
The person making such written request must
have reasonable cause to believe that the pa-
tient is mentally ill. The patient must be ex-
amined by at least two physicians registered in
Ohio and having had at least three years in
the practice of medicine. These physicians may
not be members on the staff of the mental in-
stitution or hospital to which the patient is to be
sent, nor be financially interested in this in-
stitution.
After the physicians have examined the pa-
tient, they must make a full medical report.
They must certify that they have examined
him and that they believe he is mentally ill and
requires hospitalization. This report and certifi-
cation together with the written application or
request are sent to the superintendent of the
hospital in the district in which the patient
resides. The determination of whether or not
he is to be admitted is at the discretion of the
superintendent.
In the use of this method it is important
to note that the patient, while he is not precisely
a voluntary case, may not be taken to the
hospital against his will or by the use of force.
If the patient is entirely unwilling to go and
is not susceptible to proper persuasion, the only
method available will be that of court commit-
ment. To do otherwise would result in the
deprivation of his liberty without due process
of law, a right guaranteed to all persons under
the Constitution.
This course of action requires no court pro-
cedure and there is no necessity for publicity
of any kind. It provides a speedy method of
admission in the event of emergencies, par-
ticularly where the patient is in such condition
that he may be dangerous to himself or to
others, as in cases of suicidal or homicidal ten-
dencies, hallucinations and delusions.
In many cases of mental illness, just as in
many cases of physical illness, the patient is
in no condition to determine for himself whether
or not he should be institutionalized. A few
examples of this are cases of coma, catatonic
states, and so forth. On the other hand, he
will not make any overt objection to his ad-
mission to the hospital. In such cases, as in
the case of one who is extremely ill physically,
the speedy admission will be to the benefit of
the patient.
In order that the legal rights of a patient
may be further protected under this section,
the law requires that if, at any time after his
1212
The Ohio State Medical journal
admission, he makes a written request to the
superintendent for his discharge, the request
shall be granted unless the superintendent feels
that the patient’s condition warrants his reten-
tion in the hospital.
In that case, within five days after the written
request has been made, the superintendent must
file an affidavit in the Probate Court of the
county in which the hospital is located, or the
county from whence the patient came. With
the affidavit he must file the written report and
certification filed at the time of the patient’s
admission. When this has been done by the
superintendent, the regular procedure for court
commitment will be followed and the patient
will be retained in the hospital until judicial
determination of his mental condition has been
made.
If the patient has not requested his discharge
at the end of 120 days from the date of his ad-
mission, and the superintendent does not feel
that he should be discharged, the superintendent
must file an affidavit, as mentioned in the pre-
ceding paragraph, to start poceedings in the
Probate Court for an adjudication of the pa-
tient’s condition.
The forms for this procedure may be obtained
at the county Probate Court or from the superin-
tendent of any State hospital. As in the case
of voluntary admission, forms should also he
made available to the Secretaries of County
Medical Societies and to County Health Centers.
(Sec. 1890-111 to 111-G G.C.)
THE MENTALLY DEFICIENT
The law of this State provides that with cer-
tain exceptions the State of Ohio shall have the
care, custody, control, and treatment of persons
adjudged to be feebleminded and admitted to
any institution for the feebleminded in this
State.
The term “mentally deficient” or “feeble-
minded” as meant by the law refers to any per-
son whose “intellectual development has been
retarded from birth or from an early age and
whose intellectual and social capacity is below
normal for his chronological age to such an
extent that he lacks sufficient control, judgment,
and discretion to manage himself and his af-
fairs and who by reason of such deficiency, for
his own welfare or the welfare of others of the
community requires supervision, guidance, care,
or control.” (Sec. 1890-97 G.C.)
With one exception, the provisions for the
formal commitment of a feebleminded person
are the same as those pertaining to a person
who is mentally ill. The exception is that the
affidavit to be filed in the Probate Court shall
c-ontain the allegation that the person is “feeble-
minded and in need of specialized care and
treatment.”
There have been cases Avhere an affidavit has
been filed alleging that a patient is mentally
ill, yet upon examination by the court he is
found to be without psychosis, but suffering
from a mental deficiency which leads to his
apparently anti-social conduct. In such cases
the court is at liberty to commit him to a hos-
pital for the feebleminded without the filing of
a new affidavit.
The provisions regarding discharge, release, or
trial visit and return, and the control and
custody of a feebleminded patient are the same
as those pertaining to mentally ill patients.
Feebleminded persons of any age, whether they
be public charges or not, may be admitted to
hospitals for the feebleminded, if in the judg-
ment of the Division of Mental Hygiene, they
are proper subjects for the care, treatment, and
discipline provided in such hospitals.
V. A. Restricts Use of Cortisone
On Out-Patient Basis
Inasmuch as cortisone is now available for
dispensing by retail pharmacies on prescrip-
tion, physicians will be interested in a restrictive
policy recently announced by the Veterans Ad-
ministration.
The announcement directed to pharmacists
states that effective November 15, 1950, prescrip-
tions for cortisone should not be accepted by
participating pharmacies for compounding at
V. A. expense. This restriction will apply also
to all dosage forms of the product that might
become available in the future.
Since it appears probable that ACTH might
also be made available in the not too distant
future, the same restrictions will apply, accord-
ing to the statement.
The announcement goes on to say that V. A.
fee basis physicians are being advised of thfs
restriction, and that limited quanities of these
items for out-patient use will be supplied from
the Regional Offices of the V. A. on a highly
selective basis.
In an explanation of its announcement, V. A.
stated that professional personnel in its office
feel that there is much to learn concerning the
drug’s potentialities when used on a long term
basis and that its use should be carefully con-
troled. In addition budget estimates for V. A.
drug expenditures for the present fiscal year were
established prior to the availability of cortisone
and since it is relatively expensive, adequate
funds for any indiscriminate use would not be
available.
Dr. Frank P. Corrigan, Cleveland, was the
subject of a feature article in the Cleveland
News. He is devoting his time as a member
of the United States mission to the United
Nations.
fat December, 1950
1213
Miners’ Program Expanded . . .
U. M. W. A. Fund Benefits Now Extended to Totally Disabled Members
And Dependents, Surviving Older Widows and Children, Certain Others
STABLISHMENT of a new program of
benefits by the United Mine Workers of
America Bituminous Welfare and Retire-
ment Fund, in addition to the existing program
for death benefits, pensions and hospital and
medical service, has been announced.
The new program includes benefits for totally
disabled eligible miners and their dependents;
maintenance aid for older widows and dependent
children of deceased miners; and extension of
medical and hospital services to widows and
adult dependents of miners.
The trustees of the Fund in making the
announcement emphasized that the additional
benefits now to be provided are not in any sense
a restoration of the former disability benefits.
On the contrary, they said, it is an entirely new
service with different eligibility requirements
and benefits.
Payments by the Welfare and Retirement Fund
were temporarily suspended in September, 1949.
The hospitalization and medical care phases of
the program were resumed on July 1, 1950. It
has now been announced that the disability
benefits service of the former program has
been discontinued permanently.
Rehabilitation for totally disabled miners, with
cash benefits for the miner and his family
while he is undergoing treatment, is a major
service of the new program. There also will
be maintenance grants made available to the
miner and his family in cases where it is
determined that a U. M. W. A. member is totally
and permanently disabled.
Maintenance cash benefits also were authorized
for dependent children of deceased miners and
for widows who are 50 years of age or older.
The schedule of such maintenance aid calls for
$40 a month for an eligible child living with
a widowed mother, and for $10 for each addi-
tional dependent child. This is for children under
18 years of age or those incapacitated if over
18. Widows who are 50 or more and who have
no dependent children are to receive $30 a month.
MEDICAL CARE
The present hospital and medical service for
U. M. W. A. members, their wives and children
under 18, is extended to include widows and
dependent children of deceased miners and also
to adult dependents of living miners, but the
latter are limited to 60 days of hospitalization
in any twelve-month period.
Officials of the Fund stated that the new
benefits are considered the maximum the Fund
can provide under sound administration to meet
the most urgent needs in the mining areas.
To receive rehabilitation benefits or main-
tenance aid for disabled miners, an applicant
must be presently totally disabled from any
occupation, and fall within one of the following
categories :
1. Have attained the age of 60 at date of ap-
plication and have been totally disabled for one
year preceding date of application;
2. Have attained the age of 55 and have been
totally disabled from any occupation for two
years preceding the date of application;
3. Have attained the age of 50 and have
been totally disabled from any occupation for
three years ;
4. Have attained the age of 45 and have been
totally disabled for four years;
5. Be under 45 years of age and have been
totally disabled from any occupation for five
years.
REHABILITATION BENEFITS
The amount of rehabilitation benefits for
miners undergoing treatments specified by the
Medical Service of the Fund, is $30 a month
with an additional $10 for a wife, an additional
$10 for each child under 18, and an additional
$10 for each incapacitated child over 18 who
is dependent on the miner and living in his
household. These benefits are less any regular
income received from any source.
For those eligible miners whom the Medical
Service certifies to be totally and permanently
disabled and not amenable to further rehabilita-
tion measures, there is provided a maintenance
aid with the same benefit amounts for the
miner and his wife and children.
Applicants who are considered eligible for
rehabilitation by the Fund, after they have
met all non-medical requirements, will be
referred to their Area Medical Administrator
for examination by physicians with whom ar-
rangements have been made by the Medical
Service of the Fund. Officers announced that it
is the intent of the service to rehabilitate and
restore to useful occupational life every injured
or ill miner where it is possible to do so.
SURVIVORS
Widows who were living with or were being
supported by deceased miners at the time of the
miners’ deaths shall be eligible for maintenance
aid in the following amounts, less regular in-
1214
The Ohio State Medical Journal
come received from any source and under the
following’ requirements :
1. Widows 50 years of age and over (a)
with no children, $30 per month; (b) with one
child under 18, or over 18 if incapacitated, de-
pendent upon and living with her, $40 per
month; (c) for each additional child, $10 per
month.
2. Widows under 50 years of age (a) with
one child under 18, or over 18 if incapacitated,
dependent upon and living with her, $40 per
month; (b) for each additional child, $10.
Payments to widows terminate upon remar-
riage of the beneficiary. No provisions are made
for widows under 50 years of age who do not
have dependent children.
MEDICAL SERVICE
Benefits under the Hospital and Medical Service
of the Fund are extended to include:
1. Widows of deceased miners;
2. Unmarried relatives of deceased miners
who stand in the relation of mother to such
miners’ orphaned children under 18 or incap-
acitated dependent children over 18;
3. Dependent children under 18 of deceased
miners.
Benefits for persons enumerated in foregoing
paragraphs 1 and 2 terminate upon marriage or
remarriage. '
The following persons who are disabled by
injury or disease are eligible for hospital and
medical care benefits not to exceed 60 days
hospitalization in any twelve-month period:
1. Relatives of miners who are dependent
upon and are living with them in their house-
hold and have been dependent upon and living
with them continuously for six months next
preceding their applications for benefits and
have no regular source of income.
2. Children over 18 of deceased miners who
are dependent upon and living with their
widowed mothers or any person who stands in
relation of mother to such miners’ orphaned
children in their household and have been de-
pendent upon and living with them for six
months next preceding their application for
benefits and have no regular source of income
(such benefits to terminate upon marriage or
remarriage).
The previously-established Hospitalization and
Medical Care Program of the Fund was explained
in the August issue of The Journal. Dr. Leslie
A. Falk, Pittsburgh, Pa., is area medical ad-
ministrator.
Dr. H. M. Clodfelter, Columbus, was principal
speaker at the annual dinner of the Perry
County Red Cross in New Lexington. Dr. Clod-
felter is vice-chairman of the Medical Advisory
Committee of the Columbus Regional Blood
Center.
State Health Officers Take Stand
Against Socialized Medicine
Dr. John D. Porterfield, director of the Ohio
Department of Health, was elected secretary-
treasurer of the Association of State and Ter-
ritorial Health Officers at its meeting in Wash-
ington, D. C., October 23-27. Dr. Roy L. Cleere,
executive director of the Colorado Department
of Public Health, was elected president.
Among actions taken at the meeting were the
following:
The Association urged amendment to the law
to prevent “incorporation into or on food of
chemical or other new ingredients before they
have been reviewed and approved by the Food
and Drug Administration.”
It criticized Congress and the Federal govern-
ment for reducing grant-in-aid-programs, and
directed special attention to the 50 per cent
reduction in hospital authorization funds, “which
seriously and drastically disrupts the programs
for long-range planning by communities and
states.”
It urged support for legislation providing
Federal financial assistance to state health de-
partments and developing and maintaining local
public health units, “organized to provide basic
full-time public health services in ail areas of
the nation.”
It called on the National Security Resources
Board to make available the manual on health
and medical aspects of civil defense “without
further delay.”
It reaffirmed its opposition to national com-
pulsory health insurance and renewed its demand
for creation of a Federal department of health
with cabinet status under direction of a career
physician in public health.
National health insurance is unnecessary, the
resolution says, because voluntary health and
hospitalization plans are “rapidly and progres-
sively developing to meet the apparent needs
of the people.” The resolution notes the prog-
ress in preventive medicine, protective sanitation
against evironmenta! hazards and proper public
health information, and says a major factor in
this progress has been the work of organized
public health service with qualified personnel.
At the outset the resolution states that “. . .
it is generally recognized that the people of
the United States now enjoy the highest stand-
ards of health of any country in the world.”
The opening fall meeting of the Fort Steuben
Academy of Medicine was held on Oct. 10 at the
Fort Steuben Hotel in Steubenville. Dr. Hans
May, of Philadelphia, discussed phases of
plastic surgery. The meeting inaugurated the
fifth annual program of the Academy which
consists of doctors of the Steubenville area.
for December, 1950
1215
Industrial Commission . . .
$4,607,391 Disbursed by Ohio Agency for Medical Service in 1949,
Report of Actuarial Section Shows; Claims Filed Totaled 275,471
THE Industrial Commission of Ohio paid
out $4,607,391 for medical services to in-
jured Ohio workmen during 1949, according
to a report issued by the Commission. In-
cluded in the amount is a relatively small sum
for dental services.
Other expenditures during the year, exclusive
of compensation payments, included: $3,512,507
for hospital care and nursing; $152,539 for
funeral expenses, and $126,369 for miscellaneous
costs. With disbursements for medical services
added, the total is $8,398,806.
These amounts include payments covering
treatment of injured private and public employees,
as well as similar costs for occupational disease
claims.
Comparative figures for 1948 were as follows:
$4,515,016, medical services; $3,085,151 for hos-
pital care and nursing; $165,863, funeral ex-
penses; $110,444, miscellaneous costs — a total
of $7,876,474.
DECREASE IN CLAIMS
The number of claims filed during 1949 was
275,471, or 8% per cent less than in 1948. The
peak year in number of claims during the 38-year
history of the Ohio Workmen’s Compensation
Fund was 1943 when the number of claims
reached 331,072, 81 per cent of which were
“medical-only” claims. The average number of
claims filed each working day in 1949 was 1,097.
“Medical-only” claims, involving payment for
physicians’ services, but with no compensation
to the claimant for loss of time, numbered
211,050 in 1949, or 77 per cent of all claims
filed. The average amount paid out per “medi-
cal-only” claim decreased from $10.01 in 1948
to $9.48 in 1949.
BASIC RATE CHANGES
Basic rates were lowered in two classifications,
raised in 304 and remained unchanged in six, ac-
cording to the Actuarial Revieiv.
Table 1 is a financial statement of the Ohio
State Insurance Fund.
Table 2 gives 1949 disbursements that have
been paid for active claims according to year
of injury, and having injury dates which in some
instances reach back to the beginning of the fund.
TABLE 1
OHIO STATE INSURANCE FUND
(Workmen’s Compensation)
STATEMENT OF FINANCIAL CONDITION
As of December 31, 1949
Cash
Bonds
Premiums in Course of Collection
Accrued Interest
ASS
Private
$ 2,548,174.82
. 151,370,938.39
1,865,151.79
848,778.04
E T S
Public
$ 132,665.82
7,765,917.22
1,452,274.02
42,060.63
P.W.R.E.
$ 13,777.47
773,369.35
5,381.80
3,602.62
Safety &
Hygiene
$ 12,850.53
1,208,389.61
6,214.52
Total
$ 2,707,468.64
161,118.614.57
3,322,807.61
900,655.81
Total Assets
-$156,633,043.04
$9,392,917.69
$796,131.24
$1,227,454.66
$168,049,546.63
LIABILITIES
Reserve for Medical & Compensation Benefits
$109,608,702.00
$7,997,660.12
$105,633.67
$
$117,711,995.79
Reserve for Contingencies
. 18,500,000.00
387,301.07
20,500.00
18,907,801.07
Reserve for Allocated Surplus Adjustment
808,439.00
808,439.00
Unearned Premium
7,895,624.00
199,517.50
8,095,141.50
Fund
1,227,454.66
1,227,454.66
Surplus .
20,628.717.04
669,997.57
21,298,714.61
Total Liabilities
$156,633,043.04
$9,392,917.69
$796,131.24
$1,227,454.66
$168,049,546.63
TABLE 2
1949 Awards Distributed to Year of Injury Occurrence
(Accidents and Occupational Disease Combined)
Year of Accident
Medical
or Disease
Compensation
Hospital, Etc.
Total
Per Cent
1949
$ 3,666,573
$ 3,746,784
$ 7,413,357
25
1948
5,307,685
2,663,224
7,970,909
27
1947
3,411,245
541,522
3,952,767
13
1946
1,954,505
263,674
2,218,179
8
1945
1,526,953
147,279
1,674,232
6
1944
1,490,570
101,688
1,592,258
5
1943
1,134,566
121,090
1,255,656
4
1942
706,789
77,441
784,230
3
1941
333,494
35,247
368,741
i
1940
228,754
38,184
266,938
i
1912 - 1939
1,763,072
147,945
1,911,017
7
Total
$21,524,206
$ 7,884,078
$29,408,284
100
1216
The Ohio State Medical journal
Constipation
in the Postsurgical
or Bedridden Patient
■*»£?, uT^S
The combined effects of enforced inactivity, poor appetite and
dietary restrictions frequently result in bowel sluggishness.
By adding bland "smoothage” and assuring a normal fecal
consistency and volume, Metamucil gently initiates reflex peri-
stalsis and encourages a return of normal bowel function.
METAMUCIL is the highly refined mucilloid of
Plantago ovata (50%), a seed of the psyllium group, combined
with dextrose (50%) as a dispersing agent. G. D. Searle & Co.,
Chicago 80, Illinois.
RESEARCH IN THE SERVICE OF MEDICINE
SEARLE
for December, 1950
1217
Ill Our Opinion:
REFLECTIONS ON THE
NOV. 7 ELECTION
November 7, 1950, can be chalked up as a
banner day for the medical profession of Ohio.
In case you don’t remember, that was Election
Day.
Reflections on the activities which were car-
ried on prior to November 7 and on the results
at the polling places of the state on that day
should give many physicians of Ohio and their
wives a deep feeling of satisfaction and pride.
Physicians of Ohio and their wives are being
credited by candidates and by many others who
took a personal interest in the 1950 election con-
tests with having played an outstanding role
in bringing about the upheaval which swept
into public office a host of candidates, who
for the most part, are well qualified and who
are opposed to Fair Deal socialism — national,
state and local.
Of special importance was the job done by
Ohio physicians and their wives, as well as other
professional and business men and their wives,
on behalf of Senator Robert A. Taft who was
returned to his seat in the U. S. Senate by one
of the largest majorities ever given to an
office-seeker in Ohio.
The physicians of Ohio and their wives did
nothing especially unique in the campaign which
they carried on as citizens in support of Senator
Taft and many other candidates who stood for
honest, efficient government and for sound basic
principles.
The tactics which they used were neither new
nor original.
Their real achievement was that they rolled
up their sleeves and went to work — in large num-
bers and many of them for the first time —
putting to practical use proven methods and
techniques. In other words, as independent,
thinking citizens they engaged in practical
politics.
What are some of the lessons learned during
the rather hectic pre-election battles waged in
all parts of the state? Following are a few
which, in our opinion, are of major significance:
The overwhelming majority of Ohio voters,
when the issues are clearly defined and adequate
information on the qualifications of candidates is
disseminated, will vote not as a class, as a mob,
as stooges of political bosses or under intim-
idation, but as independent, thinking citizens.
Members of the medical profession, long re-
Comments on Current Economic and Social
Questions and Professional Problems ;
Suggestions Regarding Organized Activities
garded as potentially powerful in political and
civic activities, actually can be a mighty political
force, providing they shed their traditional reti-
cence. Also, if enough of them will take a
personal interest and will conscientiously follow
through on their individual assignments.
New or unique techniques are not necessary to
achieve results. Tried and true methods which
have been used successfully by astute politicians
and citizens’ groups working in their behalf are
enough. However, these methods will suffice only
if accompanied by hard work and perfect follow-
through on the part of those in the ranks
— which was done in Ohio in 1950.
Physicians have learned that they can make
a real contribution by coordinating their activities
in support of qualified candidates with the
activities of other groups mutually interested
in electing candidates whose views on social,
economic and governmental questions are sound.
Systematic long-range planning is neces-
sary. Good field work is essential. Careful
selection of key persons is vital.
The medical profession, and others whose
views coincide with the views of the medical
profession, dare not regard the satisfactory re-
sults in 1950 as final. A similar job must be
done prior to each election — national, state or
local. To maintain the active interest of phy-
sicians in political affairs, similar activities must
be undertaken year after year.
Every medical society has a role to play
in pre-election campaigns and should be pre-
pared to do so. Although confronted with cer-
tain legal limitations, each medical society can,
legally and properly, interview candidates and
pass on to its members information relative
to their qualifications and opinions on medical-
health issues. It is up to the individual phy-
sician then to make use of this data as he
sees fit. Moreover, it is not only the right but
the duty of the medical society to pound away
at its membership on the point that physicians
are citizens and that citizenship carries with
it certain responsibilities and obligations, one of
which is participation in political affairs.
The force and influence which can be brought
to bear by the individual members of the woman’s
auxiliary of a medical society must not be over-
looked. A remarkable job during the 1950 pre-
election campaign was performed by the wives
of thousands of Ohio doctors.
Political activities by physicians, or anyone
1218
The Ohio State Aledical Journal
else, must start at the grass roots — at least
the bullets must be fired at the grass roots.
Entanglement in partisan politics can be
avoided. Workers will really do the job re-
gardless of party affiliations when medical issues
or issues involving democratic principles are
at stake, or inferior candidates in the running.
True, socialized medicine was one of the issues
debated in Ohio during the 1950 campaigns.
Nevertheless, it was made a partisan issue be-
cause of the propaganda issued by one of the
major political parties and because of the voting
records or known beliefs of some of the candi-
dates. That being the case, the physicians of
Ohio and others who agree with their views
on this question, had no choice but to take a
stand and let the chips fall.
OHIO REAPS THE WHIRLWIND
AS U. S. CUTS HEALTH GRANTS
Ohio v/ill probably take a beating on hospital
construction and on some of its essential public
health services during the ensuing months.
Why? Primarily because Ohio has been rely-
ing too heavily on Federal Funds for these activ-
ities and now Federal grants have been cut.
The cuts announced will amount to about 12
per cent of the Ohio Department of Health’s
total resources. Aside from the hospital build-
ing program, other programs which will have
to be curtailed due to reduction in funds, in-
clude: Tuberculosis, general health, heart dis-
ease, cancer and venereal diseases.
Two years ago spokesmen for the Ohio State
Medical Association stood before committees in
the State Legislature, pleading for a better fi-
nancial deal from state funds for the health de-
partment. They hoisted the warning that Ohio
was largely at the mercy of Uncle Sam — to the
extent of about 75 cents out of each dollar
spent. They expressed the fear that Ohio would
surely suffer if the Federal Government decided
to reduce grants-in-aid. These warnings went
unheeded.
Nowr Ohio is behind the eight-ball.
Ohio citizens want a strong state depart-
ment of health, as well as strong local health
departments. In our opinion they will be willing
to foot the bill. They are not going to like this
turn of events, we believe.
The new General Assembly convening in
January ought to take a really serious look-see
at the situation. A more equitable distribution
of state money among the administrative de-
partments must be worked out. If that is done,
the health department’s status can be improved.
If it were not a serious matter, the observa-
tion might be made that the great State of
Ohio is getting just what it deserves.
DO YOU ITEMIZE
YOUR STATEMENTS?
You may not agree but in our opinion the
following excerpt from a bulletin of the Illinois
Medical Society hits the bull’s-eye and makes a
lot of sense — contains a suggestion which all
physicians would do well to follow:
“Would you pay your bill at the garage if
it came to you: ‘Repair on 1948 car — $64.32’?
You’d much rather know that $8.00 went for
checking the front end alignment; $1.25 for ad-
justing brakes; $1.25 for switching the tires,
and that parts amounted to $22.75 and the rest
was labor.
“Perhaps Mrs. Jones didn’t understand the
charges for Junior’s case of infectious mononu-
cleosis; maybe she doesn’t know what laboratory
work is. Did you explain to her exactly what
was wrong with Junior? Did you tell her
why laboratory work had to be done? Does your
bill carry the statement that you made a night
call on Wednesday, June 20th? If it does,
maybe she’ll remember how glad she was to see
you.
“Or did you send Mrs. Jones a statement for
‘Services rendered’ ?
“Think it over. Put on Mrs. Jones’s size 5%
shoes for a while and see if they pinch — just
a little.”
PROGRESS MADE IN FORMING
STUDENT A.M. A.
It’s gratifying to knowr that progress is being
made in organizing the Student American Medi-
cal Association.
An excellent piece of education can be done
once this organization is on a going basis.
There certainly is need to familiarize medical
students with the aims and purposes of medical
societies — local, state and national — and to keep
them up to date on current events and develop-
ments affecting the medical profession.
This can be done more effectively through an
organization of their own than at present, al-
though there is still a definite place for talks
and discussions with them, sponsored by medical
societies where the schools are located.
COLLEGE OF SURGEONS CONTINUES
HOSPITAL INSPECTION
An alarm sounded by the A. M. A. to the effect
that the American Hospital Association had
proposed taking over the traditional standardiza-
tion and approval of hospitals by the American
College of Surgeons was reported in the Novem-
ber issue of The Joui'nal. Physicians can now
be reassured. At a recent meeting the regents
of the College voted unanimously to continue
the program.
Commenting on action of the board of regents,
for December, 1950
1219
The Journal of the A.M.A. points out that this
action does not necessarily preclude consider-
ation of proposals for participation of other
interested agencies in this program but does
make it clear that the American College of
Surgeons has an undiminished interest in it
and will consider no proposal which will not
insure its continuation in the best interests of
the public.
EWING BLISTERED FOR POKING
NOSE INTO OHIO POLITICS
Dr. Ed. McCormick really blistered Oscar
Ewing in a statement published in Toledo
newspapers, answering Ewing’s attack on Sen-
ator Taft and the A. M. A. at a Toledo union
meeting which had been billed as a discussion
of national health insurance — not politics or the
A. M. A.
Said Dr. McCormick:
“Mr. Ewing demonstrated his usual lack of
respect for facts, truth and the right of the
American people to think for themselves. He
completely distorted the motives, methods and
results of the A. M. A. advertising program.
“Mr. Ewing apparently has lost all political
restraint and all sense of intellectual decency in
his frantic, frustrated efforts to play politics
with the health of the American people. He
now maligns not only the medical profession,
but also all Americans who choose to agree
with the medical profession.
“His psychotic distortions, inaccuracies and
accusations are an insult to the intelligence and
integrity of all Americans who believe in free-
dom of speech and fair play.”
The council of the Toledo Academy of Medi-
cine advised members to turn down invitations
to attend the meeting as it felt “this attempt
by an Administrative officer of the government to
influence legislation and our Ohio elections is
both improper and a misuse of public funds.”
HATS OFF TO TOLEDO AND
CLINTON COUNTY SOCIETIES
The Toledo Academy of Medicine and the Clin-
ton County Medical Society are requested to
step forward and take a bow.
In a recent issue of the A. M. A. Public Rela-
tions Bulletin, “The PR Doctor,” a nice boost
was given to the Toledo Academy on its news-
paper advertising program.
An editorial in a recent issue of The Journal
of the A. M. A. complimented the Clinton County
Medical Society on the fine work which it
carried on, with other local groups, in making
a health survey of the county.
These are examples of things which county
medical societies can do if they want to.
ALL IS NOT WELL WITH
BRITISH HEALTH SCHEME
Britain’s national health scheme is threatened
with collapse, Socialists in the southeast London
area warned Health Minister Aneurin Beven
recently. A committee including doctors warned
that the increase in patients and the lack of
doctors mean overworked doctors, dissatisfied
patients and the end of personal relations with
them.
The report said that a total of 17,545 doctors
received $106,398,493, which gave them indi-
vidually less than half the income earned by
dentists. About 13,400 pharmacists and sup-
pliers of surgical appliances shared $81,763,380.
Payments for ophthalmic services totaled $57,-
596,980.
Meanwhile resignation forms are going out to
all general practitioners from the British medi-
cal guild with an urge that doctors resign if
their pay claims are not met by the end of the
year. The British Medical Association has been
negotiating since January, 1948 — six months
after the health service started — for revision in
the pay system.
Wholesale issuance of prescriptions presents
another bug in the scheme. Statistics show
that 201,000,000 prescriptions had been dis-
pensed for national health service patients in
England and Wales last year — about a half pint
of mixture for every man, woman and child in
the country.
MEDICAL SOCIALIZERS HIT
BELOW BELT AGAIN
Look out for more below-the-belt punches by
Socialized Medicine advocates of the Democratic
National Committee! Here’s what happened in
one state:
Minnesota newspapers carried photographs
showing wounded American soldiers in Korea
with superimposed headlines such as, “Financial
Help Now Essential To Nation’s Medical
Schools”; “15 of 3,000 Doctors Answer Army
Call,” and the like.
Doctors were dumbfounded when they looked
at the credit line and found “Wide World Photos”
— an ethical news photo service operated by
the Associated Press. The medical profession
traced the origin with the help of Wide World
and found the photos were in truth Wide World
pictures but that the Democratic National Com-
mittee had added its own propaganda.
Wide World in a letter to the A.M.A. wrote:
“Use of the picture in the manner in which
you saw it printed was not authorized by Wide
World. We took up the matter immediately
with representatives of the Democratic National
Committee which improperly handled the publica-
tion. The organization sent out a notice to kill
the photo credit.”
1220
The Ohio State Medical Journal
"The . . . estrogen
preferred by us is
'Premarin,’ a mixture
of conjugated estrogens,
the principal one
of which is
55
estrone sulfate.
Hamblen, E.C.: North Carolina M.J. 7:533 (Oct.) 1946.
In treating the menopausal syndrome
with “Premarin” Perloff* reports that
“Ninety-five and eight tenths per cent
of patients treated with 3.75 mg.
or less daily obtained complete relief
of symptoms”; also, “General tonic
effects were noteworthy and the greatest
percentage of patients who expressed
clear-cut preferences for any drug
designated ‘Premarin! ”
Thus, the sense of “well-being”
usually imparted represents a “plus” in
“Premarin” therapy which not only
gratifies the patient but is conducive to
a highly satisfactory patient-doctor
relationship.
Four potencies of “Premarin”
permit flexibility of dosage: 2.5 mg.,
1.25 mg., 0.625 mg. and 0.3 mg. tablets;
also in liquid form, 0.625 mg. in
each 4 cc. (1 teaspoonful) .
•Perloff. W. H.: Am.J. Obst.& Gynec. 58:684 (Oct.) 1949.
While sodium estrone sulfate is the principal estrogen in
“Premarin)’ other equine estrogens. ..estradiol, equilin,
equilenin, hippulin...are probably also present in varying
amounts as water-soluble conjugates.
Estrogenic Substances ( water-soluble) also known as Conjugated Estrogens ( equine)
5003
Ayerst, McKenna & Harrison Limited
22 East 40th Street, New York 16, N. Y.
for December, 1950
1221
Henderson Answers C. I. 0. . . .
Charges in Paid Advertisements that Profession Opposed Progress in
Medicine and Health Are Branded as False by A. M. A. President
THE C. I. O. National Health Committee —
whatever that is — used more than 1,000
words in a paid advertisement appearing
in a number of newspapers during the week of
October 22 to tell doctors that it did not like
the American Medical Association’s national
advertising campaign against socialized medi-
cine. The advertisement, headed “Dear Doctor,”
evidently appeared in newspapers in cities where
a C. I. 0. candidate was running for office on a
platform to support the administration’s com-
pulsory health insurance plan.
A. M. A. President Elmer L. Henderson replied
to the ad in a two-page article appearing on
pages 933 and 934 in the November 11 issue of
The Joumnal of the American Medical Association.
The advertisement, which bitterly denounced
the A. M. A. and nearly everything for which
it stands, was, Dr. Henderson said, “the same
old fancy-wrapped package of lies, untruths,
half-truths and part-truths — all aimed at con-
fusing the American people on the issue of so-
cialized medicine.”
Dr. Henderson said in his reply that the public,
in reading the advertisement, naturally did
not know that nearly the entire text was taken
from a speech which Rep. Andrew J. Biemiller,
Democratic representative from Milwaukee, made
before Congress and which was printed in the
Congressional Record.
Incidentally, Biemiller was defeated on Nov-
ember 7.
Following is Dr. Henderson’s statement in
part:
Congressman Biemiller as we all know, has
sung the praises of socialized medicine for a
long time; yet in 1937 and again in 1939, he
failed to sell such a scheme to the people of
Wisconsin. He once managed the Midwest
campaign of Norman Thomas, a Socialist candi-
date for President, and a Republican officeholder
referred to him during the present campaign as
“the man who came sailing out of Eastern uni-
versities to Wisconsin as the socialist educational
director for Milwaukee County.”
In a sense, therefore, the advertisement was
written by Congressman Biemiller, who gave
the American Medical Association a lashing on
several points, saying the Association and its
state and local medical societies: Opposed vac-
cination against diphtheria and other contagious
diseases by public health authorities; fought
against the reporting of communicable diseases
and public health services to control tuberculosis
and they still oppose free diagnostic centers for
tuberculosis and cancer; fought against setting
up free venereal disease clinics; fought work-
men’s compensation laws; fought group medical
practice; fought the American Red Cross blood
bank plan; fought voluntary insurance plans;
and fought many other projects.
His charges are outright lies. Neither he nor
those responsible for preparing the advertise-
ment took the time or trouble to ascertain
the truth. Evidently, the propagandists had only
one objective in mind; to fool the American peo-
ple.
IMMUNIZATION
The truth of the matter is that the House
of Delegates, the policy-making body of the
American Medical Association, never opposed
vaccination against diphtheria or against any
other contagious disease. And it never fought
against the reporting of communicable diseases
and public service health services to control
tuberculosis. In fact, the House in 1925 urged
periodic health examinations for the general
public, and in 1937 it adopted a resolution urging
that “every effort be made to promote all fea-
tures of preventive medicine, including diphtheria
and all communicable diseases, and to make
these features available to the public.” That
certainly does not smack of opposition.
CANCER AND TUBERCULOSIS
In his wild reference pertaining to cancer and
tuberculosis control, Mr. Biemiller did not trouble
himself to check the resolution, passed by the
House back in 1905, which commended the
“American Society for the Control of Cancer”
for its program of public education on detection
and prevention of cancer. Nor did he bother to
delve into the fine work which the Woman’s
Auxiliary to the American Medical Association
has done since its founding in 1922 to prevent
and eradicate tuberculosis, especially among
children. His comments about venereal disease
clinics are ridiculous. In 1937 — 13 years ago —
the House adopted a resolution recommending
special venereal disease divisions in health de-
partments and use of hospital and dispensary
clinics for early treatment and follow-up.
WORKMEN’S COMPENSATION
It might interest Mr. Biemiller to know that
the Association never opposed the principle of
workmen’s compensation legislation. Any state-
1222
The Ohio State Medical Journal
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for December, 1950
1223
ment to that effect is a deliberate untruth, aimed
to mislead the American working man. During
the formative period of this legislation, the
American Medical Association did contend that
there were certain inadequate provisions for the
supplying of medical care to injured workmen,
and pointed particularly to the absence of any
right given to the injured workman to select
his own physician. That stand of the Associa-
tion was to protect the working man and not
to challenge any benefits he might receive. As
Dr. William D. Haggard, president-elect of the
Association in 1925 said, “The denial of the
right of the patient to choose his own physician
or surgeon when injured is un-American, unwise
and one step toward state medicine.”
GROUP PRACTICES
Mr. Biemiller said, too, that the American
Medical Association fought group practice. The
statement actually is silly, because three Mayo
Clinic physicians have served as presidents of
the Association, and at least three members
of its Board of Trustees are connected with such
clinics. Dr. William Mayo served as president in
1906, Dr. Charles Mayo in 1916 and Dr. E.
Starr Judd in 1931. All three were connected
with the best known group practice clinic in the
world.
The American Medical Association has con-
sistently fought for the highest type of standards
in group practice. When any group practice
plan was tied in with a questionable insurance
scheme or when a patient was restricted to a
particular group of doctors by his insurance
policy or when any group practice plan restricted
a patient in the free choice of a physician, the
Association was never hesitant in voicing bitter
objection. This was done in the sole interest
of better medical care for the patient. The
attitude of the American Medical Association
toward group practice is plainly revealed in a
section of its “Principles of Medical Ethics,”
which says, “The ethical principles actuating and
governing a group or clinic are exactly the same
as those applicable to the individual.”
RED CROSS
Mr. Biemiller made his caustic reference to
the American Medical Association and the
American Red Cross Blood Bank plan even
though the American Medical Association’s House
of Delegates had gone on record as endorsing
the idea of a national blood procurement pro-
gram under auspices of the Red Cross. Further-
more, when the Red Cross Blood Bank plan
was first conceived — even before it was pub-
licly announced — the Board of Trustees of the
American Medical Association approved it in
principle. If Mr. Biemiller had investigated first,
he would have learned also that the Association,
at considerable cost to member doctors, made
the only comprehensive survey of blood banking
in the United States.
VOLUNTARY HEALTH INSURANCE
For Mr. Biemiller to imply that the Ameri-
can Medical Association opposed voluntary health
insurance plans of the type available today is
a deliberate falsification of facts. Fifteen years
ago, the Association did oppose some of the so-
called voluntary health plans, but for good rea-
son. Certain features were objectionable1, and
they have long since been eliminated thereby
helping to speed up the growth of the strong
voluntary health plans as they exist today.
Today, the total number of persons protected
by all types of hospitalization and medical care
insurance exceeds 70,000,000, a remarkable figure
when one considers that the total only five years
ago was 26,000,000.
FEDERAL AID TO MEDICAL SCHOOLS
Mr. Biemiller said, too, that the American
Medical Association “blocked Federal- aif'fo
medical schools.” He is right, but he failed to
explain that the bills proposed would lead to
control of the medical schools by the Federal
government either directly or indirectly with
a gradual deterioration of medical education be-
cause of political domination. The Association
long has held that the problem of financial
support for medical schools should be freely
in the hands of the communities or states
served by these schools.
NOTHING IS FREE
The advertisement inspired by Mr. Biemiller’s
speech said that, since “the cost of medical care
is too high for anyone except the wealthy, the
people want to pool their resources to meet a
common risk.” What the advertisement failed
to tell union men is that under whatever method
a worker’s medical care is paid, he himself
eventually will have to pay the bill.
If the bill comes from Uncle Sam, it will be
a tax bill and there will be no escaping it.
It will be a stiff bill, too, because it will have
added to it all the lost motion, waste and in-
efficiency that goes with government manage-
ment in any big business. Added to the worker’s
medical costs will be the salaries and main-
tenance of administrators, accountants and super-
vising physicians, as well as the costs of ac-
counting machinery and the necessary build-
ings to house the records. The worker cer-
tainly will be subject to all the disadvantages
of deteriorating medical care at a high price.
By placing such an advertisement in news-
papers, those responsible for it showed that they
have lost all sense of fair play. As a union, the
C. I. O. believes that every member has a right
to have something to say about the conditions
under which he works. Doctors have as much
1224
The Ohio State Medical Journal
Cor tone'
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CORTONE* (Cortisone) is now available, through your usual source of
medicinal supplies, without restriction. Pharmacists are prepared
to fill your prescriptions for use of this remarkable hormonal
substance in your daily practice. Hospitalization of individual patients
is at the discretion of the physician.
Key to a New Era in Medical Science
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*CORTONE is the registered
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Inc. for its brand of cortisone.
for December , 1950
1225
right as the coal miner, the steel worker, the
railroad man or any other person to have a
voice in determining the conditions under which
they work. They, as Dr. W. W. Bauer said in
his recently published book, Santa Claus, M. D.,
especially are entitled to this privilege because
of the safeguards their profession believes is
necessary for the welfare of the patient. Yet,
through what is advocated in the advertisement,
impossible conditions would be imposed on the
200,674 physicians in the United States. This
is dishonest, unfair and contrary to all American
principles and contrary to what members of a
union themselves fight for.
New Members of O. S. M. A.
Following are the names of new members of
the Ohio State Medical Association, since Sep-
tember 1, 1950. The list shows the county
in which they are affiliated, city in which they
are practicing, or temporary addresses in cases
where physicians are taking postgraduate work.
AUGLAIZE COUNTY
David W. Nielsen,
Waynes field
CLARK COUNTY
H. M. Tardif, Springfield
CUYAHOGA COUNTY
Bernard L. Brofman,
Cleveland
Peter J. Corrigan, Jr.,
Cleveland
Thomas I. Crawford,
Cleveland
Richard G. Deucher,
Cleveland
William J. Donaldy,
Cleveland
A. E. Handy, Jr., Cleve-
land
Robert A. Hays,
Cleveland
Joseph C. Jenkins, Cleve-
land
Louis J. Jindra, Cleve-
land
John W. King, Cleveland
William J. McGannon,
Cleveland
Jack Meltzer, Cleveland
Pierce H. Mullally, Cleve-
land
Alexander P. Orfirer,
Cleveland
Arthur J. Patek, Jr.,
Cleveland
Robert H. Perchan, Cleve-
land
John R. Reed, Cleveland
Ausey H. Robnett, Cleve-
land
Donal R. Ross, Bay Village
Harry M. Wildblood,
Cleveland
Charles G. Zegiob, Cleve-
land
R. J. Zwalsh, Cleveland
DELAWARE COUNTY
William D. King, Delaware
FAYETTE COUNTY.
Byers W. Shaw, Wash-
ington C. H.
FRANKLIN COUNTY
Beatrice Bamberger, Co-
lumbus
Robert I. Barickman, Jr.,
Muncie, Ind.
Roderick A. Bryce, Co-
lumbus
William O. Duggar, Co-
lumbus
John Shiu Fung, Columbus
Robert A. Heilman, Co-
lumbus
Torrence A. Makley, Jr.,
Columbus
James Richard Monroe,
Columbus
Darwin K. Phelps, Colum-
bus
Robert Jones Rohn, In-
dianapolis, Ind.
Gerald G. Schreiber, Co-
lumbus
Joseph P. Whitlatch, Co-
lumbus
HAMILTON COUNTY
Sanford Blank, Cincin-
nati
Gordon L. Block, Jr., Cin-
cinnati
Cornelius B. DeCourcy,
Cincinnati
Leonard Gottesman,
Cincinnati
Ralph S. Grace, Cincin-
nati
Frederick D. Haffner, Cin-
cinnati
Edward Hartenian,
Cincinnati
Helen L. Jackson, Cin-
cinnati
Roy T. Johnson, Jr., Cin-
cinnati
Sol Kessel, Cincinnati
John A. Kirchner, Cincin-
nati
Harry J. Konerman,
Cincinnati
Frederick V. Kristoff,
Cincinnati
Clifford E. McIntyre, Cin-
cinnati
John F. Miley, Cincinnati
Frank Princi, Cincinnati
William Ransohoff, Cin-
cinnati
Samuel A. Trufant, Cin-
cinnati
John C. Willke, Cincinnati
John P. Wissinger, Cin-
cinnati
HARDIN COUNTY
William T. Ellis, Dunkirk
LAWRENCE COUNTY
Harry Nenni, Ironton
LOGAN COUNTY
Robert H. Lanfersieck,
Quincy
LORAIN COUNTY
Charles J. Cooley, Oberlin
William H. Miller, Jr.,
Elyria
John W. Wherry, Elyria
Richard M. Wilke, Lorain
LUCAS COUNTY
Philip Cohn, Toledo
Arthur M. Dalton, Toledo
Marian M. Rejent, Toledo
Kenneth Schoenrock,
Toledo
MARION COUNTY
James A. McGlew, Marion
Richard W. Mills, Marion
Frank V. Murphy, Jr.,
Marion
MIAMI COUNTY
Gerard F. Wolf, Piqua
MUSKINGUM COUNTY
John Q. Adams, Zanes-
ville
PICKAWAY COUNTY
Ray Carroll, Circleville
Mark H. Huckeriede,
Circleville
PUTNAM COUNTY
James L. Goddard, Kalida
James B. Overmier, Leipsic
SENECA COUNTY
Thomas D. Efstation,
Tiffin
SUMMIT COUNTY
Clinton S. Bond, Akron
Albert H. Bremer, Stow
George W. Duffey, Akron
Louis A. Lame, Cuyahoga
Falls
Charles K. Wintrup, Akron
John L. Zintsmaster,
Akron
New Doctor Film for Schools
Is Available
A new film, “Your Friend, the Doctor,” was
released recently by Coronet Instructional Films,
Inc., Chicago. Fred V. Hein, Ph. D., and Dr.
Donald A. Dukelow, of the A. M. A. Bureau of
Health Education, served as consultants in the
development of the film, which is intended for
use in primary and intermediate grades (first
to sixth).
The film portrays the role of the family phy-
sician in the school and home and stresses his
friendly guardianship of child and family health.
The film is available in both color and black
and white, and will soon be available to schools
from state and local health and education de-
partments.
Local medical societies may obtain the film
from Coronet Films, Inc., 65 E. South Water St.,
Chicago. Screening of this 16 mm. film before
parent-teacher groups and others concerned with
family-school-physician relations is desirable
from the public relations standpoint, the
A. M. A. advises.
Rural Health Conference
Scheduled in Memphis
The sixth annual National Conference on Rural
Health will be held in Memphis, Tenn., February
23-24. It will be sponsored by the Committee
on Rural Health of the American Medical Asso-
ciation in cooperation with national farm organ-
izations.
More than 700 farm and health leaders, in-
cluding representatives of health and farm
groups, farm newspapers, agricultural extension
organizations, rural health committees, schools,
public health officials and others, are expected
to attend. Sessions will be held in the Peabody
Hotel.
State rural health committee chairmen will
hold a preliminary meeting on February 22,
the day before the conference opens.
1226
The Ohio State Medical Journal
INGLESIDE FARM INGLESIDE HOME
Hospitals for Nervous and Mental Disorders
VIEW AT INGLESIDE FARM
THE FARM - Chardon, Ohio
Telephone Chardon 355
Medical Director, Neil T. McDermott, M.D.
THE HOME - 8821 Euclid Ave.
Cleveland, Ohio Cedar 5416
Mabel A. Woodruff, Director
Facilities for
Chronics and Convalescents
for December, 1950
1227
Hospital Building Curtailed . . .
U. S. Budget Cut May Materially Affect Construction in Ohio Unless
Congress Takes Steps To Restore Appropriations Formerly Approved
CURTAILMENT of hospital construction in
Ohio during the next 18 months is inevi-
table unless Congress takes action to restore
drastic cuts ordered by the U. S. Department of
the Budget in Federal appropriations made under
the Hill-Burton Act.
This situation was considered at a recent
meeting of the Ohio Hospital Advisory Council
to the Division of Hospital Facilities, State De-
partment of Health.
It had been anticipated that Ohio would
have $6,000,000 a year in Federal funds for the
fiscal years, June, 1950, to July, 1951, and
June, 1951, to July, 1952; also, approximately
the same amount for the fiscal year starting in
June, 1953.
Long range planning on this basis was done
by the hospital facilities division and by ap-
plicants. Federal grants-in-aid to many potential
applicants were promised and some planning
started.
Because of the cuts made by the Federal
Government amounting to about 50 per cent, the
division has been forced to establish a special
priority of hospital projects, some of which
have been started; others in the preliminary
planning stage.
New factors which were taken into considera-
tion were: bed needs met, funds available,
readiness to construct, value to emergency, ex-
penditures incurred to date, etc.
The following projects were determined to
qualify for immediate assistance under funds
available for the present fiscal year, June, 1950,
to July, 1951: Hardin Memorial Hospital, Ken-
ton; Chillicothe Hospital; Cuyahoga County
Chronic Disease Hospital; Williams County Joint
Township Hospital, Montpelier; Timken Mercy
Hospital, Canton; Toledo Health Center; St.
Charles Hospital, Toledo; Columbus Health
Center; Mercy Hospital, Mt. Vernon; St. Eliza-
beth Hospital, Dayton, and Citizens Hospital,
Barberton.
Approximately $2,000,000 of next year’s funds
will have to be used to make possible the com-
pletion of the foregoing projects.
The following Ohio projects which have been
approved for grants-in-aid or are in a stage of
planning that will guarantee approval, will be
given assistance in the order mentioned as
rapidly as additional funds are made available
by the Federal Government:
South Unit, Youngstown; Peoples, Akron;
Aultman, Canton; Newark City; St. Elizabeth,
Youngstown; Good Samaritan, Dayton; Mercy,
Canton; Jackson; Miami Valley, Dayton; Fair-
view Park, Cleveland; Massillon City; Barnes-
ville; Bellaire; Martins Ferry; Van Wert; Find-
lay; East Liverpool; Bethesda, Zanesville; Good
Samaritan, Zanesville; Marion; Middletown; Ft.
Hamilton, Hamilton; Green Cross, Akron; Jewish,
Cincinnati; Mt. Carmel, Columbus; St. Ann’s
Columbus.
Some interesting data on the hospital build-
ing program nationally were complied recently
by the Washington Office of the American Medi-
cal Association, as follows:
From the start of the program in 1948 and
up to September 1, 1950, the Federal govern-
ment had given final and binding approval to
1,091 projects, where the Federal share totaled
$261,000,000.
Payments through September totaled $91,-
430,872. It is estimated that total payments
by the end of the current fiscal year will be
close to $250,000,000, a binding obligation for
which Congress has or will make appropriations.
Smaller towns are getting more hospitals,
but bigger towns and cities more money. Spe-
cifically, 65 per cent of the general hospital
projects are in communities of less than 10,000
population, but these get less than 45 per cent
of the money.
About 43 per cent of all general hospital proj-
ects under the program are of 50 beds or smaller,
but bigger hospitals are receiving 80 per cent
of the money.
Money is not going to smaller towns, mainly,
because residents either don’t want to sponsor
hospitals or can’t demonstrate they would be
able to maintain them once built.
Dermatologists To Meet In
Chicago, December 2-7
The ninth annual meeting of the American
Academy of Dermatology and Syphilology will
be held in Chicago from Saturday, December 2
through Thursday, December 7, Dr. John E.
Rauschkolb, Cleveland, secretary-treasurer, an-
nounced. Principal sessions will be held at the
Palmer House.
Among those taking part are the following
Ohio physicians, all of Cleveland: Dr. Clyde L.
Cummer, in charge of technical exhibits; Dr.
Herbert Z. Lund, and Dr. John R. Haserick who
will present scientific papers. Dr. Earl W. Nether-
ton, also of Cleveland, is assistant secretary-
treasurer.
1228
The Ohio State Medical Journal
THE NEW YORK POLYCLINIC
MEDICAL SCHOOL AND HOSPITAL
(Organized 1881)
THE PIONEER POST-GRADUATE MEDICAL INSTITUTION IN AMERICA
SYMPOSIUM ON OTOLARYNGOLOGY - OPHTHALMOLOGY
Five Days — April 16-20, 1951
A review of recent advances in the diagnosis and treatment of the more common
disorders in the fields of Otolaryngology and Ophthalmology, comprising lectures,
motion pictures and demonstrations in the clinics, operating rooms and dissecting
room. Guest speakers and members of our staff will participate. Fee, $50.00.
Limited class.
OBSTETRICS AND GYNECOLOGY
PROCTOLOGY AND GASTROENTEROLOGY
A full time course. In Obstetrics : . Lectures ; pre-natal
clinics; witnessing normal and operative deliveries; op-
erative obstetrics (manikin). In Gynecology; Lectures;
touch clinics; witnessing operations; examination of pa-
tients pre-operatively ; follow-up in wards post-opera-
tively. Obstetrical and gynecological pathology. Anes-
thesia. Attendance at conferences in obstetrics and
gynecology. Operative gynecology on the cadaver.
A combined course comprising attendance at clinics and
lectures; instruction in examination, diagnosis and treat-
ment; witnessing operations; ward rounds; demonstra-
tion of cases; pathology; radiology; anatomy; operative
proctology on the cadaver.
For Information Address
345 WEST 50th STREET MEDICAL EXECUTIVE OFFICER NEW YORK CITY 19
Have You an Article in this Issue?
The Stoneman Press will still have the type standing on the December
Ohio State Medical Journal until the 10th of the month and will
furnish reprints of your article at the following prices:
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STONEMAN PRESS SSlSS'TjSS
for December, 1950
1229
In Memoriam
• • •
John R. Buchanan, M. D., Youngstown; State
University of Iowa College of Medicine, 1925;
aged 49; died October 19; member of the Ohio
State Medical Association and a Fellow of the
American Medical Association; diplomate of the
American Board of Pediatrics. Dr. Buchanan
began practice in Youngstown in 1924. In addi-
tion to his professional practice, he was active in
several organizations among which were the
Unitarian Church, the Elks Club and the Youngs-
town Club. Surviving are his widow, a son, a
daughter, two sisters and three brothers.
George L. Chapman, M. D., Toledo; Miami
Medical Colege, Cincinnati, 1899; aged 79; died
October 1; member of the Ohio State Medical
Association and the American Medical Associa-
tion. Dr. Chapman began his practice in Toledo
upon completion of his education and continued
until his retirement about two years ago. Dur-
ing World War I, Dr. Chapman served overseas
in the Army Medical Corps. He was a member
of the Presbyterian Church. Surviving are his
widow, a son and a brother.
John Corliss Evans, M. D., Mt. Airy; Eclectic
Medical College, Cincinnati, 1893; aged 78; died
October 9 as the result of a traffic accident.
Dr. Evans had been surgeon for the New York
Central Railroad for approximately 37 years.
His widow and a son survive.
Arthur B. Hobson, M. D., Salem; University of
Wooster, Medical Department, Cleveland, 1895;
aged 79; died October 27; member of the Ohio
State Medical Association and the American
Medical Association through 1948. Dr. Hobson
moved his practice from Cleveland to Salem in
1908 and continued active until 1938 when he
went into semi-retirement. Last year he was
presented the 50- Year Pin and Certificate of the
Ohio State Medical Association through the
Columbiana County Medical Society. He was
trustee in the Methodist Church. Three brothers
survive.
Jonah L. Hurst, M. D., Dorset; Eclectic Medi-
cal College, Cincinnati, 1902; aged 72; died
October 31; member of the Ohio State Medical
Association and the American Medical Associa-
tion. In addition to his private practice, Dr.
Hurst was active for many years in health work.
He was a member of the Ashtabula County Health
Board, 1932-1935 and health commissioner, 1935-
1940. He served for 12 years on the Dorset
School Board. Two sons survive.
Gustav A. Jand, M. D., Cleveland; Pulte Medi-
cal College, Cincinnati, 1897; aged 78; died
October 31. Dr. Jend had served virtually all of
his medical career in Cleveland. He was a
member of Phi Epsilon Rho and the Methodist
Church. Surviving are his widow, a daughter,
two brothers and a sister.
David M. Keating, M. D., University Heights;
St. Louis University School of Medicine, 1926;
aged 52; died October 18; member of the Ohio
State Medical Association and the American
Medical Association through 1949; vice-president
of the Cleveland Academy of Medicine, 1946;
delegate 1946. In addition to his practice and
many activities in the Academy, Dr. Keating
devoted much time to other civic interests,
among which was the hospital fund-raising cam-
paign. He was a member of the Catholic
Church and the Cleveland Skating Club. Surviv-
ing are his widow and a sister.
Henry F. Kenkel, M. D., Cincinnati; University
of Cincinnati College of Medicine, 1920; aged 46;
died October 16; member of the Ohio State Medi-
cal Association and the American Medical Asso-
ciation through 1948. Dr. Kenkel practiced
medicine in the north side of Cincinnati for
24 years before retiring about six years ago be-
cause of his health. He was a member of the
Catholic Church.
Charles Louy, M. D. Toledo; Toledo Medical
College, 1897; aged 81; died October 21; mem-
ber of the Ohio State Medical Association and
the American Medical Association through 1942.
Dr. Louy had practiced for more than 50 years
in Toledo, and last year was presented the 50-
Year Pin and Certificate of the Ohio State Medi-
cal Association by the Academy of Medicine
of Toledo. During World War I, he served in
the Army Medical Corps. He was a member
of the Catholic Church, the Elks Club, the
American Legion, Ephoneta Auxiliary, Catholic
Knights of America, and the Holy Name So-
ciety. Surviving are his widow, a sister and a
brother.
John F. McHugh, M. D., Shelby; University of
Louisville School of Medicine, 1921; aged 53;
died October 24 as the result of a traffic ac-
cident while in the East; member of the Ohio
State Medical Association and the American
Medical Association; secretary-treasurer of the
Richland County Medical Society, 1942-1943 and
its president in 1944. Dr. McHugh had practiced
in Shelby beginning in 1926. He was a member
of the Catholic Church and a past commander
of the Knights of Columbus. Surviving are his
widow, two daughters, a son, his mother and
two sisters.
Robert H. McKelvey, M. D., Salem; Ohio State
University College of Medicine, 1933; aged 45:
1230
The Ohio State Medical Journal
died November 2; member of the Ohio State
Medical Association and the American Medical
Association. Dr. McKelvey moved to Salem
from Bethesda 12 years ago. He was a member
of the Medical Corps during World War II. A
daughter survives.
Wayland B. Recker, M. D., Leipsic; St. Louis
University School of Medicine, 1926; aged 48;
died October 29; member of the Ohio State Medi-
cal Association and a Fellow of the American
Medical Association; secretary-treasurer of the
Putnam County Medical Society, 1929; vice-
president, 1934 and 1937; president, 1939; dele-
gate, 1948 and 1950; past-president of the
Northwestern Ohio Medical Association; mem-
ber of the American Association of Railway
Surgeons. Dr. Ricker had practiced medicine
in Leipsic for 24 years. He was on the staffs
of St. Rita’s Hospital of Lima and the Lima
Memorial Hospital. Activities in medical profes-
sion work included membership on the Com-
mittee on Rural Health of the Association. He
was a member of the Catholic Church and the
Knights of Columbus. Surviving are his widow,
one son and three daughters, his father and
three brothers.
George Washington Stober, M. D., Shaker
Heights; Ohio State University College of
Homeopathic Medicine, 1918; aged 56; died
November 2; member of the Ohio State Medical
Association and a Fellow of the American Medi-
cal Association. Dr. Stober had been health
director for East Cleveland for approximately
30 years. For many years also prior to 1947
he had been school physician in the area. He
was the author of a number of medical articles,
especially in the field of gastro-enterology-
Surviving are his widow and two daughters. #
Edward von den Steinen, M. D., Tucson, Ariz.;
Western Reserve University School of Medi-
cine, 1905; aged 74; died October 10; member of
the Colorado State Medical Association and the
American Medical Association. Dr. Von den
Steinen was director of physical education at
Western Reserve University from 1903 to 1920,
before going to Colorado. Surviving are a son,
a daughter, a brother and two sisters.
A competitive examination for appointment
of Medical Officers in the Regular Corps of the
U. S. Public Health Service will be held Febru-
ary 12-14. Applications must be in by January
15. Additional information may be obtained
by writing the Surgeon General’s office, Division
of Commissioned Officers.
ANNUAL CLINICAL CONFERENCE
GPUcaya Me.dic.at iPxtjdeiy,
March 6, 7, 8, 9, 1951
Palmer House, Chicago
A Conference planned to keep physicians abreast of the new things which are developed
from year to year.
Special feature of the 1951 Conference — DAILY TEACHING DEMONSTRATION
PERIODS from 11:00 to 12:00 noon and 1:30 to 3:00 P. M. Demonstrations will cover:
Amputation and Prostheses
Patients Treated with ACTH and Cortisone
Dermatologic Clinic
Organization of a Blood Bank
Neurological Clinic
Sterility Tests
Speech Without Larynx
Proper Application of Casts and Splints in Fractures
Local Anesthesia
Fluid and Electrolytic Balance in Surgery
Use and Misuse of Obstetrical Forceps
Common Problems in X-ray Interpretations
Laboratory Tests (Diabetes, Proper Use of Insulin,
Prothrombin Tests)
Thirty-four outstanding teachers and speakers will present half-hour lectures on subjects of interest
to both general practitioner and specialist.
Four PANELS on timely topics.
Scientific exhibits worthy of real study and helpful and time-saving technical exhibits.
I
The CHICAGO MEDICAL SOCIETY ANNUAL CLINICAL CON-
FERENCE should be a MUST on the calendar of every physician.
Plan now to attend and make your reservation at the Palmer House.
1
for December. 1950
1231
Do You Know? . . .
Additional facilities for pre-medical training
at Ohio Wesleyan University, Delaware, will be
provided by the Edward L. Rice Pre-Medical
Fund established by Dr. John E. Brown, Co-
lumbus, as a tribute to Professor Edward L .
Rice, head of the zoology department for 45
years. Dr. Brown graduated at 0. W. U. in 1884.
sfs sf:
Dr. Karl E. Kimber, chief of professional
services of the Veterans Administration Hospital,
Brecksville, is the new president of the Ohio
Tuberculosis Hospital Association. Dr. James
Villani, superintendent of Edwin Shaw Sanator-
ium, Akron, is the secretary-treasurer.
❖ ^
Dayton physicians were guests of the Miami
Valley Pharmaceutical Association at a banquet,
November 1, at the Hotel Biltmore. Mr. Charles
S. Nelson, Executive Secretary of the Ohio State
Medical Association, was the speaker.
* * *
Driver’s license in New Jersey next year will
note holder’s blood type, in case he needs quick
transfusion after atomic disaster.
* * *
U. S. doctors collected $2,267,000,000 for serv-
ices in 1949, or about 1.2 per cent of all money
spent on personal goods and services, reports
Department of Commerce.
* * *
More than three-fourths of the pharmacists
responding to a recent poll favor the voluntary
medical care plans, while only nine per cent
favor a government-sponsored plan, according
to American Druggist.
* * *
The subscription price of The Journal ofAhe
A.M. A. will be increased from $12 to $15 ef-
fective in January. The Board voted not to
increase the special rate to students and others,
which was put into effect last February.
^ He
Fellowship dues of the American Medical
Association have been set at $5 per year by the
Board of Trustees. Those Fellows who enter
military service after the end of 1950 will be
required to pay Fellowship dues for the half
year in which they go into service, but not there-
after while they are in service.
Hi H* %
The Ohio Department of Health and the U. S.
Public Health Service is cooperating with local
authorities in studying the poliomyelitis epidemic
in Paulding County. The county of about 15,000
population had 32 cases in a period of about
two months.
Medical - Dental Management-
Of Cincinnati
WILL SURVEY AND STUDY
YOUR BUSINESS AFFAIRS
Our experience working exclusively
in physicians’ and dentists’ offices
makes impartial judgment possible.
WILL GIVE EXPERT
ATTENTION TO
Preparing your tax returns.
Handle tax examinations.
Managing your practice and office.
Install simplified but adequate books.
Instruct secretary in keeping books.
Audit these books.
Report to you every month.
Guide general office routine.
Compare fees with similar practices.
Service patients’ accounts —
No commission.
Assist in your public relations.
Advise in buying & selling practices.
Reviewing Your Estate
Investments — insurance — trusts.
ALL SERVICE STRICTLY
CONFIDENTIAL
You may arrange for an interview in
your office — No Obligation. You may
discontinue our service at any time,
and we reserve the same privilege. We
render service to clients within 100
miles of Cincinnati. Our rates on a
month-to-month basis are Surprisingly
Low.
Medical - Dental Management-
Of Cincinnati
514 U. S. F. & G. Bldg.
Cincinnati 2, Ohio
GArfield 5160
24 East Sixth St.
Clayton L. Scroggins
Raymond E. Scroggins
1232
The Ohio State Medical Journal
Activities of County Societies . . .
First District
(COUNCILOR: D. W. HEUSINKVELD, M. D.,
CINCINNATI)
HAMILTON
Speaker at the Nov. 14 meeting of the Acad-
emy of Medicine of Cincinnati was Dr. DeWitt
Stetten, Jr., chief of the Division of Nutrition
and Physiology of the Public Health Research
Institute of the City of New York, whose sub-
ject was “Fat and Carbohydrate Stores in Ex-
perimental Diabetes.” A joint meeting was held
with the Diabetes Council.
At the Nov. 28 meeting, Dr. Brian B. Blades,
professor of surgery, George Washington Uni-
versity School of Medicine, Washington, D. C.,
spoke on “The Practical Application of Recent
Advances in Thoracic Surgery.”
Coming meetings will feature the following
programs :
Dec. 5 — “Functional Patterns in Renal Dis-
ease: Clinical and Therapeutic Correlations,”
Dr. Arthur C. Corcoran, Cleveland Clinic Found-
ation.
Jan. 9 — “Newer Clinical Knowledge Regard-
ing ACTH,” Dr. John R. Mote, Armour Labora-
tory, Chicago.
Jan. 23 — “A Plea for the Stethoscope,” Dr.
Samuel A. Levine, Harvard Medical School,
Boston (The Alfred Friedlander Lecture); a
joint meeting with the Heart Council.
Second District
(COUNCILOR: M. D. PRUGH, M. D., DAYTON)
CLARK
Dr. Frank H. Mayfield, Cincinnati, discussed
“Management of Acute Head Injuries” at the
Oct. 16 meeting of the Clark County Medical
Society. The scientific program was sponsored
by the Committee on Trauma of the American
College of Surgeons, Southwestern District of
Ohio.
GREENE
Dr. Robert A. Lyon, associate professor of
pediatrics, University of Cincinnati College of
Medicine, and one of the founders of the Chil-
dren’s Heart Association, spoke on the subject,
“Heart Disease in Children and Rheumatic
Fever,” at the Nov. 9 meeting of the Greene
County Medical Society in Xenia. His talk was
illustrated by the use of slides.
At the Oct. 12 meeting of the Society, Dr.
Hans G. Schlumberger, Department of Pathology,
Ohio State University College of Medicine, spoke
on the subject of bone-producing lesions of the
scalp, skull and brain.
The following members were appointed a
committee to conduct a diabetic survey of school
children as a part of the observance of National
Diabetic Week: Dr. Ernest Hoffman, Yellow
Springs; Dr. Harvey McClellan, Xenia; and Dr.
C. K. Schloss, Fairborn.
MIAMI
The regular meeting of the Miami County
Medical Society was held on Nov. 3 at the
Nurses’ Home of Stouder Hospital, Troy. Dr.
Irving Rothchild, Ohio State University Col-
lege of Medicine, Columbus, spoke on the sub-
ject, “Endocrinology — a Help or a Hindrance
to the General Practitioner.” Dinner was served
at the hospital following the meeting.
A new series of radio programs sponsored
by the Society over Station WPTW, Piqua, be-
gan on Nov. 4. It is entitled “The Story Behind
the Discovery,” and is broadcast each Saturday
at 10:30 a. m. A special broadcast was made
on Sunday, Nov. 5, entitled, “The Wooden Fish.”
MONTGOMERY
At a meeting of the General Practice Sec-
tion of the Montgomery County Medical Society
on Oct. 25, Dr. Smith Freeman and Dr. David
Markson, Northwestern University Medical
School, presented a program on ACTH and Cor-
tisone. Dr. Allan S. Horwitz, section president,
was in charge.
Fourth District
(COUNCILOR: CARLL S. MUNDY, M. D., TOLEDO)
DEFIANCE
The Defiance County Medical Society sponsored
a luncheon on Oct. 10 at the Kettering Golf Club
in Defiance, at which U. S. Public Health Service
physicians and technicians discussed findings con-
cerning the epidemic of poliomyelitis in nearby
counties. Doctors of the surrounding counties
were guests.
LUCAS
The program of the Academy of Medicine of
Toledo and Lucas County for October was as
follows:
General Meeting, Oct. 6 — Panel Discussion —
William Roche Hospital.
Section on Pathology, Experimental Medicine
and Bacteriology, Oct. 13 — “Localized Enlarge-
ment of the Thyroid,” Dr. John B. Hazard, Cleve-
land Clinic.
General Practice Section, Oct. 17 — No meeting
because of meeting of Northwestern Ohio Medical
Association.
Medical Section, Oct. 20— “Clinical Experiences
for December, 1950
1233
with ACTH,” Dr. John E. Howard, Johns Hopkins
University.
Surgical Section, Oct. 27 — ‘‘A New Technic for
the Excision and Transplantation of Split Skin
Grafts,” Dr. John D. Reese, Philadelphia, Pa.
COLUMBIANA
Dr. Arthur G. James, Ohio State University
College of Medicine, Columbus, spoke on “Can-
cer of the Face and Neck,” at the Sept. 19
meeting of the Columbiana County Medical So-
ciety.
Fifth District
(COUNCILOR: CHARLES L. HUDSON. M. D.,
CLEVELAND)
LAKE
The Lake County Medical Society met Nov. 14
at Lake County Memorial Hospital, Dr. Paul
Reading, president, presiding. The Mental Hy-
giene Committee reported that the psychiatric
examination service by Dr. F. E. Merritt, of
Cleveland, each Thursday at the Hospital has
been eminently successful. Probably more hours
will have to be added because the demand for
service has been so great, the committee re-
ported. The Public Relations chairman reported
that the physicians’ call bureau sponsored by
the Society has been functioning to the public’s
satisfaction.
The following officers and delegates were
elected for 1951: Dr. Thomas Byrne, Menta,
president; Dr. Keeth Miles, Madison, vice-
president; Dr. G. Robert Smith, Painesville,
secy.-treas.; Dr. M. G. Carmody, Painesville,
delegate; Dr. B. S. Park, Painesville, alternate;
and Dr. C. B. Elliott, Painesville, censor.
Dr. Robert Eiben, director of contagious dis-
eases at City Hospital, Cleveland, was introduced
by the program chairman, Dr. Thomas Byrne.
Dr. Eiben spoke on “Poliomyelitis.” — F. J. Dineen,
M. D., Pub. Relations Chairman.
Sixth District
(COUNCILOR: PAUL A. DAVIS, M. D., AKRON)
Mr. Matthew Curry, local director of wel-
fare, spoke on “Problems in Welfare Depart-
ment Work in Columbiana County,” at the Oct.
17 meeting.
MAHONING
•
Dr. Marion A. Blankenhorn, University of Cin-
cinnati College of Medicine, spoke on the subject
“The Spotted Fevers,” at the Sept. 19 meeting
of the Mahoning County Medical Society in
Youngstown. At a previous meeting of the
Society’s Council, applications for active member-
ship were acted upon favorably for Dr. Harold
Teitelbaum and Dr. Francis J. Gambrel.
Speaker for the Nov. 14 meeting was Dr.
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The Ohio State Medical Journal
Howard F. Root, physician-in-chief, Deaconess
Hospital, Boston, Mass., and past-president of the
American Diabetes Association, whose subject
was “Medical and Surgical Treatment of Dia-
betes.”
STARK
Dr. Alan R. Moritz, professor of pathology,
Western Reserve University, School of Medicine,
Cleveland, spoke on the subject, “Fatal Non-
Penetrating Injuries of the Head, Neck and Body,”
at the Nov. 9 meeting of the Stark County
Medical Society in Canton. The annual business
meeting of the Society will be held at the Hotel
Onesto at 8:30 p. m. on Dec. 14.
%
Seventh District
(COUNCILOR: R. J. FOSTER, M. D., NEW
PHILADELPHIA)
BELMONT
Dr. William M. Sheppe, Wheeling, W. Va., spoke
on the subject of diabetes with special reference
to NPH-50 insulin at the Oct. 26 meeting of
the Belmont County Medical Society at the
Belmont Hills Country Club. Other matters
discussed were a cancer clinic for the county
and the qualifications of candidates for public
office.
Eighth District
( COUNCILOR : CHESTER P. SWETT, M. D„ LANCASTER)
GUERNSEY
The regular meeting of the Guernsey County
Medical Society was held with luncheon at the
Berwick Hotel, Cambridge, on Nov. 2, with 12
members present and Dr. Reo Swan, president,
in the chair.
The Society was favored with a visit from
Dr. Chester P. Swett, Lancaster, Councilor of
the Eighth District of the Ohio State Medical
Association, who spoke comprehensively regard-
ing many subjects discussed at the September
meeting of The Council of the 0. S. M. A.
(Minutes of this Council meeting have appeared
since in the November issue of The Journal.)
Legislative Committeeman Dr. Robert A.
Ringer reported on progess made in interview-
ing candidates for public office.
The scientific portion of the program was in
charge of Dr. James A. Toland who presented
a comprehensive color movie with sound on the
subject of allergy, produced at the University
of Pittsburgh. — Gordon Lawyer, M. D., Sec'y.-
Treas.
Tenth District
(COUNCILOR: H. M. CLODFELTER, M. D., COLUMBUS)
FRANKLIN
“Birth Injuries in Retrospect” was the title
of a discussion by Dr. Charles F. McKhann, pro-
fessor of pediatrics at Western Reserve Uni-
versity School of Medicine, at the Nov. 20
meeting of the Columbus Academy of Medicine.
The annual Academy banquet and dance was on
schedule for Nov. 29 at the Chittenden Hotel.
ROSS
“The Irritable Colon,” was the subject dis-
cussed by Dr. Snmuel W. Robinson, Ohio State
University College of Medicine, at the Oct. 19
meeting of the Ross County Academy of Medi-
cine in Chillicothe.
Eleventh District
(COUNCILOR: JOHN S. HATTERY, M. D., MANSFIELD)
HURON
The Huron County Medical Society held its
regular quarterly dinner meeting on Sept. 29
in Norwalk. The policy of the National Edu-
cation Campaign of the A. M. A. was presented.
Members of the legislative committee presented
factual information on candidates in the coming
election.
LORAIN
The regular meeting of the Lorain County
Medical Society was held on Nov. 14 at the
Spring Valley Country Club, Elyria, with dinner.
A memorial address for the late Dr. Walter W.
Tilock of Lorain who died Oct. 14 was given by
Dr. Leonard A. Stack. The remainder of the
meeting was devoted to discussion of business
and professional matters pertaining to the
Society.
Woman’s Auxiliary . . .
By MRS. S. L. MELTZER, Chairman, Publicity Committee
2442 DORMAN DRIVE, PORTSMOUTH
President — Mrs. George W. Cooperrider, 1828 Bryden Road,
Columbus
President-Elect — Mrs. Farrell Gallagher, 1527 W. Clifton
Blvd., Lakewood
Vice-President — Mrs. E. P. Greenawalt, 1707 St. Paris Road,
Springfield
Recording - Secretary — Mrs. Ross Knoble, 219 - 44th St.,
Sandusky
Corresponding Secretary — Mrs. Oscar Jepsen, Canal Win-
chester
Treasurer — Mrs. A. Paul Hancuff, 3551 Maxwell Road,
Toledo 13
Past-President — Mrs. C. W. Kirkland, 4805 Guernsey Street,
Bellaire
ALLEN
“Sidelights on San Francisco,” presented by
Mrs. Carl H. Zinsmeister, featured the program
of the Sept. 26 meeting of the Woman's Auxiliary
to the Lima and Allen County Academy of
Medicine. During the business session, presided
over by Mrs. W. B. Light, president, the year's
plans — as formulated earlier by the executive
board — were presented. Program booklets were
distributed and detailed plans for coming meet-
ings were outlined by Mrs. R. L. Tecklenberg,
program chairman. Mrs. Karl F. Ritter, his-
torian, reported that books had been placed in
for December, 1950
1235
the Lima Public Library in memory of Mrs.
Allan Wisely, Dr. W. H. Beery, Dr. John R.
Tillotson and Dr. Harvey Basinger. The legis-
lative chairman, Mrs. Miles Flickinger, re-
ported that reminders had been sent to mem-
bers and doctors who had not yet registered.
Mrs. J. M. McBride was hostess for the
meeting, assisted by Mrs. F. G. Maurer and Mrs.
Tecklenberg.
The year’s money-making event was held on
Tuesday, Oct. 17, when the Auxiliary sponsored
a “Canasta Fiesta” in the nurses’ home at
Memorial Hospital. Proceeds from the Fiesta
will be used to augment the student nurses’ loan
fund. At present the group is assisting six
nurses, at the community’s two hospitals — St.
Rita’s and Memorial. Mrs. J. W. Burke and
Mrs. R. G. Hendershot served as co-chairmen.
CLARK
Mrs. E. W. Smith and Mr. P. D. Leveaux
shared the stimulating program of the Nov. 1
meeting of the Woman’s Auxiliary to the Clark
County Medical Society, held at Ker-Deen Inn.
Mrs. Smith presented a monologue in costume,
entitled “Medicine Marches On” — a characteriza-
tion of the doctor’s wife of yesterday, today,
and tomorrow. It also portrayed the story of
medicine of those three periods.
Mr. Leveaux, who spoke on “Probable Rea-
sons for the Rise of Socialism in England,”
based his talk on his own personal experiences.
He was a native of England and resided there
until eighteen months ago. . He spent eight
years in the British Army. When asked whether
England could return to its former society under
a possible new conservative government, he an-
swered, “Now that the damage has been done,
England’s situation is like an omelet — you can’t
unscramble it.”
Mrs.- E. W. Schilke, president, welcomed the
evening’s guests who included the husbands of
members. Mrs. Victor Fredericks, president of
the Champaign County Auxiliary, also was
present with her husband as was Dr. E. W.
Smith of Dayton. Mrs. C. T. Doeing, program
chairman, introduced the speakers. The program
committee acted as hostesses for the evening
with Mrs. Starling Yinger, chairman of the
social hour which followed the program.
ERIE
A luncheon at the “Log Cabin Inn” and a
fashion show presented in cooperation with the
William Frankel Company highlighted the Oct. 9
meeting of the Woman’s Auxiliary to the Erie
County Medical Society. In addition to the regu-
lar members, some 30 guests were also present.
During a brief business session conducted by the
president, Mrs. E. J. Meckstroth, a report was
submitted by the legislative committee chairman,
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The Ohio State Medical Journal
gram chairman, announced that Nov. 19 had been
scheduled as the date and the Business Women’s
Club the scene of the Auxiliary’s tea for all city
and county high school senior girls who are
interested in nursing. Luncheon hostesses were
Mrs. E. C. Alexander, chairman, Mrs. W. F.
Burger, and Mrs. Harold Bolman. A musical
program was presented by Mrs. Burger and Mrs.
Leah Thomas.
GUERNSEY
The Guernsey County Auxiliary held its Nov-
ember luncheon meeting at the home of Mrs.
J. D. Knapp. Mrs. 0. R. Jones, president, con-
ducted the business session. Mrs. C. A. Craig
reported on the Eighth District meeting held in
Newark. Mrs. Arthur Thomas was speaker
of the afternoon, using “Ceramics” as her topic.
She was presented by Mrs. James Toland. The
group voted a contribution for the local com-
munity chest.
HAMILTON
The Cincinnati Auxiliary held a dessert lunch-
eon on Tuesday, Oct. 17, at the home of Mrs.
J. T. Clear. Mrs. A. J. Huesman served as
hospitality chairman, assisted by a committee of
eleven. Mrs. Leonard Wuest and Mrs. Cyril
Schrimpf presided at the tea table. Mrs. Richard
D. Bryant, president, conducted the business
meeting following the luncheon. She welcomed
new members of the Auxiliary who were pre-
sented by Mrs. Richard Vilter, membership
chairman. Mrs. Dale P. Osborn, program chair-
man for the day, introduced the speaker, Dr.
Clarence A. Mills, who spoke on “Radiant Heat-
ing and Cooling at ‘Reflection Point’.” “Reflec-
tion Point” is the recently completed home of
Dr. and Mrs. Mills. The doctor has spent
many years in research on the effect of climate
on health at the University of Cincinnati, where
he is professor of experimental medicine in the
College of Medicine. His early endeavors in this
field were directed toward planning for the com-
fort of hospitalized patients.
Mrs. Vinton E. Siler, program chairman, an-
nounced plans for an all-day excursion to the
Eli Lilly Pharmaceutical Laboratories in In-
dianapolis. It was announced that this would
take the place of the regular November meeting.
HURON
The Woman’s Auxiliary to the Huron County
Medical Society met on Oct. 13, at the Norwalk
Country Club for a luncheon and business session.
The sponsoring of an essay contest to be held
in the senior classes of the parochial and public
high schools in the near future was discussed
in great detail. Mrs. W. H. Kauffman, president,
distributed candies and rubber scrub pads to each
member — the moneys from which will be turned
into the general fund. It was voted to transfer
a sizeable amount from the group’s general
fund to a separate bank account in order to start
a nurses’ scholarship fund.
KNOX
Mrs. I. S. Workman was hostess to members
of the Knox County Auxiliary at its October
meeting. Mrs. C. E. Cassaday, president, con-
ducted the business session which was followed
by a non-partisan review of the candidates for
election, given by Mr. Stanley Johnson, Jr., local
attorney. Refreshments were served by the
hostess, assisted by Mrs. George Imhoff, Mrs.
Joseph Allman, and Mrs. Cassady.
LAWRENCE
The Woman’s Auxiliary to the Lawrence County
Medical Society met on Oct. 16, at the home of
Mrs. Harry Nenni for a dessert luncheon and
meeting. The group voted to endorse the 3.5
mill school levy and agreed to help get voters
to the polls on Election Day. The nurse re-
cruitment committee is planning an active spring
program. A report of the Ninth District meet-
ing was given. Mrs. Nenni was appointed by
the executive board to complete the unexpired
term of Mrs. F. R. Stewart, secretary-treasurer,
who has resigned. Following the business meet-
ing, which was conducted by Mrs. G. N. Spears,
president, Mrs. Vallee Blagg reviewed an article
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from Today's Health and discussed the contents
of the most recent issue. Information was also
given on the rules of the Today's Health con-
test being sponsored by the American Medical
Association.
LAKE
The Lake County Woman’s Auxiliary held
its first meeting of the 1950-51 season at Par-
rish’s Rose Room. The project of a nurses’
scholarship was discussed at length as were
other possible projects to be undertaken by the
group. Mrs. J. W. Davis reported on the state
Auxiliary meeting. The Nov. 3 meeting featured
Mrs. S. C. Lind, Fifth District director, who was
guest speaker.
LICKING
At the dinner meeting of the Licking County
Auxiliary held on Sept. 26, at the Hotel Warden,
Mrs. William E. Shrontz was appointed general
chairman for the Eighth District Medical meet-
ing to be held at Newark on Oct. 5. Twenty-
eight members attended the September meeting.
Mrs. Donald Sperry and Mrs. Roland Jones,
who attended the conference in Columbus for
presidents and presidents-elect, gave a resume
of the meeting. They included excerpts from
the talk given b/ State Senator Roscoe Walcutt
on “The Business of the Other Fellow.” Mrs.
L. H. Miller addressed the local group on
“Health Service.” Plans were made by the
Auxiliary for a rummage sale to be held the
latter part of October.
Twenty members attended the Oct. 24 dinner
meeting of the Licking County group at Hotel
Warden. Mrs. Roland Jones, president, presided at
the business session and thanked the members
for their efforts in helping to make the Eighth
District meeting a successful one. It was an-
nounced that the November meeting would be
held at the home of Mrs. Victor Turner. A
casserole dinner was announced to precede what
has been termed a “work meeting.” The mem-
bers will make net stockings for the Red Cross,
to be sent to the Veterans’ Hospital in Chilli-
cothe. Gifts will also be taken so that the
veterans will be able to choose gifts to be sent
to their families.
LORAIN
The Lorain County Auxiliary met on Oct. 19,
at Spring Valley for its monthly meeting, which
was presided over by Mrs. Delbert Russell, presi-
dent. Social service projects for the coming year
were discussed. The chief project will be the
establishment of a student nurses’ scholarship
fund. The first step toward the raising of
money for this new project was announced as
the sponsoring of a play to be presented by
the Elyria Theater Guild the latter part of
November. The nurses’ fund as well as the
group’s other welfare activities are under the
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tions chairman. The committee in charge of
arrangements for the play includes Mrs. A. J.
Novello, Mrs. Peter Etzkorn, Mrs. M. C.
Kolczun, and Mrs. R. C. Novatney.
MAHONING
Dr. Fred W. Dixon, president-elect of the Ohio
State Medical Association, addressed 170 mem-
bers and guests of the Mahoning County Auxi-
liary at a luncheon on Oct. 24, at Squaw Creek
Country Club. Special guests of the group
were the presidents of all the federated women’s
clubs of Youngstown. This was the first venture
of the group into the field of public relations
with other women’s organizations; seventy-five
groups were represented, including the League
of Women Voters, the Women’s Republican Club
and the Women’s Democratic Club.
It was the tenth anniversary of the Auxiliary
to the Mahoning County Medical Society. Mrs.
R. M. Morrison, the group’s first president,
was especially honored. Dr. Dixon addressed
the group on ‘‘A Doctor Looks at Socialism.”
Another feature of the afternoon was observance
of World-Wide United Nations Day. Mrs. Paul
J. Mahar, vice-president, described the workings
of the United Nations and presented a fitting
tribute to that important organization. This ob-
servance was- concluded with a prayer for peace.
The speaker’s table was arranged with minia-
ture flags of the United Nations and a floral
plateau in our national colors.
Mrs. William H. Evans, president, announced
that all Mahoning County Medical Society phy-
sicians and their wives were one hundred per
cent registered. Credit for this fine showing
was given to the diligent efforts of the public
relations chairman, Mrs. Ashar Randall, the
legislative chairman, Mrs. Herman Ipp, and the
committees of both. Mrs. Evans announced that
the square dance for the benefit of the nurses’
scholarship fund that was held on Sept. 23 was
a big success and that it will be continued as an
annual event. Each year two girls are selected
and sponsored by the Auxiliary — one to train
at the Youngstown City Hospital and the other
at St. Elizabeth’s Hospital.
SCIOTO
The September meeting of the Woman’s
Auxiliary to the Hempstead Academy of Medi-
cine was held at the home of Mrs. H. M. Keil.
Luncheon preceded the business session. Mrs.
Clyde W. Everett, president, presided and dis-
cussed the Auxiliary plans to assume respon-
sibility for the serving of dinners to those tak-
ing part in a horse show benefit for Portsmouth
General Hospital to be held that month. Mrs.
George W. Obrist, legislative chairman, reported
on the doctor draft bill. Mrs. Clyde Fitch “was
the afternoon’s speaker, presenting a stimulating
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talk on “Westward Ho!” — an account of the trip
to San Francisco aboard the Ohio State Special.
It was announced that the regular October meet-
ing would not be held, because the Scioto
Auxiliary would be hostess to the Ninth District
Meeting on October 12.
The November 8 meeting was a luncheon for
members and guests at the Turkey Shoppe in
Portsmouth. Mr. Howard Lee, president of
Portsmouth’s Little Theater, gave a highly
interesting talk on the theater and a detailed
explanation of what goes on behind the scenes
of a Little Theater movement. Mr. Lee is a
talented actor and director. He has also been
associated with the Pittsburgh Players.
Mrs. Clyde Everett, president, opened the meet-
ing with a fitting poem, “We Thank Thee for
Ohio.” Mrs. J. W. Daehler was appointed legis-
lative chairman at the business meeting which
followed Mr. Lee’s talk. Mrs. Louis Chaboudy
and Mrs. Spencer Miller were the day’s hostesses.
FIRST DISTRICT
The First District of the Woman’s Auxiliary
to the Ohio State Medical Association met
Sept. 26, at the Highland House in Hillsboro.
Mack Sauer, of Leesburg, addressed the meeting.
His talk was a delightful blend of humor and
sound philosophy. Among the special guests in
attendance were Mrs. George W. Cooperrider,
state president, who also addressed the meeting;
Mrs. N. M. Reiff, state public relations chairman;
Mrs. Gerald P. Castle, editorial staff of the
Ohio State Medical Auxiliary News; Mrs. Paul
Woodward, state legislative chairman; Dr. John
Anderson, president, Highland County Medical
Association, and Mrs. Anderson; Mrs. Richard
Bryant, president, Hamilton County Auxiliary;
Mrs. Paul Ivins, president, Butler County Aux-
iliary; and Mrs. J. H. Frame, president, Clinton
County Auxiliary.
The district meeting was under the direction
of Mrs. Azel Ames, First District director. She
was assisted by Mrs. G. B. Glenn, Mrs. W. H.
Wilson, Mrs. J. Martin Byers, Mrs. A. M.
Brenner, Mrs. J. C. McBride, Mrs. M. Herzberg,
Mrs. John McBride, Mrs. J. C. Bohl and Mrs.
W. M. Hoyt.
SECOND DISTRICT
The Second District meeting was held in Day-
ton on Oct. 18 at the Biltmore Hotel. One hun-
dred twenty members attended the luncheon
and business session. Mr. Robert Freeman,
executive secretary of the Montgomery County
Medical Society, spoke on “Politics in Medicine.”
Mrs. Harold Messenger, Second District direc-
tor, was in charge of the day’s activities. Mrs.
George W. Cooperrider, state president, addressed
the group. A question and answer period fol-
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lowed. In the evening, the women joined the
men for a dinner in conjunction with the Medical
Society’s Second District meeting.
THIRD DISTRICT
Members of the Woman’s Auxiliary to the
Marion County Academy of Medicine were
hostesses to more than 60 members from nearby
counties on Oct. 20 at the Hotel Harding at
the fourth annual meeting of Auxiliaries in the
Third District. Dr. Fred W. Dixon, president-
elect of the Ohio State Medical Association, was
the guest speaker. Talks were also given by
Mrs. George W. Cooperrider, state president;
Mrs. Farrell Gallagher, state president-elect;
Dr. Robert T. Gray, president of the Marion
County Academy of Medicine; and Mrs. Walter
E. Hane, immediate past-president of the Seventh
District, Ohio Association of Nurses. Mrs. H. K.
Mouser, district director, presided. Dr. Dixon
talked on “Political Problems Affecting Medi-
cine Today.” Mrs. Cooperrider and Mrs. Gal-
lagher discussed the work of the State Aux-
iliary and Mrs. Hane spoke on the recruitment
of nurses.
Miss Luella Coffalt, contralto, presented a
group of musical numbers. Preceding the main
part of the meeting, Mrs. Cooperrider and Mrs.
Mouser presided over an informal discussion
period. The gavel was presented to the Hardin
County Auxiliary for having the largest number
of members present. Counties represented in-
cluded Mercer, Auglaize, Hardin, Crawford,
Wyandot, Allen, and Marion. Other guests in-
cluded Mrs. Oscar W. Jepson, state correspond-
ing secretary, and Dr. James Greetham, Dr.
Samuel Katz, Dr. Harold K. Mouser, and Dr.
William Leffler.
EIGHTH DISTRICT
Forty members and guests were present at
the meeting of the Eighth District held on
Oct. 5 at the Moundbuilders’ Country Club in
Newark. Representatives were present from
Zanesville, Marietta, Lancaster, and Cambridge.
Mrs. Roland W. Jones, president of the Licking
County Auxiliary, the hostess group, wel-
comed the guests at the luncheon. Mrs. 0.
R. Jones, Eighth District director, conducted
the business meeting and introduced the state
officials and county officers. Mrs. George W.
Cooperrider, state president, told of the Worth-
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undertaken for the betterment of the com-
munity. These included nurse recruitment, con-
tributions to a smaller medical college, furnish-
ing of a room in the local hospital, and send-
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ing worthy nurses for further study in particu-
lar fields. Charles Nelson, Executive Secretary
of the Ohio State Medical Association, talked
on the importance of the coming election and
the necessity for every person to vote. He urged
the Auxiliary to work for the betterment of
the community and to assist in getting the
vote out on Election Day.
Later, Mrs. J. Fleek Miller took a number
of the guests on a tour of the mounds and
Mrs. Ralph Pickett entertained with a social
hour in her home before the combined dinner
for the Licking County Medical Society, the
Auxiliary and guests, at the Moundbuilders’
Country Club.
NINTH DISTRICT
The Ninth District meeting was held on Oct.
12, at the Chez Paree in Portsmouth. Mem-
bers from Scioto and Lawrence Counties at-
tended. Mrs. Clyde W. Everett, president of
the local group, gave an address of welcome.
The afternoon’s business session was presided
over by Mrs. George W. Obrist, Ninth District
director, Mrs. George W. Cooperrider, state presi-
dent, discussed the needs, problems, and accom-
plishments of the local Auxiliaries. A lively
question and answer period followed her talk.
Mrs. William F. Marting of Ironton, the Ohio
Mother of 1950, was the recipient of special
honors in an effective tribute by Mrs. Obrist.
Following the serving of refreshments, Ollie
James, chief editorial writer and columnist with
the Cincinnati Enquirer, was the afternoon’s
guest speaker. He presented an hour’s program
of delightful humor. The women joined the men
at a dinner meeting given by the Ninth District
Medical Societies.
TENTH DISTRICT
Dr. Arthur S. Fleming, president of Ohio
Wesleyan University and chairman of the Ohio
Hoover Commission, spoke at the Tenth District
annual meeting on Oct. 23, at the Seneca Hotel
in Columbus. His subject was “What’s Happen-
ing to the Recommendations of the Hoover Com-
mission?” Special guests included Mrs. George
W. Cooperrider, state president, Mrs. Farrell
Gallagher, state president-elect, and Mrs. Oscar
W. Jepson, state corresponding secretary. The
day’s program was under the direction of Mrs.
James Snider, Tenth District director. Counties
represented were Franklin, Fayette, Ross, Union,
Pickaway, Madison, Delaware, Marion and
Knox. The Tenth District is 100 per cent or-
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COLUMBUS 15, OHIO
II
X-RAY DIAGNOSIS AND THERAPY
FEVER THERAPY
RADIUM
It
TELEPHONES
Office Residence
MA. 3743 EV. 5644
THE MARY E. POGUE SCHOOL
Complete facilities for training Re-
tarded and Epileptic children educa-
tionally and socially. Pupils per
teacher strictly limited. Excellent
educational, physical and occupational
therapy programs.
Recreational facilities include rid-
ing, group games, selected movies
under competent supervision of skilled
personnel.
Catalogue on Request
G. H. MARQUARDT, M. D.
Medical Director
BARCLAY J. MacGREGOR
Registrar
29 Geneva Rd., Wheaton, Illinois (near Chicago)
1242
The Ohio State Medical Journal
“Shall We Have Compulsory Health Insur-
ance?” "was the topic of a panel discussion
during the Ohio Welfare Conference in Colum-
bus, November 14. Participants were: R. Clyde
White, Ph. D., Professor of Public Welfare,
School of Applied Sciences, Western Reserve
University, Cleveland; George H. Saville, Direc-
tor of Public Relations, Ohio State Medical As-
sociation; Leon O. Moscovitz, Technical Assist-
ant, Social Service Department, U. A. W.-C. I. 0.,
Detroit; Ralph W. Jordan, Executive Vice-
President, Central Hospital Service, Columbus;
James Brindle, Director of Assistance, Pennsyl-
vania Department of Public Assistance, Harris-
burg, and Arthur J. Sullivan, Executive Direc-
tor, Springfield City Hospital. The moderator
was Henry J. Robison, Assistant Director, and
Coordinator of Social Services, Ohio Depart-
ment of Public Welfare.
COMING MEETINGS
Ohio State Medical Association, Annual Meet-
ing, Netherland Plaza, Cincinnati, April 24-26,
1951.
A. M. A. Clinical Session, Cleveland, December
5-8.
Radiological Society of North America, 36th
Annual Meeting, Palmer House, Chicago, Decem-
ber 10-15.
THE WENDT- BRISTOL COMPANY
Announces the opening of a
Third store in Columbus
UNIVERSITY BRANCH
Directly across the street from the new
Ohio State University Medical Center
Now Three Complete Ethical Stores
1660 Neil Avenue
51 E. State St. 721 N. High St.
COLUMBUS, OHIO
for the convenience of the Physicians and
Surgeons — and the many people they serve
Three Prescription Departments
maintained in a high class manner with
large staff of registered Pharmacists
Other Complete Departments
OFFICE EQUIPMENT
PHYSIO THERAPY APPARATUS
HOSPITAL SUPPLIES
W-B Pharmaceutical Supplies
JOBBING STOCKS ALL LEADING
MANUFACTURERS
Antitoxins and Vaccines in Special
Refrigeration Plants
Prompt Service on Phone Orders
INDEX TO ADVERTISERS
Abbott Laboratories 1145
Ann Arbor School, The 1237
Ar-Ex Cosmetics, Inc. 1244
Ayerst, McKenna & Harrison, Ltd. 1221
Birtcher Corporation, The 1234
Bowen, Charles F., M. D. 1238
Camp, S. H., Company l 1146
Chicago Medical Society 1231
Cincinnati Sanitarium 1152
Clinical and Pathological Laboratory 1238
Coca-Cola Company 1227
Columbus Orthopaedic Appliance Co. 1239
Cook County Graduate School of Medicine 1239
Endo Products, Inc. 1143
General Electric X-Ray Corp. 1223
Hanger, J. E., Inc. 1240
Harding Sanitarium 1150
Ingleside Home, Inc. 1227
Lederle Laboratories, Inc. 1163
Lilly, Eli, and Company Insert Between
Pages 1164-1165
Maltbie Laboratories 1147
McMillen Sanitarium 1152
Medical-Dental Management ___1232
Mead Johnson & Company Back Cover
Medical Protective Company 1240
Mercer Sanitarium, The 1150
Merck & Company, Inc. 1225
Miller, W. H., M. D. 1242
Neil Training School 1244
New York Polyclinic Medical School 1229
Num Specialty Company 1244
Oak Ridge Sanatorium 1151
Parke, Davis & Company 1252 and
Inside Back Cover
Pfizer, Charles & Co., Inc. _ 1156 and 1157
Picker X-Ray Corp. 1155
Pogue, The Mary E., School 1242
Quincy X-Ray & Radium Laboratories ___ 1244
Resthaven 1241
Rupp & Bowman Company 1241
Sawyer Sanatorium 1141
Schering Corporation 1153
Schmid, Julius, Inc. 1158
Sealy Mattress Company .1236
Searle, G. D., & Company 1217
Squibb, E. R., & Sons 1160 and 1161
Stoneman Press 1229
Upjohn Company 1164
Wander Company 1154
Wendt-Bristol Company 1243
Wickhaven Sanitarium „ 1150
Windsor Hospital 1150
Winthrop-Stearns, Inc. 1162
Wyeth, Inc. 1159
for December, 1950
1243
Rates: 50 cents per line. Minimum charge of $1.00 for each insertion. Price covers the cost
of remailing answers. Forms close 16th of the month preceding publication.
FOR SALE : Brown-Berger cystoscopes, urethrascope,
metal and glass instrument cabinet. Box 95, Ohio State
Medical Journal.
OPPORTUNITIES FOR PHYSICIANS: Are you inter-
ested in a position of one of our county or district health
departments? Salary $5,600 to $7,200, with $70 a month
travel allowance. Public health scholarships available with
liberal stipends. Men and Women physicians eligible. Felix
J. Underwood, M. D., Mississippi State Board of Health,
Jackson, Miss.
FOR SALE : Established general practice of 39 years
in progressive village on. Lake Erie ; office, equipment and
drugs available. Doctor is urgently needed. Fine oppor-
tunity. Box 114, Vermilion, Ohio.
GENERAL SURGERY RESIDENCY : Three year ap-
proved; beginning January 1 and July 1, 1951. Apply:
Administrator, Good Samaritan Hospital, Cincinnati 20, O.
FOR SALE : G. E. D. R. F. Shockproof Radiographic
and Fluoroscopic Machine 15 M. A. Horizontal bucky table.
Horizontal and vertical Fluoroscope. Complete dark room
equipment. Price $800. A. C. Siddall, M. D., Oberlin,
Ohio. Telephone 500.
ON ACCOUNT of my age, I wish to sell my equipment
and office furniture, good will, etc. I will either sell or
rent my office so the purchaser can walk in and go to
work. This office is located in central Ohio in a city
of 40,000. Box 621, Ohio State Medical Journal.
SALE of clinic possibility, very adaptable ten-room, two-
bath, two-lavatory, brick center hall colonial, with large
basement. Cleveland Heights middle class neighborhood, in
central location, zoned for business. Owner will help
finance. Markel Co., 1908 Lee Rd., YE 20550, Cleveland
Heights, Ohio.
WANTED : Competent physician for temporary work in
Industrial Office. 200 Republic Building, Cleveland 15, Ohio.
GENERAL SURGEON — 31 ; Veteran ; completing 4 years
general surgical training ; seeks association with certified
surgeon. Box 624, Ohio State Medical Association.
AVAILABLE 2- or 3-year surgical assistancy, January 1,
1951. Private practice. Doctors Austin and Damstra, 920
Fidelity Bldg., Dayton, Ohio.
WANTED : Psychiatrist, Counselling Clinic, psycho-
dynamically oriented, personality diagnosis and counselling.
Competent staff psychologists. Excellent conditions, forty-
four hour week, no night or week-end work. Correctional
experience not required. $6,300. Contact : Director, Coun-
selling Clinic, Ohio Penitentiary, Columbus 15, Ohio.
RADIUM and RADIUM D+E
(Including Radium Applicators)
FOR ALL MEDICAL PURPOSES
Est. 1919
Quincy X-Ray and Radium
Laboratories
(Owned and Directed by a Physician-Radiologist)
HAROLD SWANBERG, B. $., M. D., Director
W. C. U. Bldg. Quincy, Illinois
TREATMENT
INDICATED
discourage
NAIL
»mnc
tmum
wctmc
Extract of capsicum in an
acetone and isopropyl base.
ORDER FROM YOUR SUPPLY HOUSE OR PHARMACIST
NEIL TRAINING SCHOOL
WANTED: Staff physician for 600 bed mental hospital.
Experience in psychiatry not essential. Two story fur-
nished brick residence with laundry and meals for physician
and family. Apply : Dr. M. P. Smith, Superintendent, Tiffin
State Hospital, Tiffin, Ohio.
X-RAY tilt top table with Bucky and fluoroscopic
screen. Stationary anode fluoroscopic and radiographic
tube. Remote control with timer for 1/10 to 14 seconds.
85 KVP - 60 MA. Forest Hill Hospital, 13240 Euclid Ave.,
East Cleveland, Ohio.
PHYSICIAN going into residency training Jan. 1 wants
doctor to take over general practice temporarily or possibly
permanently ; newly-remodeled office includes drugs, good
equipment including x-ray and BMR and patient file ; 5-room
furnished apartment includes refrigerator and dishwasher ;
potential 1,000 to 2,000 patients ; county seat in central
Ohio has 75-bed hospital, open staff. Box 625, Ohio State
Medical Association.
Registered by the American Medical Association
For Retarded and Exceptional
Children
Individual attention given to educational, emotional
and speech problems. Highly-trained teachers and
supervisors.
Suburban Estate Day and Boarding Pupils
Mrs. Helen Aston Copeland,
Director
4914 W. Broad St., Columbus, Ohio. FR. 8-5394
In eke'Jitii from LIPSTICK
Intractable exfoliative lip dermatoses may often be traced to eosin
lipstick dyes. Remove the offending irritants, and the symptoms
often disappear. In lipstick hypersensitivity, prescribe AR-EX NON-
PERMANENT LIPSTICK — so cosmetically desirable, yet free from all
known irritants. Send for Free Formulary.
PRESCRIBE
AR-EX
NON-PERMANENT
LIPSTICK
AR-EX COSMETICS, INC. 1036 w. van buren st. Chicago 7, ill.
1244
The Ohio State Aledical Journal
THE OHIO STATE MEDICAL JOURNAL
INDEX TO VOLUME 46—1950
January Pages
February
March ”
April ”
May ”
June ”
July ”
August
September ...
October . ”
November
December - ”
1
to
104
105
to
200
201
to
300
301
to
412
413
to
524
525
to
628
629
to
754
755
to
844
845
to
940
941
to
1036
1037
to
1140
1141
to
1252
CLINICAL PAPERS
Accidental Vaccination: Report of Three Cases in Adults
with Severe Generalized Vaccinia in One Case
(Harry Wain and Wallace H. Bucker) 1176
Acute Leukemia in Children, Treatment of (Robert
W. Heinle) 133
Acute Leukemia, "Innocuity of Protracted Oral Ad-
ministration of Special Fermentation Concentrates
of B12 as Demonstrated in a Patient with, (Robert
D. Barnard and Harry L. Fox) 784
Acute Thrombophlebitis, Diagnosis and Treatment of
(Lawrence N. Atlas) 243
Anatomy Law of 1881, The Ohio — Part I, (Linden
F. Edwards) - 1190
Anesthesia, Early Recognition of Danger Signals Dur-
ing, and Their Correction (Rolland J. Whitacre) 459
Annual Examination for Men, A Plan of (R. M.
Watkins) - 976
Antibiotics, Newer : A Brief Review of Biological and
Clinical Properties of Bacitracin, Polymyxin,
Aureomycin, Chloromycetin and Neomycin (Louis
Weinstein) 546
Aphorisms, Adages and Maxims (J. J. Sutter) 973, 1072
Appendicitis, Acute (C. R. Lulenski) 121
Arterial Infusion (Donald E. Hale) 317
Bl2, Innocuity of Protracted Oral Administration of
Special Fermentation Concentrates of, as Demon-
strated in a Patient with Acute Leukemia (Robert
D. Barnard and Harry L. Fox) 784
B 12, Vitamin, The Effect of, on the Hematologic and
Neurologic Manifestations of Pernicious Anemia
John F. Mueller, Thomas Jarrold, V. R. Hawkins
and Richard W. Vilter) 225
Bacterial Allergy, Sinusitis Due to ; Identified by Tissue
Culture and Treated by Specific Desensitization
(Herman Blatt and Frank A. Nautz) ... 319
Bacterial Endocarditis, Transient Diabetes Insipidus
Complicating (Salvatore M. Sancetta and Henry A.
Zimmerman) 140
Basal Metabolic Rate, Relation of Blood Cholesterol to,
(R. W. Kissane, Richard Brooks and Thomas E.
Clark) 1063
Bauman's, James E., Service to the State of Ohio
Biggar, Dr. Hamilton Fiske, 1839-1926 (Lucy Stone
Hertzog) 464
Blood Cholesterol, Relation of, to Basal Metabolic Rate,
R. W. Kissane, Richard Brooks and Thomas E. Clark 1063
Bronchoscopy in the Newborn (C. C. Roe Jackson) _ 869
Brucellosis, The Control and Treatment of, (John A.
Prior) 455
Burned Patient, The Immediate Supportive Treatment
of the Severely, (James Mithoefer) 981
Cancer Mortality Falls (George M. Wilcoxon) 559
Cancer of the Tongue (Arthur G. James) 1184
Causes of Failures in Patients in Whom Resuscitation
Was Attempted (Frank M. Barry and Frederick
R. Mautz) 230
Cervical Cord Lesions, High, Foramen Magnum and.
Simulating Degenerative Disease of the Nervous
System (Kenneth H. Abbott) 465
Cervical Spine With Marie Strumpel Disease, Unusual
Fracture of (Harvey R. Hathaway) 236
Chloromycetin Treatment of Typhoid Fever (John A.
Prior, C. T. Kasmersky and George Hummel) 773
Cholecystitis, Acute, The Management of, (Charles E.
Holzer, Jr.) 779
Cholesterol, Blood, Relation of to Basal Metabolic Rate,
(R. W. Kissane, Richard Brooks and Thomas E.
Clark) ■ 1063
Chorionepithelioma of the Fallopian Tube: Report of a
Case with Autopsy (Otis G. Austin) 787
Clinical Use of the Thematic Apperception Test, The
(J. M. Wittenbrook, R. T. Sidwell and A. J.
Kandik) . 337
CO2, The Use of, in Inhalation Therapy (Adolph Shor) 664
Common Bile Duct Pathology, The Etiology and Ra-
tionale of Treatment of, (H. Vern Sharp) . 541
Convulsions, 252 Recorded, Eclampsia in a 14-Year
Old Negress with ; Case Report (Eduard Eichner
and Lloyd P. Mallin) 882
Cross-Eyed Child, The Problem of the, (Lewis V. Kogut) 1061
Culture Is Based on History ; and History Is Based
Upon the Written Word (Jonathan Forman) .... 566, 671
Cyst of the Liver, Solitary Non Parasitic (H. H.
Pevaroff) 1071
Danger Signals, Early Recognition of, Daring Anes-
thesia and Their Correction (Rolland J. Whitacre) 459
Deafness in Childhood, The Prevention and Treatment
of (Harry C. Rosenberger) 1180
Degenerative Disease of the Nervous System, Foramen
Magnum and High Cervical Cord Lesions, Simulat-
ing (Kenneth H. Abbott) 645
Dermatitis, Contact, Due to Cinnamon (Francis Willner
Epstein) 659
Dermatology, Development of, in Ohio (Leon Gold-
man) 989, 1086
Diabetes, Control of: Glycosuria an Unreliable Index
to Glycemia (Henry J. John) 1073
Diabetes Inspidus, Transient, Complicating Bacterial
Endocarditis (Salvatore M. Sancetta and Henry A.
Zimmerman) 140
Diabetic Children, A Summer Camp for, (E. Perry
McCullagh, Philip W. Russell and R. E. Schneck-
loth) . — 452
for December, 1950
1245
Diphtheria, Pertussis and Tetanus Immunization “At
Birth,” Preliminary Report on, (Richard E. Bul-
lock and Herbert D. Chamberlain) 875
Doctors of Morgan County in 1848, Ground Rules for,
(Reprint from the Morgan County Herald, McCon-
nelsville, Ohio) 462
Eclampsia in a 14-Year Old Negress with 252 Recorded
Convulsions: Case Report (Eduard Eichner and
Lloyd P. Mallin) 882
Efforts To Revive the Heart, Sudden Death During
Surgical Operation, with Report of (Harold Feil
and H. K. Hellerstein) 125
Electro-Mechanical Aids in Resuscitation and Anes-
thesia (H. J. Rand III and Kenneth Wolfe) 39
Electroshock Therapy, Failures in, (Charles Landis
Anderson) 331
Enucleation Surgery, The Advantages of Ocular Im-
plants in, (David E. Rolf) 886
Epileptic Child in School, The, (Jerry C. Price, de-
ceased) 794
Esophagus, Leiomyoma of The : Report of a Case
with Successful Resection (Wallace C. Madden and
Edwin G. Olmstead) 974
Face and Jaw Injuries, The Early Management of,
(Bruce C. Martin) - 241
Fallopian Tube, Chorionepithelioma of the : Report of a
Case with Autopsy (Otis G. Austin) 787
Fibrinous Bronchitis, Acute, with Massive Atelectasis
(Forrest W. Merica) 1079
Fibrositis and Segmental Neuralgia (Joseph M. Strong) 554
Foreign Body of the Rectum and Colon (Leo J. Szary) .783
Gastro-Intestinal Hemorrhage, The Emergency Manage-
ment of Acute Massive Upper (Stanley O. Hoerr) 652
Geiser, Dr. Samuel R.— 1850-1924 (Lucy Stone Herztog) 895
General Medical Society of Ohio in 1829, Proceedings
of the (Robert G. Paterson) 51
General Practitioner, The, and the Hospital Staff
(Edward J. McCormick) 53
Glycosuria an Unreliable Index to Glycemia. Control
of Diabetes: (Henry J. John) 1073
Great Omentum, Primary Torsion of the: Case Report
(David B. Gilliam) 246
Hemorrhage, Gastro-Intestinal, The Emergency Manage-
ment of Acute, Massive Upper (Stanley O. Hoerr) 652
Hernia, Current Trends in the Treatment of (Glenn
Frank) 25
Histoplasmosis, A Case of Proven Systemic, with Ap-
parent Recovery (Valerie Friedman, J. E. Brown, Jr.,
History of Medicine in Gallia County, Ohio (Ella G.
Lupton) 143
Hodgkin’s Granuloma, Unilateral, Cause of a Sudden
and Unexpected Death (William Kulka, deceased) 1186
Hoyt Family, The, 1839-1949 (Lucy S. Hertzog) 252
Hygiene of Pregnancy (Robert F. Daly) 668
Hypasthetic Patient, Clinical Significance and Manage-
ment of the (Joseph M. Hayman) — - 655
Hyperthyroidism, Mild : A Common Disease (Herbert
E. Christman) 965
Hyperthyroidism, Propyl and Methyl Thioracil and Radio-
active Iodine in the Treatment of (E. Perry Mc-
Cullagh) : gj. - . .. . 127
Hysterectomy: An Analysis of 225 Cases (John F.
Mohan) — 561
Immunization, “At Birth” Diphtheria, Pertussis and
Tetanus, Preliminary Report on (Herbert D.
Chamberlain and Richard E. Bullock) 875
Infancy, Elective Surgery in (Henry W. Lehrer, Henry
G. Lehrer, and David R. Lehrer) 136
Infertility, Recent Concepts in the Study of (Hubert
D. Clapp and David R. Weir) 877
Infusion, Arterial (Donald E. Hale) 317
Inguinal Herniation of Stomach : Case Report (Tom
F. Lewis and Paul S. Ross) 987
Inhalation Therapy, The Use of C02 in (Adolph Shor) 664
Intestinal Obstruction Caused by Spasm of Colon (Wil-
liam D. Monger) _ .. 986
Left Iliac Artery, Aneurysm of. Producing1 Thrombosis
of Spermatic Artery and Vein (Paul J. Shank) 1069
Leiomyoma of the Esophagus : Report of a Case with
Successful Resection (Wallace C. Madden and
Edwin G. Olmstead) , 974
Leukemia, Acute, in Children, Treatment of (Robert W.
Heinle) 133
Leukemia, Acute, Innocuity of Protracted Oral Ad-
ministration of Special Concentrates of B12, as
Demonstrated in a Patient with (Robert D. Bar-
nard and Harry L. Fox) 784
Lipoma, Pedunculated: Case Report (Carl Minning) . 980
Liver, Solitary Non Parasitic Cyst of the (H. H.
Pevaroff) 1071
Marie Strumpel Disease, Cervical Spine with, Unusual
Fracture of (Harvey R. Hathaway) 236
McCann, Dr. Thomas A. 1858-1943 (Lucy Stone Hertzog) 464
Mediastinitis, Chronic, and Phlebitis, Superior Vena
Cava Obstruction Due to (Salvatore M. Sancetta
and Harold E. McDonald) 1173
Medicine in Gallia County, Ohio, History of (Ella G.
Lupton) 143
Meningitis, Pneumococcic — A Case Report (Robert E.
Slemmer) 47
Mental State, The Physician and Privileged Communi-
cations as They Relate to (E. H. Crawfis) 1082
Mononucleosis, Infectious, After Splenectomy, A Case
of Splenic Neutropenia Complicated by (Eugene H.
Sterne, Jr., and Carl I. Wyler) 888
Nervousness, Benign (Leonard L. Lovshin) 971
Neuralgia, Segmental, Fibrositis and (Joseph M.
Strong) 554
Neurological Congress, The Fourth International
(Joseph L. Fetterman) 329
Newborn, The, Bronchoscopy in (C. C. Roe Jackson) 869
NPH-50, New Modified Protamine Zinc Insulin (Harry
E. King and Thomas P. Sharkey) 449
Obstetrics and Gynecology, Posture — Its Role in (Leonard
B. Greentree) 1066
Ocular Implants, The Advantages of, in Enucleation
Surgery (David E. Rolf) 886
Ovarian Cyst, Unusual, Developing Post Partum: Case
Report (Marion E. Black) 884
Pancreatitis, Acute, Present Concepts in the Diagnosis
and Treatment of (Vinton E. Siler and John H.
Wulson) 437
Peptic Ulcer, Medical Follow-Up of Vagotomy Plus
Gastro-Enterosotomy or Pyloroplasty for (E. N.
Collins, George Crile, Jr., and W. S. Dempsey) 33
Peptic Ulcer, Psychosocial Factors in the Pathogenesis
of a, in an 89-Year Old Man (Charles K. Hofling) 1064
Pericarditis Complicating Pregnancy : Case Report
(D'avid H. Greegor) - - 1077
Pernicious Anemia, The Effect of Vitamin Bi2 on the
Hematologic and Neurologic Manifestations of
(John F. Mueller, Thomas Jarrold, V. R. Hawkins
and Richard W. Vilter) ----- 225
Phlebectomy, Sympathectomy and, for Post-Phlebitic
Ulcer (Richard Hotz and Fred M. Douglass, Jr.) — 237
Physician, The, and Privileged Communications as They
Relate to Mental State (E. H. Crawfis) 1082
Physicians, Ohio, in the Nineteenth Century, A Statis-
tical Study (Frederick C. Waite) - 791, 893
Pneumonococcic Meningitis, A Case Report (Robert E.
Slemmer) 47
Poliomyelitis, Low Calcium and Mineral Oil Treat-
ment of, — Three-Year Report (Bert C. Wiley) 234
Postgraduate Work in Rotunda Hospital, Dublin, Ire-
land (F. Graham Fallon) - 564
Postmenopausal Bleeding, Uterine Fibroids as a
Cause for (Charles H. Hendricks) 978
Posture — Its Role in Obstetrics and Gynecology (Leonard
B. Greentree) — 1066
Pregnancy — Full Term Intra- Abdominal (J. L. Reycraft,
E. R. Hill, and W. B. Crosley) 666
Pregnancy, Hygiene of (Robert F. Daly) — 668
Pregnancy, Intra-Abdominal Hemorrhage D*uring, from
the Spontaneous Rupture of a Uterine Vein: A Case
Report and Survey of the Literature (Franklin C.
Hugenberger, James M. McCord, and Charles H.
Hendricks) 789
Pregnancy, Pericarditis Complicating : Case Report.
(David H. Greegor) 1077
Proceedings of the General Medical Society of Ohio
in 1829 (Robert G. Paterson) 51
Propyl and Methyl Thioracil and Radioactive Iodine in
the Treatment of Hyperthyroidism (E. Perry Mc-
Cullagh) — - 127
Protamine Zinc Insulin, New Modified, (NPH-50) (Harry
E. King and Thomas P. Sharkey) 449
Psychiatric Aspects of Medicine (Kenneth E. Appel) __ 323
Psychosocial Factors in the Pathogenesis of a Peptic
Ulcer in an 89-Year Old Man (Charles K. Hofling) 1064
Psychosomatic Complaints, The Interpretation of, to the
Patient (Blake Crider and Robert Schott) 130
Receiving Hospitals, The Purpose of (Eugene E. Elder) 247
Rectum & Colon, Foreign Body of the (Leo J. Szary) 783
Resuscitation and Anesthesia, Electro-Mechanical Aids
in (H. J. Rand III, and Kenneth Wolfe) - 39
Resuscitation, Causes of Failures in Patients in Whom,
Was Attempted (Frank M. Barry and Frederick R.
Mautz) 230
Rotunda Hospital, Dublin, Ireland, Report on Post-
graduate Work in (F. Graham Fallon) - 564
Rupture of a Uterine Vein, Intra-Abdominal Hemor-
rhage During Pregnancy from the Spontaneous —
A Case Report and Survey of the Literature (Frank-
lin C. Hugenberger, James M. McCord and Charles
H. Hendricks) . ^89
Severely Burned Patient, The Immediate Supportive
Treatment of the, (James Mithoefer) — — 981
Siemon, Dr. Lester E., 1867-1943 (Lucy Stone Hertzog) 464
Sight Restoration Program of the Cleveland Society for
the Blind (Charles I. Thomas) . 41
Sinusitis Due to Bacterial Allergy : Identified by Tissue
Culture and Treated by Specific Desensitization
(Frank A. Nantz and Herman Blatt) ---- 319
Spasm of Colon, Intestinal Obstruction Caused by, (Wil-
liam D. Monger) 986
1246
The Ohio State Medical Journal
Special Fermentation Concentrates of Bi2, Innocuity of
Protracted Oral Administration of, as Demon-
strated in a Patient with Acute Leukemia (Robert
D. Barnard and Harry L. Fox) 784
Spermatic Artery and Vein, Aneurysm of Left Iliac
Artery Producing Thrombosis of, (Paul J. Shank) 1069
Splenic Neutropenia, a Case of, Complicated by In-
fectious Mononucleosis After Splenectomy (Eugene
H. Sterne, Jr., and Carl J. Wyler) 888
Sterility, The Treatment of : Report of 100 Consecutive
Cases (Moses Garber) 36
Stomach, Inguinal Herniation of : Case Report (Tom F.
Lewis and Paul S. Ross) 987
Story Behind the Word, Some Interesting Origins of
Medical Terms (Harry Wain) 46, 142, 233, 328, 545,
663, 786, 885, 970, 1065, 1179
Sudden Death During Surgical Operations, with Re-
port of Efforts To Revive the Heart (Harold Feil
and H. K. Hellerstein) 125
Summer Camp for Diabetic Children (E. Perry Mc-
Cullagh, Philip W. Russel and R. E. Schneckloth 452
Superior Vena Cava Obstruction Due to Chronic Medi-
astinitis and Phlebitis (Salvatore M. Sancetta and
Harold E. McDonald) 1173
Sympathectomy and Phlebectomy for Post-Phlebitic Ulcer
(Richard Hotz and Fred M. Douglass, Jr.) ... 237
Tetanus, Case Report of, (Dorothy Stannard Allen) ..... 385
Thematic Apperception Test, The Clinical Use of the,
(J. M. Wittenbrook, R. T. Sidwell, and A. J.
Kandik) 337
Thrombo-Embolic Disease (Noble Fowler and Johnson
McGuire) 660
Thrombophlebitis, Acute, Diagnosis and Treatment of,
(Lawrence N. Atlas) 243
Tobacco Smoking : Some Hints of Its Biologic Hazards
(Clarence A. Mills) 1165
Tongue, The, Cancer of, (Arthur G. James) 1184
Typhoid Fever, Chloromycetin Treatment of, (John A.
Prior, C. T. Kasmarsky and George Hummel) 773
Ulcer, Post-Phlebitic, Sympathectomy and Phlebectomy
for, (Richard Hotz and Fred M. Douglass, Jr.) 237
Uterine Fibroids as a Cause for Postmenopausal Bleed-
ing (Charles H. Hendricks) 978
Vaccination, Accidental: Report of Three Cases in
Adults, with Severe Generalized Vaccinia in One
Case (Harry Wain and Wallace H. Buker) 1176
Vagotomy Plus Gastro-Enterosotomy or Pyloroplasty
for Peptic Ulcer, Medical Follow-Up of, (E. N.
Collins, George Crile, Jr., and W. S. Dempsey) .... 33
Wood, Dr. James Craven, 1859-1948 (Lucy Stone
Herztog) 344
AUTHORS OF CLINICAL PAPERS AND CASE RECORDS
Abbott, Kenneth H. (Columbus) 645
Allen, Dorothy Standard (Lawrence, Kans.) 335
jinutiouu, vuaiiw juanuio ( »» ui umigtou y oojl
Appel, Kenneth E. (Philadelphia, Pa.) 323
Atlas, Lawrence N., (Cleveland) 243
Austin, Otis G. (Medina) 787
Barnard, Robert D. (Long Island, N. Y.) 784
Barry, Frank M. (Cleveland) 230
Black, Marion E. (Cleveland) 884
Blatt, Hermann (Cincinnati) 319
Brooks, Richard (Columbus) 1063
Brown, John E., Jr. (Columbus) 44
Buker, Wallace H. (Mansfield) 1176
Bullock, Richard E. (McArthur) 875
Chamberlain, Herbert D. (McArthur) 875
Christman, Herbert E. (Lakewood) 965
Clapp, Hubert D. (Cleveland) 877
Clark, Thomas E. (Columbus) 1063
Collins, E. N. (Cleveland) 33
Crawfis, E. H. (Cleveland) 1082
Crider, Blake (Cleveland) 130
Crile, George, Jr., (Cleveland) 33
Crosley, W. B. (Cleveland) 666
Daly, Robert F. (Columbus) 668
Dempsey, W. S. (Cleveland) 33
Douglas, Fred M., Jr. (Toledo) 237
Edwards, Linden F. (Columbus) 1190
Eichner, Eduard (Cleveland) 882
Elder, Eugene E. (Youngstown) 247
Epstein, Francis Willner (Toledo) 659
Fallon, F. Graham (Cleveland) 564
Feil, Harold (Cleveland) 125
Fetterman, Joseph L. (Cleveland) 329
Forman, Jonathan (Columbus) 566, 671
Fowler, Noble (Cincinnati) 660
Fox, Harry L. (Queens, N. Y.) 784
Friedman, Valerie (Los Alamos, N. M.) 44
Garber, Moses (Cleveland) 36
Gilliam, David B. (Columbus) 246
Glenn, Frank (New York City) 25
Goldman, Leon (Cincinnati) 989, 1086
Greegor, David H. (Findlay) 1077
Greentree, Leonard B. (Columbus) 1066
Hale, Donald E. (Cleveland) 317
Hathaway, Harvey R. (Lakewood) 236
Hawkins, V. R. (Cincinnati) 225
Hayman, Joseph M., Jr. (Cleveland) 655
Heinle, Robert W. (Cleveland) 133
Hellerstein, Herman K. (Cleveland) 125
Hendricks, Charles H. (Columbus) 789, 978
Hertzog, Lucy Stone (Chardon) 252, 344, 464, 895
Hill, E. R. (Cleveland) 666
Hoerr, Stanley O. (Cleveland) 652
Hofling, Charles K. (Cincinnati) 1064
Holzer, Charles E., Jr. (Gallipolis) 779
Hotz, Richard (Toledo) 237
Hugenberger, Franklin C. (Columbus) 789
Hummel, George (Columbus) 773
Jackson, C. C. Roe (Cleveland) 869
James, Arthur G. (Columbus) 1184
Jarrold. Thomas (Dayton) 225
John, Henry J. (Cleve'and) 446, 1073
Kandik, A. J. (Cleveland) 337
Kasmersky, C. T. (Columbus) 773
King, Harry E. (Dayton) 449
Kissane, R. W. (Columbus) 1063
Kogut, Lewis V. (Cleveland) 1061
Kulka, William (deceased) (Cleveland) 1186
Lehrer, David R. (Sandusky) 136
Lehrer, Henry G. (Sandusky) 136
Lehrer, Henry W. (Sandusky) 136
Lewis, Tom F. (Columbus) 987
Lovshin, Leonard L. (Cleveland) 971
Lulenski, C. R. (Cleveland) 121
Lupston, Ella G. (Gallipolis) ~ 143
Madden, Wallace C. (Dayton) 974
Mallin, Lloyd P. (Cleveland) 882
Martin, Brice C. (Columbus) 241
Mautz, Frederick R. (Cleveland) — 230
McCord, James M. (Columbus) 789
McCormick, Edward J. (Toledo) 53
McCullagh, E. Perry (Cleveland) 127, 452
McDonald, Harold E. (Cleveland) 1173
McGuire, Johnson (Cincinnati) - 660
Merica, Forrest W. (Lakewood) 1079
Mills, Clarence A. (Cincinnati) .1165
Minning, Carl (Williamsburg) 980
Mithoefer, James (Cincinnati) 981
Mohan, John F. (Cincinnati) 561
Monger, William G. (Lancaster) 986
Mueller, John F. (Cincinnati) 225
Nantz, Frank A. (Cincinnati) ~ 319
Olmstead, Edwin G. (Milwaukee, Wis.) 974
Paterson, Robert G. (Columbus) 51, 249, 341
Pevaroff, H. H. (Cleveland) 1071
Price, Jerry C. (deceased) Beverly Hills, Calif.) 794
Prior, John A. (Columbus) 455, 773
Rand, H. J., Ill (Cleveland) - — 39
Reycraft, James Leonard (Cleveland) — 666
Rolf, David E. (Cleveland) - 886
Rosenberger, Harry C. (Cleveland) 1180
Ross, Paul S. (Columbus) 987
Russell, Philip W. (Cleveland) 452
Sancetta, Salvatore M. (Cleveland) 140, 1173
Schneckcloth, R. E. (Cleveland) 452
Schott, Robert (Los Angeles, Calif.) 130
Shank, Paul J. (Dayton) 1069
Sharkey, Thomas P. (Dayton) _ 449
Sharp, H. Vern (Akron) _ 541
Shor, Adolph (Cincinnati) 664
Sidwell, R. T. (Cleveland) _ 337
Siler, Vinton E. (Cincinnati) 437
Slemmer, Robert E. (Cincinnati) 47
Sterne, Eugene H., Jr. (Cincinnati) _ 888
Strong, Joseph M. (Elyria) - 654
Sutter, J. J. (Lima) 973, 1072
Szary, Leo J. (Akron) 783
Thomas, Charles I. (Cleveland) 41
Turner, E. V. (Columbus) 44
Vilter, Richard W. (Cincinnati) 225
Wain, Harry (Mansfield) 46, 142, 233, 328, 545,
663, 786, 885, 970, 1065, 1176, 1179
Waite, Frederick C. (Dover, N. H.) 791, 893
Watkins, Ralph M. (Cleveland) 976
Weir, David R. (Cleveland) 877
Weinstein, Louis (Brighton, Mass.) 546
Whitacre, Rolland J. (East Cleveland) 459
Wilcoxon, George M. (Alliance) 559
Wiley, Bert C. (Dayton) 234
Wittenbrook, J. M. (Cleveland) 337
Wolfe, Kenneth (Cleveland) 39
Wulsin, John H. (Cincinnati) 437
Wyler, Carl J. (Cincinnati) 888
Zimmerman, Henry A. (Cleveland) 140
for December, 1950
1247
GENERAL INDEX
Advertisers, Index to — 102, 198, 298, 410, 522, 626,
754, 842, 938, 1034, 1138 1243
Advertising, Classified— 103, 199, 299, 411, 523, 627, 755,
843, 939, 1035, 1139, 1244
American Medical Association — -
High Spots of Interim Session, Washington,
Dec. 6-9, 65 ; Special Train to San Francisco
Meeting, 163 ; Name of Hygeia Changed to Today’s
Health, 165 ; A. M. A. Authorizes Study of Phy-
sicians’ Incomes, 198 ; Space Still Available on
Special Train, 367 ; A. M. A. Joins Inter-Association
Committee on Health, 371 ; A. M. A. Warns on Cold
Cures, 374 ; A. M. A. Witnesses Point Flaws in Dis-
ability Clause (H. R. 6000), 375 ; A. M. A. Estab-
lished Microbiologic Laboratory, 409 ; Brookings
Workers Visit A. M. A., 474 ; 10,000 Physicians
Expected at A. M. A. Meeting, 479 ; Conference of
County Medical Society Officers Scheduled in San
Francisco, 507 ; Study of Physicians’ Incomes Is
Under Way, 587 ; A. M. A. Directory Being Dis-
tributed, 684 ; 1951 Interim Session To Be Held in
Houston, 709; A. M. A. Launches Ad Campaign,
712 ; Knock-Out Drive Planned, 726 ; Report (Pre-
liminary) of A. M. A. Annual Session San Fran-
cisco, 822 ; A. M. A. Annual Session in San Fran-
cisco— Brief of Actions of House of Delegates, 896 ;
The Hess Report, 899 ; A. M. A. Clinical Session,
Cleveland, Dec. 5-8, 1018; A. M. A. Cleveland Meet-
ing, 1100 ; A. M. A. Announces Standards for Ap-
proval of Sunlamps, 1199 ; Progress Made on Stu-
dent A. M. A. 1219
Annual Meeting —
Hotel Reservation Page, 57 ; 156, 253, 360, 465 ;
Features of the 1950 Meeting, 155 ; Annual Meeting
Instructional Courses, 255 ; Announcing the 1950 ,
Annual Meeting (Complete Program), 345; Mark
These Red Letter Days, 466 ; Summary of 1950
Annual Meeting, 467 ; Detailed Report Will Appear
in July Issue, 573 ; Reports of 1950 Meeting, 673 ;
“A Half-Century of Progress,” Address of Presi-
dent Carl A. Lincke at Annual Meeting, 688 ;
Presenting the New Officers, 692 ; Annual Meeting
Review, 695 ; Photographs at 1950 Meeting, 696 ;
Rebroadcast of Senator Taft Speech and Address
by Dr. Lull, 699 ; Annual Meeting Again Sets
Record, 701 ; 1951, 1952 Annual Meetings, 714 ;
Hotel Reservation Page 1206
Associations, Societies and Organizations —
American College of Allergists Jan. 16-18 Meet-
ing, 152 ; Domus Medica, 263 ; Northern Tri-State
Medical Association, Grand Rapids, April 11, 264 ;
Ohio Public Health Association, Columbus, May
11-12, 264 ; Ohio Society for Crippled Children To
Sponsor Easter Seal Drive, 297 ; Hamilton Academy
Elects Officers, 394 ; Fort Steuben Academy Meet-
ing, 407 ; Women Doctors Invited to Luncheon
by Cleveland Branch, American Medical Women’s
Association, 482 ; Planned Parenthood League of
Ohio Schedules Meeting, 490 ; X-Ray Technicians
Schedule National Meeting in Columbus, 507 ; Col-
lege of Surgeons Initiates Fellows for 1949, 573 ;
Doctors Orchestra of Akron Completes 24th Sea-
son, 604 ; Fort Steuben Academy, 612 ; Ohio Society
of Anesthesiologists Course, 620 ; American College
of Physicians Announces 1951 Meeting, 687 ;
Regional Meeting, American College of Physicians,
700; Ohio State Radiological Society Holds An-
nual Meeting, 708 ; Michigan Annual Meeting, 814 ;
International College of Surgeons, U. S. Chapter,
Meeting in Cleveland, 917 ; Northwestern Associa-
tion Lima Program, 1029 ; American College of
Physicians Nov. 18 Meeting, 1030 ; Ohio Radiologists
Set 1951 Meeting, 1100 ; American Speech and
Hearing Association To Meet in Columbus, 1128 ;
Am. College of Surgeons Elects 1203
Attorney General, Legal Opinions — -
On Health Districts and Quarantine, 56 ; On
Coroner’s Appointment of Technician, 180 ; Aid
for Aged Does Not Constitute Poor Relief, 604 ;
Funeral Directors Cannot Delegate Authority To
Investigate and Arrest, 841 ; Sec. 4036 Cannot Be
Read Separate — Pertaining to Hospital Boards, 841 ;
Prosecuting Attorneys Are Legal Advisors to
Board of County Hospitals, 841 ; “Social Service” of
Child Welfare Boards Defined, 998 ; Tuberculous
Entitled to Poor Relief, 113.8 ; Authority in Absence
of Health Commissioner, 1138 ; Filling of Vacancies
on Health Boards 1138
Audit, Annual of O. S. M. A. Books — 484
Blood Banks —
Columbus Blood Center Ranks High, 263 ; Medical
Advisory Committee for Blood Bank Named, 1029 ;
Dr. Haden Named Medical Director of National
Red Cross Blood Program, 1129 ; Surgeon General
Puts “Go Slow” Sign on Blood Typing 1205
Buckeye News Notes — 81, 267, 394, 505, 606, 734,
832, 934, 1018, 1122
Cancer —
Ohio State and Western Reserve Each Receive
8300,000 for Construction of Cancer Facilities, 69 ;
Cancer April Drive, 376 ; Cancer Film Available,
604 ; Breast Cancer Film Available, 816 ; Cancer
Meeting Sponsored in Columbus 1097
Child Welfare—
Ohio Commission on Children and Youth Paving
Way 496
Civic and Governmental Affairs —
Think Over This One, Doctor, 166 ; Shades of
Houdini (President’s Prosperity Predictions), 167;
Figures on Inertia of Citizens, Including Doctors,
380; The Temptation Was Just Too Great, 492 ;
Good Work Being Done in Lorain County, 492 ;
Too Little Taught About What Is Right in U. S.,
433 ; Not What You Have, But What You Share,
591 ; Are Doctors Citizens ? a Letter by President
Swartz, 709 ; Taft Raps Reorganization Plan 27,
713 ; Lives of Great Men Remind Us, 730 ; Doctors
Must Be Citiizens, 807 ; Your One Vote May Be
the Deciding Vote, 920 ; It Will Take More Than
100 To Do the Job, 9247~What You Can Do — Should
Do- — Between Now and Nov. 7, 1000 ; Alleges
“Ohio Doctors Backing Taft,” 1012 ; Chance for
Doctors in Rural Areas To Act, 1012 ; Reflections
on the Nov. 7 Election, 1218 ; Henderson Answers
C. I. O. 1222
Civil Defense —
Commission Studies Indoctrination in Aspects of
Atomic Warfare, 509 ; Civilian Defense Program Set
Up by Governor, 926 ; Ohio Civil Defense Program,
1112 ; Basic Civil Defense Plans Now Being Pre-
pared 1116
Coming Meetings — 102, 198, 298, 410, 522, 626, 939,
1034, 1138, 1243
Conference of County and State Officers, O. S. M. A. —
Conference Announced for March 5, 165 ; Report of
Conference, March 5, 1950 368
Council, Minutes of Meetings —
Minutes of Dec. 18, 1949, 149 ; Minutes of April
22-23 Meeting, 569 ; Reports to Council of Com-
mittees on Education, Public Relations and In-
dustrial Health, 574 ; Minutes of Meetings, May 15
and May 18, 1950, 673 ; Minutes of Sept. 16-17
Meeting 1086
County Societies, Activities of — 90, 184, 282, 396, 511,
614, 740, 837, 935, 1031, 1130, 1233
Mahoning Sponsors Contest on Voluntary System,
365 ; Columbiana Society Calls for Action on Public
Health, 380 ; Defiance County Makes 50-Year
Awards Community Project, 410 ; Lorain County
Doing Something About Public Relations, 585 ; Cin-
cinnati Academy Acts on Rebate Question, 586 ;
Mahoning County Essay Contest Winners An-
nounced, 716; Tuscarawas County Society Sponsors
School Health Conference, 811 ; Clark and Lake
Counties Establish 24-Hour Emergency Services,
836 ; Hats Off to Toledo and Clinton Societies, 1220
Deaths — 86, 174, 280, 390, 502, 610, 736, 828, 929,
1020, 1126, 1230
Distribution of Doctors —
Rural Doctor Shortage, 84 ; Brookings Workers
Visit A. M. A., 474 ; New Directory Shows One
Doctor for Every 750 Persons, 576 ; Report Increase
of 2,266 in Physician Population, 706; Family
Doctors Outnumber Specialists Two to One 714
District Societies —
Eighth District Meeting Scheduled at Rocky Glen
June 15, 506 ; Sixth District Postgraduate Day,
898 ; Second District Meeting Scheduled, 999 ; Ninth
District To Convene in Scioto County, 1028 ; North-
western Association Program in Lima, 1029 ; Eighth
District Meeting in Newark, 1030 ; Second Dist.
Meet 1205
Do You Know?— 82, 170, 276, 386, 498, 596, 732, 833,
933, 1016, 1123, - 1232
Dues — A. M. A. —
An Investment Which Is Sound and Warranted,
74 ; Explanation of A. M. A. Dues and How To Pay
Them, 153 ; Mr. Christensen Pays His “l>ues,”
272 ; How To Pay A. M. A. Dues Again Explained,
1248
The Ohio State Medical Journal
382 ; Payment of A. M. A. Dues Explained, 520 ; Last
Call for Payment of A. M. A. Dues 920
Editor’s Activities — 158, 812, 918
Ethics, Matters of Policy, Etc. —
Problem of Malpractice, 60 ; Fees and Public Rela-
tions, 68 ; It’s Time for a House Cleaning, 384 ;
Show and Tell Them What We’re For, 491 ;
Cincinnati Acts on Rebates, 586 ; The Prescription
Refill Problem, 588 ; The Hess Report, 899 ; What
Do You Profess? 1118
Exhibits —
Summit County Auxiliary Sponsors Health Days
Exhibit, 372 ; Tour of Exhibits Should Be Must on
Your Schedule, 492 ; Many County Fairs Covered
by Association’s Exhibits — 1098
Federal Government —
Appoint Towne Chief Basin Engineer at Cincinnati,
88 ; Allergy May Be Tipoff on Man Wanted by
F. B. I. 675
Federal Grants-in-Aid —
For Heart Research at Reserve, 66 ; Three Grants,
67 ; Grants for Construction at Ohio State and
Western Reserve, 69 ; Heart Research at Cleveland
Clinic 263
Fifty-Year Members (Sea Under Activities of County
Societies) —
Defiance County Makes 50-Year Awards Community
Project 410
General Practitioners —
General Practitioner and the Hospital Staff, 53 ;
Franklin County Chapter Elects, 264 ; — Okie Acad-
emy of G. P. Supports $25 A. M. A. Dues, 372 ; Dr.
Alvarez To Edit GP, 482 ; GP Welcomed to the
Fold, 492 ; Ohio Academy of General Practice
Elects Officers 722
Historian’s Notebook — 51, 143, 249, 341, 462, 566, 671,
791, 893, 989, 1086, 1190
Hospitals —
Inspection of Hospitals for Casualty Hazards, 74 ;
New Student Center at Ohio University, Athens,
365 ; Hospitals Subject to Taxation, 485 ; Plans for
Wood County and Defiance Hospitals Featured in
“Hospitals,” 519 ; Ohio Hospitals Approved for
Intern and Residency Training, 577 ; Cincinnati
Sanitarium Announced Expansion of Visiting Staff,
675 ; Ohio Hospitals, A. M. A. Survey Report, 724 ;
The Problem of Rising Hospital Costs, 1014 ; Hos-
pital Approval Program, 1120 ; College of Surgeons
Continues Hospital Inspection 1219
Hospital Facilities Office —
First Hill-Burton Hospital Completed, 261 ; Ap-
pointments at Cleveland Clinic, 295 ; Four Members
Reappointed on Hospital Advisory Council, 612 ; More
Hill-Burton Hospitals Open — Washington C. H. and
Nelsonville, 710 ; Wyandot Memorial Hospital Is
Dedicated, 1114 ; Hospital Bldg. Curtailed 1228
House of Delegates — -
List of Delegates and Alternates, 363 ; Resolutions
To Be Presented at Annual Meeting, 480 ; Pro-
ceedings of Sessions of 1950 Annual Meeting, Cleve-
land, 676 ; House of Delegates Roll Call, 1950 Meet-
ing, 685 ; House Resolution Opposed State Plan
for Compulsory Non-Oceupational Sickness Bene-
fits . 686
In Onr Opinion —
Few Have Been Able To Escape the Tax Collector,
74 ; An Investment Which Is Sound and Warranted
(A. M. A. Dues), 74; Inspection of Hospitals for
Casualty Hazards, 74; Editors Only Print the
News, 76 ; Offers for Help in Campaign Need
Screening, 76 ; Medical Coverage for the Individual,
76; Who Says It’s Not a Political Issue? (Socialized
Medicine), 78; Physicians Can Make or Break the
Blue Cross Plan, 78 ; Tax and Tax and Give Orders,
78 ; Mayors of Other Cities, Please Take Note (on
Consulting County Societies), 78; Think Over This
One, Doctor (Neglect of Civic Affairs), 166; Let’s
Have a Real Epidemic of This (Answering Emergency
Calls), 166; Questions for Medical School Survey
Committee, 166 ; Shades of Houdini or Is It Ponzi ?
(President’s Prosperity Predictions), 167; Big Devils
and Little Devils, (Socialized Medicine-Compulsory
Health Insurance), 167 ; Mercy Slaying and the
Welfare State, 167 ; Long Jaunt but Worth It,
168 ; Aid of Health Department Offered Doctors,
168 ; Pamphlet Stresses Care of Dogs in Research,
168 ; Half-Heard — or Perhaps Very Poorly Told,
168 ; Red Cross To State Annual Campaign, 168 ;
What Are You Going To Do About It, Doctor?
(Policy on Socialized Medicine), 271; Talk-It-Over
Sessions with the Druggists, 271 ; Facts, Figures
and Fallacies, 271 ; Mr. Christensen Pays His Dues,
272 ; Study of Methods of Teaching Medicine, 272 ;
AMVET Columnist Warns His Buddies, 274 ; In-
dustrial Fumes Should Be Concern of Doctors, 274 ;
Public Health Recognized as a Specialty, 274 ; Fig-
ures on Inertia of Citizens, Including Doctors, 380 ;
Action Called for in Columbiana County (Public
Health Set Up), 380 ; How To Pay A. M. A. Dues
Again Explained, 382 ; When Discarding Samples
Do a Complete Job, 382 ; Move To Help Tax-
payers Causes Loud Wails, 382 ; It’s Time for a
House Cleaning (Excessive Fees), 384; What’s Down
“The Road Ahead”?, 384; Ford Makes Another
Smart Move, 384 ; Doctor Says Friendly Rivalry
Puts Physicians on Toes, 384 ; Inflated Costs Will
Wreck (Voluntary Health Insurance) Programs,
491 ; Show and Tell Them What We’re For, 491 ;
Medical Board on Job, Report Reveals, 491 ;
“GP” Welcomed to the Fold, 492 ; The Temptation
Was Just Too Great (To Promote Certain Candi-
dates), 492 ; Will Ohio Rank Low Again in Birth-
Death Registrations?, 492 ; Good Work Being Done
in Lorain County (on Registration), 492; Tour of
Exhibits Should Be a Must, 492 ; Too Little Taught
About What Is Right in U. S-, 493 ; Medicine
Loses a Real Friend (Keys), 493 ; The Govern-
ment Can Supply Some Needs, But Not All, 493 ;
Profound Words by Mr. Brannan, 493 ; It (Govern-
ment) Usually Takes More Than It Gives, 493 ;
Narcotic Don’ts for the Physician, 589 ; Have
You Cooled Your heels in Court?, 589; Making
Friends With the Press is Good Public Relations,
590 ; Too Many Riding the Wagon — Too Few Push-
ing, 590 ; Physicians, Hospitals Play Parts in
Decreased Maternal Hazards, 590 ; Mr. Green Speaks,
but Hastily, 591 ; Clauses in Radium Contracts
May Entail Legal Entanglements, 591 ; Not What
You Have, But What You Share, 591 ; Blessed Are
the Poor for They Shall Inherit the Debt, 591 ;
Knock-Out Drive Planned by A. M. A., 726 ; Ex-
cellent Hunches for Auxiliary Programs, 728 ;
Check Your Workmen’s Compensation Files Often,
728 ; Accidental Death Rate for 1949 Reaches All-
Time Low, 730 ; Lives of Great Men Remind Us,
730 ; It Wouldn’t Be Free Here, Either, 730 ; Doc-
tors and the Present War Emergency, 824; Florida
County Goes All Out in Emergency Call Service,
824 ; Some Healthful Thinking on the Part of
Health Personnel, 824 ; It Isn’t What You Say So
Much as the Way You Say It, 826 ; The Score-
board Is Usually the Best Indication of the Score,
826 ; Your One Vote May Be the Deciding Vote,
920 ; Last Call for Payment of A. M. A. Dues,
920 ; Essential Role of Physicians in Helping the
Handicapped, 922 ; Rural Preceptorship Program
Studied, 922 ; It Will Take More Than 100 To Do
the Job, 924 ; Have-Nots Versus the Haves, 924 ;
Socialized Medicine the Real Issue on Nov. 7, 1010 ;
Two-Year Rule on Filing W. C. Fee Bills and
Reports, 1010 ; How To Set Up an Office and
Where, 1010 ; Doctors Need This Kind of Publicity,
1012 ; Alleges “Ohio Doctors Backing Taft,” 1012 ;
Chance for Doctors in Rural Areas To Act, 1012 ;
The Problem of Rising Hospital Costs, 1014 ;
’Twould Be Funny If It Were Not So Serious,
1014 ; Basic Civil Defense Plans Now Being Pre-
pared, 1116 ; Mr. Rayburn Comments on Lobbies,
1116 ; Oregon Doctors Win First Bout with U. S.,
1118; What Do You Mean “Free Choice”?, 1118;
What Do You Profess?, 1120; Reflection on the
Nov. 7 Election, 1218 ; Ohio Reaps Whirlwind as
U. S. Cuts Health Grants, 1219 ; Do You Itemize
Your Statements? 1219; Progress Made in Forming
Student A. M. A., 1219 ; College of Surgeons Con-
tinues Inspection, 1219 ; Ewing Blistered for Poking
Nose into Ohio Politics, 1220 ; Hats Off to Toledo
and Clinton County Societies, 1220 ; All Is Not
Well with British Health Scheme, 1220 ; Medical
Socializers Hit Below Belt Again, — 1220
Industrial Health —
Workers’ Welfare To Be Subject of Industrial
Health Congress, 178 ; Industrial Fumes Should Be
Concern of Doctors, 274 ; Report of Committee on
Industrial Health and Workmen’s Compensation,
574; Ind. Health Conference Scheduled 1205
Insurance —
Insurance Examination Fee Study in West Verginia,
473 ; Forty-Three Life Insurance Companies An-
nounce Increases in Fee Schedules 820
Journal, The —
Notice of Discontinuance If Dues Are Not Paid, 260
Keeping Up With Medicine — 35, 135, 248, 461, 558, 778,
887, 991, 1088, 1183
Laws and Legislation —
Problem of Malpractice, 60 ; On the Congressional
Front (State-of-the-Union Message of the Presi-
dent), 157 ; A. M. A. Witnesses Point Flaws in Dis-
ability Clause of H. R. 6000, 375 ; A. M. A. Issues
Statement Against H. R. 5182, Proposing United
for December, 1950
12 49
Medical Administration, 490 ; Washington Roundup,
494 ; Ruling on Unemployment Compensation to
Person Who Left Ohio for Health, 499 ; Payments
for Rabies Cases, 506 ; Have You Cooled Your Heels
in Court?, 589 ; Clauses in Radium Contracts May
Entail Legal Entanglements, 591 ; Collection
Agencies, Dealings With, 592 ; Ohio Supreme Court
Rules Out Medical Texts in Evidence, 613 ; House
of Delegates Resolution Opposes State Plan for
Compulsory Non-Occupational Sickness Benefits, 686 ;
Failure To Vaccinate Is Not Neglect Under Sec.
1639-3, Court Rules, 810; Oregon Doctors Win First
Round, 1118 ; Rights of Limited Practitioners
Defined 1200
Licensure, Medical (See also Ohio State Medical Board) —
Licenses Issued Through Endorsement, 72 ; 295,
594, 808, 1026 ; Licenses Granted at Jan. 16-17
Meeting of Board, 162 ; List of Questions for Dec.
12-14v 1949 Examinations, 162 ; Questions for June
14-17, 1950 Examinations, 815 ; Licenses Granted
at Aug. 8 Board Meeting 1002
Medical Education (See also Postgraduate Activities) —
Questions for Medical School Survey Committee,
166 ; Committee on Medical History and Archives,
Ohio Archaeological and Historical Society, Co-
lumbus, April 15, 268 ; Study of Methods of Teach-
ing Medicine, 272 ; Drs. Vosburgh and Patek Named
at Western Reserve, 510 ; Report of Committee on
Education, 574 ; Ohio Hospitals Approved for In-
tern and Residency Training, 577 ; Dr. Karsner
Heads National Board of Medical Examiners, 711 ;
Navy Civilian Intern Training Program, 808 ;
Windsor Offers Two Residencies, 831 ; Postgraduate
Course in General Medicine, Cleveland Clinic, 842 ;
New Arthritis Film Available, 918 ; Rural Pre-
ceptorships Program Studied, 922 ; Medical Schools
Set Enrollment Records, 999 ; Fellowship Grants
Awarded, 1030 ; Fellowships in Industrial Health
Offered 1097
Members, Roster of New— 72, 182, 262, 394, 580, 718,
927, 1027. .1226
Military Affairs (See also War) —
Meiling Will Guide Policies of Consolidated Medi-
cal Journals, 72 ; Meiling To Direct Paring of
Military Hospitals, 296 ; Army Seeks Civilian Doc-
tors, 576 ; Provisions for Reserve Officers Re-
viewed, 502 ; Health Services for Civilians in
Military Services Unified, 684 ; Navy Makes
Available Data on Atomic Radiation Effects, 714 ;
Symposium for Medical Officers, 843 ; Health Situa-
tion in Korea Headache for Medical Officers, 938 ;
Veteran Patients to Military Hospitals Limited,
998 ; Civil Relief Act, 1204 ; Doctors and the War,
1207 ; Return Questionnaire 1207
Miscellaneous —
Mayors of Other Cities Please Note (and consult
county societies), 78; Dr. Curtis Honored, 298; Medi-
cine Loses a Real Friend (Keys), 493; Publica-
tion of Association of Medical Illustrators, 604 ;
Ohio Golf Tournament, 806 ; Dr. Schriver Honored
at Conference of State Associations’ Officers, 814 ;
Employment of Physically Handicapped, 842 ; Medi-
cal Care Price Indexes Below Cost of Living for
1949, 918 ; Essential Role of Physicians in Helping
the Handicapped, 922 ; How To Set Up an Office
and Where, 1010 ; Ohio Drivers’ Licenses Now
Expire on Licensees’ Birthday, 1024 ; Clinic in Cleve-
land Matches Cardiacs to Job Demands 1027
Narcotics —
Board of Pharmacy Offers Interpretations on Pre-
scribing Barbiturates, 67 ; Narcotic Don’ts for the
Physician, 589 ; Narcotic Licenses Must Be Re-
newed by July 1 600
Nursing —
Ohio Nurses’ Association Elects Officers, 816 ;
Capital U. Establishes Nursing School 937
Ohio Department of Health (See also Hospital Facilities
Office) —
Aid of Department Offered Doctors in Blue Baby
Cases, 168 ; Department Warns About Parrot Fever,
270 ; Department Offers To Underwrite Expenses
at Papanicolaou Course, 270 ; New Specimen Con-
tainers Used by State Laboratory, 469 ; Depart-
ment Jointly Sponsors Animal Disease Reporting,
476 ; Department Sets Up Five District Consulting
Offices, 499 ; Communicable Disease Regulations,
508 ; New TB Division Chief Named, 691 ; Real-
location of Federal Health Funds, 813 ; Commit-
ment to and Discharge from Lima State Hospital,
834 ; New Allocation of Federal Health Funds
Legally Approved, 1004 ; Eligibility for Local
Health Aid, 1111 ; Ohio Reaps Whirlwind on Health
Cuts 1219
Ohio Department of Welfare —
New Program for Feeble-Minded, 470 ; Central States
Regional Meeting of the American Public Welfare
Association Scheduled in Columbus, 509 ; Changes
Made in Division of Aid for Aged Fee Schedule,
938 ; Clinics on Epilepsy To Continue in 1951, 1112 ;
Admissions to Mental Institutions Reviewed, 1210 ;
Welfare Conference 1243
Ohio General Assembly — (See Laws and Legislation)
Ohio Industrial Commission —
Procedure Outlined on X-Rays Sent Industrial Com-
mission, 182 ; Commission No Longer Will Pay
for Penicillin and Streptomycin, 264 ; Two Changes
Approved in Workmen’s Compensation Fee Sched-
ule, 714 ; Check Your Workmen’s Compensation
Files Often, 728 ; Two-Year Rule on Filing of W. C.
Fee Bills and Reports, 1010 ; 1949 Financial State-
ment 1216
Ohio Medical Indemnity— (See Also Prepaid Plans)
Doctors’ Plan Is Expanding, 164 ; Contract Liber-
alized, Directors and Officers Elected 598
Ohio State Medical Association — (See Also The Coun-
cil, Annual Meeting, House of Delegates)
Association Sponsors Conference on School Health,
258 ; Association Assigned Health Aspects on In-
stitute on Education by Radio, 482 ; Reports of Com-
mittee on Education, Public Relations and In-
dustrial Health, 574 ; Second Rural Medical Schol-
arship Awarded, 928 ; County Fair Exhibit Pro-
gram 1098
Ohio State Medical Board (See also Licensure) —
Medical Board on Job, Report Reveals, 491 ; Ques-
tions for December 12-14, 1949 Examinations, 162 ;
Questions for June 14-17, 1950, Examinations 815
On the Firing Line — 70, 172, 278, 388 500
Pharmaceuticals —
Board of Pharmacy Offers Interpretations on Pre-
scribing Barbiturates, 67 ; A. M. A. Warns Against
Unwise Use of Cold Tablets, 102 ; Food and Drug
Administration Policy on Antihistaminic Drugs,
265 ; A. M. A. Warns on Cold Cures, 374 ; When
Discarding Samples Do a Complete Job 382
Photographs (Other Than Portrait) —
Scene of the 1950 Meeting (Cleveland Auditorium),
154 ; Cleveland Hotel and Western Reserve Uni-
versity Hospitals, 254 ; School Health Committee-
men Hear Problems Discussed, 259 ; Wooster Com-
munity Hospital Scheduled To Open, 261 ; Chair-
men of Auxiliary Annual Meeting Committee,
364 ; Candid Shots at Conference of County Of-
ficers, 369 ; Health Days in Akron, 373 ; Photos
at Conference, Columbus, March 14, 472 ; High Spots
at Annual Meeting, 696 ; Dr. Wilzbach Named
President of Ohio Public Health Association, 751 ;
Exhibits at County Fairs 1099
Physician’s Bookshelf— 8, 112, 208, 306, 420, 532, 634,
764, 852, 948, 1044, 1148
Postgraduate Activities — (See also Medical Education) —
Bunts Institute and Cleveland Clinic, General Sur-
gery, April 6-8, 262 ; Papanicolaou Course at
Cornell, 270 ; St. Luke’s Hospital Schedules Weekly
Symposia, 898 ; Medina Hospital Program, 898 ;
Sixth District Postgraduate Day, 898 ; Second Dis-
trict Meeting Scheduled in Dayton, 999 ; St. Luke’s
Schedules October Symposia, 1021 ; U. of Michigan
Courses, 1024 ; Ninth District To Convene in
Scioto County, Oct. 12, 1028 ; Northwestern Asso-
ciation Schedules Program at Lima, Oct. 17, 1029 ;
American College of Physicians Midwest Meeting,
Nov. 18, 1030 ; Eighth District Schedules Meeting
at Newark, Oct. 5, 1030 ; St. Luke’s Symposia
Continued, 1098 ; Resuscitation Course in Cleve-
land 1209
Prepaid Hospital and Medical Care Plans (See also
Ohio Medical Indemnity) —
Medical Coverage for the Individual, 76; Phy-
sicians Can Make or Break the Blue Cross, 78 ;
Athens County Society Deplores Criticism of
U. M. W. Fund, 266 ; Inflated Costs Will Wreck
Programs, 491 ; Welfare and Retirement Fund of
U. M. W. Again in Operation, 809 ; Labor Looks
at Prepaid Medical Care, 992 ; V. M. W. Program
Expanded 1214
Public Health, State and Local (See also Ohio Dept, of
Health) —
Parrot Fever Brings Warning, 270 ; Public Health
Is Recognized as a Specialty, 274 ; Northwest Meet-
ing of Ohio Public Health Association, 376 ; Action
Called for in Columbiana County, 380 ; Ohio Pub-
lic Health Association To Meet May 11-12, 392 ;
Animal Disease Reporting, 476 ; Dr. Wilzbach
1250
The Ohio State Medical Journal
Named President of Ohio Public Health Associa-
tion, 751 ; Ohio’s Public Health Needs — a Report
of Committee on Public Health 1093
Public Relations —
Fees and Public Relations, 68 ; Editors Only Print
the News, They Don’t Make It, 76 ; Offers for
Help in Campaign Need Screening, 76 ; Let’s Have
a Real Epidemic of This, 166 ; Pamphlet Stresses
Care of Dogs in Research, 168 ; Half-Heard or
Perhaps Very Poorly Told, 168 ; New Health Edu-
cation Discs Available from A. M. A., 266 ; Mahon-
ing Society Sponsors Student Contest on Voluntary
System, 365 ; Order Blank for Campaign Pamphlets,
375 ; Association Assigned Health Aspects of In-
stitute on Education by Radio, 482 ; Report of
Committee on Public Relations, 574 ; The Public
Views the Doctor, by Elwell, 581 ; Lorain County
Doing Something About Public Relations, 585 ;
Making Friends With the Press Is Good Public
Relations, 590 ; Mahoning County Essay Contest
Winners Announced, 716 ; Florida County Goes All
Out in Emergency Call Service, 824 ; It Isn’t What
You Say So Much as the Way You Say It, 826 ;
The Scoreboard Is Usually the Best Indication of
the Score, 826 ; Labor Looks at Prepaid Medical
Care, 992 ; Doctors Need This Kind of Publicity,
1012 ; Mr. Rayburn Comments on Lobbies, 1116 ;
Do You Itemize Your Statements? 1219
Red Cross —
Red Cross To Stage Annual Campaign, 168 ; Co-
lumbus Blood Center Ranks High, 263 ; Medical
Advisory Committee for Blood Bank Named 1029
Rural Health —
Rural Doctor Shortage, 84 ; Report of Annual
Conference on Rural Health, Kansas City, Feb. 3-4,
268; Farm Bureau Advisory Councils Formu-
late Objectives, 366 ; Rural Health Committee
Approves Lecture Course, 509 ; A. M. A. Director for
Rural Health Committee Named, 718 ; Second Rural
Medical Scholarship Awarded, 928 ; Rural Health
Conference Scheduled 1226
School Health —
Conference on School Health in Columbus spon-
sored by Association, 258 ; Dr. Shaffer To Direct
Workshop in School Health, 612 ; College Health
Directors Hold Meeting at Kent, 627 ; A. M. A. Sur-
vey of College Health Services, 691 ; Tuscarawas
School Health Conference, 811 ; New Doctor Film
for Schools Available 1226
Scientific Exhibits —
Second Call for Entries at 1950 Meeting, 58 ;
Application Form, 59 ; Roster of Exhibits and
Exhibitors, 1950 Annual Meeting 361
Socialization of Medicine —
Who Says It’s Not a Political Issue?, 78; State-of-
the-Union Message of the President, 157 ; Perils
of Welfare State (by John S. Knight), 159; Mr.
Tucker Exposes Subtle Strategy of Medical So-
cializes, 161 ; Fuzzy Thinking on Problem of Eco-
nomics, 166 ; Mercy Slaying and the Welfare State,
167 ; Big Devils and Little Devils, 167 ; Long Jaunt
but Worth It, 168 ; Low Level of Soviet Medicine
Laid to Shackling of Doctors, 178 ; Feeling the
Public’s Pulse on Federal Health Plan, 182 ; What
Are You Going To Do About It, Doctor?, 271;
AMVET Columnist Warns His Buddies, 274 ; Deans
Report on British System, 378; What’s Down
“The Road Ahead”?, 384; Patient Waits and Waits
Under Medical Program in England, 489 ; The
Government Can Supply Some Needs, But Not All,
493 ; Profound Words by Mr. Brannan, 493 ; It
Usually Takes More Than It Gives, 493 ; Survey
Indicates Large Percentage Favor Free Medical
System, 522 ; Too Many Riding the Wagon, 590 ;
Mr. Green Speaks — But Hastily, 591 ; Blessed Are
the Poor for They Shall Inherit the Debt, 591 ;
It Wouldn’t Be Free Here, Either, 730 ; Patients
Who ‘Pay’ Get Service Under ‘Free’ British
Medical System, 753 ; English Newspaper Reports
Revolt, 841 ; Have-Nots Vs. Haves, 924 ; Second
Pamphlet Promotes Truman Health Plan, 937 ;
Socialized Medicine the Real Issue on Nov. 7, 1010 ;
’Twould Be Funny If It Weren’t So Serious, 1014 ;
What Do You Mean “Free Choice”? 1118; Ewing
Blistered for Poking Nose in Ohio Politics, 1220 ;
All Is Not Well With British Scheme, 1220 ; Medi-
cal Socializers Hit Below Belt Again, 1220
Story Behind the Word— 328, 545, 663, 786, 885, 970,
1065, 1170
Surveys —
Observations From Cleveland X-Ray Survey 199
Taxation —
Few Have Been Able To Escape the Tax Collector,
74 ; Tax and Tax and Give Orders, 78 ; Average
Physician Exempt Under New Wage-Hour Act,
264 ; A. M. A. Dues Deductible on Income Tax Re-
turns, 264 ; Move To Help Taxpayers Causes Loud
Wails, 382 ; Hospitals Subject to Taxation, 485 ;
Federal Income Tax Laws Unfair to Professions,
Says Economist, 752; Tax Roundup Article To Ap-
pear in December Issue, 1114 ; Income and Other
Taxes 1193
Technical Exhibitors —
Exhibitors, 1950 Annual Meeting 362
Tuberculosis —
Ohio Tuberculosis and Health Association to Meet,
471 ; Ohio Trudeau Society Formed, 474 ; New TB
Division of Ohio Dept, of Health Named, 691 ;
Tuberculosis Association, Trudeau Society, Elect
Officers, 816 ; Tuberculosis Abstracts, 50, 892
U. S. Public Health Service —
Form Radiological Health Service, 375 ; Public
Health Grants, 408 ; Assistant Surgeon General
Talks on Nursing in Cincinnati, 479 ; Saline Solu-
tion in Treatment of Burn Shock 1171
Veterans Administration —
Dr. Botts to Chillicothe, 56 ; Number of Cases
Treated by Dentists, 56 ; Orthopedic Teams, 56 ;
V. A. Can Pay But One Fee Unless Separate
Service Is Rendered, 88 ; Changes in Rehabilita-
tion Services, 608 ; Bids on Cleveland Hospital, 608 ;
Fifteen Million Veterans Benefit Under GI Bill,
754 ; New V. A. Ruling on T. B., 908 ; Disabled
Veterans Classified, 1123 ; Veterans of Spanish-
American War, etc., Eligible for Out-Patient
Care, 1123 ; V. A. Restricts Use of Cortisone 1213
Veterans (See also Veterans Administration) —
Veterans Must File For Bonus by June 30, 476 ;
New Law Liberalizes Provisions for Veterans’
Home Loans 600
Vital Statistics —
Causes of Accidental Deaths on Ohio Farms
Analyzed, 165 ; Birth-Death Registration Test Is
On, 180 ; Death Rate Reached Low in 1948, 408 ;
Will Ohio Rank Low Again on Birth-Death Regis-
trations ?, 492 ; U. S. Leads in Preventing Infant
Deaths, 510 ; Physicians, Hospitals Play Parts in
Decreased Maternal Hazards, 590 ; Accidental Death
Rate Low 730
War (See also Military Affairs) —
Doctors and the Present War Emergency, 824 ;
Impact of the War on Physicians, 910 ; Doctors and
the War, 1005 ; 1102 ; Registration Date for Other
Doctors Under 50 Not Set, 1104 ; Questionnaires
Being Sent Out, 1106 ; Must Have Advisory Com-
mittee in Each County, 1108 ; Quick Way To
Obtain Commission Announced by Army, 1110 ;
Doctors and the War 1207
Washington Roundup — 720, 818, 904 1022
Welfare, Public —
The Poor Relief Problem 906
Woman’s Auxiliary — 97, 195, 289, 403, 513, 621, 746,
839, 936, 1033, 1134, 1235
Conference of Officers Sponsored by O. S. M. A.,
165 ; Program for 1950 Annual Meeting, 364 ;
Auxiliary Amendment for Honorary Members, 365 ;
Summit County Auxiliary Sponsors Health Days,
372 ; Auxiliary Officers Are Guests of Association,
March 14, 472 ; Auxiliary Annual Meeting, 707 ;
Excellent Hunches for Auxiliary Programs 728
for December, 1950
1251
CAPSULES
CHLOROM YCETH
rapid response
eumonias
Chloromycetin
( chloramphenicol, Parke-Davis )
is supplied in Kapseals® of 250 mg.,
and in capsules of 50 mg.
CHLORAMPHENICOL
50 mg.
Caution — To be dispense!
wty by or on the prescrip-
tion of a physician.
CHLORAMPHENICOL
250 mg.
Caution — lb be dispensed
only by or on the prescrip-
tion of a physician
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